Pancreas bumI would imagine that every pancreas with a history of -itis remembers the ole good days of bumming around until the pain was over… Lipase 3 times the upper limit of normal was good enough for the pancreas to rest and „self-digest” ;-).

Just refer to any major textbook and it will tell you to starve that poor -itisized pancreas. However, if you look at the most recent guidelines on Management of Acute Pancreatitis (AP) published by the American College of Gastroenterology, it does not seem like such a good idea anymore.

Here, just for you the newest nutritional recs to de-bum the pancreas care:

  1. In mild AP, oral feedings can be started immediately if there is no nausea and vomiting, and the abdominal pain has resolved (conditional recommendation, moderate quality of evidence).
  2. In mild AP, initiation of feeding with a low-fat solid diet appears as safe as a clear liquid diet (conditional recommen- dations, moderate quality of evidence).
  3. In severe AP, enteral nutrition is recommended to prevent infectious complications. Parenteral nutrition should be avoided, unless the enteral route is not available, not tolerated, or not meeting caloric requirements (strong recommendation, high quality of evidence)
  4. Nasogastric delivery and naso-jejunal delivery of enteral feeding appear comparable in efficacy and safety (strong recommendation, moderate quality of evidence).

Have you seen this revelation? ENTERAL FEEDING is recommended to PREVENT INFECTIOUS COMPLICATIONS? Clinical and experimental studies have shown that bowel rest is associated with intestinal mucosal atrophy and increased infectious complications because of bacterial translocation from the gut. Patients provided with oral feeding early in the course of AP have a shorter hospital stay, decreased infectious complications, decreased morbidity, and decreased mortality. Total parenteral nutrition should be avoided in patients with mild and severe AP.

So don’t let the pancreas bum around, at least not too much. Feed enterally as early as you can! And by the way, while we are on it, you can also stop that clear liquid or naso-jejunal nonsense.