Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy.
Department of Emergency, Anesthesiological and Reanimation Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy.
Nutrients. 2023 Apr 18;15(8):1939. doi: 10.3390/nu15081939.
The nutritional management of acute pancreatitis (AP) patients has widely changed over time. The "pancreatic rest" was the cornerstone of the old paradigm, and nutritional support was not even included in AP management. Traditional management of AP was based on intestinal rest, with or without complete parenteral feeding. Recently, evidence-based data underlined the superiority of early oral or enteral feeding with significantly decreased multiple-organ failure, systemic infections, surgery need, and mortality rate. Despite the current recommendations, experts still debate the best route for enteral nutritional support and the best enteral formula. The aim of this work is to collect and analyze evidence over the nutritional aspects of AP management to investigate its impact. Moreover, the role of immunonutrition and probiotics in modulating inflammatory response and gut dysbiosis during AP was extensively studied. However, we have no significant data for their use in clinical practice. This is the first work to move beyond the mere opposition between the old and the new paradigm, including an analysis of several topics still under debate in order to provide a comprehensive overview of nutritional management of AP.
胰腺炎（AP）患者的营养管理随时间发生了广泛变化。“胰腺休息”是旧范式的基石，营养支持甚至不包括在 AP 管理中。AP 的传统管理基于肠道休息，包括或不包括完全肠外喂养。最近，基于证据的数据强调了早期口服或肠内喂养的优越性，可显著降低多器官衰竭、全身感染、手术需求和死亡率。尽管有当前的建议，专家们仍在争论肠内营养支持的最佳途径和最佳肠内配方。这项工作的目的是收集和分析 AP 管理中营养方面的证据，以研究其影响。此外，还广泛研究了免疫营养和益生菌在调节 AP 期间炎症反应和肠道菌群失调中的作用。然而，我们在临床实践中没有这些方法的使用的显著数据。这是第一份超越旧范式和新范式之间的简单对立的工作，包括对几个仍在争论中的主题进行分析，以提供 AP 营养管理的全面概述。
