Critical Care Medicine-Gastrointestinal, Nutrition and Genitourinary Disorders>>>>>Pancreas
Question 2#

All of the following statements are true regarding nutrition in patients with moderate to severe acute pancreatitis EXCEPT:

A. Oral feeding can be initiated early in the setting of improving abdominal pain and decreasing inflammatory markers
B. If oral feeding cannot be tolerated, it is recommended to start enteral nutrition by day 5 to 7
C. Enteral nutrition is preferred over total parenteral nutrition if it can be tolerated
D. Enteral nutrition likely helps to maintain the intestinal mucosal barrier, thereby reducing bacterial translocation and infectious complications of acute pancreatitis
E. Nasojejunal feeding is preferred over nasogastric feeding because of deceased pancreatic stimulation

Correct Answer is E


Correct Answer: E

Historically, patients presenting with moderate to severe episodes of acute pancreatitis were made nil per os in an attempt to provide bowel rest and avoid further pancreatic stimulation. Multiple studies looking at all severities of acute pancreatic have demonstrated that not only is initiation of early enteral feeding safe, but it also has favorable effects on infectious outcomes and mortality. It is believed that early enteral nutrition maintains the integrity of the gut mucosal barrier, thereby limiting bacterial overgrowth and intestinal atrophy, which may play a role in bacterial gut translocation. If oral feeding can be tolerated, it is recommended to resume an oral diet within 24 hours and allowing up to 3 to 5 days before initiating enteral feeding with nasogastric or nasojejunal feeding tube placement. In general, enteral nutrition is preferred over total parenteral nutrition for the aforementioned reasons, and thus the role of total parenteral nutrition is limited to those patients who are unable to tolerate any form of enteral nutrition despite maximal support. Despite the theoretical reasons to avoid gastric feeding, including avoidance of pancreatic stimulation, multiple studies have shown that there are no differences in nasogastric and nasojejunal feeding. 


  1. Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN; American Gastroenterological Association Institute Clinical Guidelines Committee. American gastroenterological association institute guideline on initial management of acute pancreatitis. Gastroenterology. 2018;154(4):1096-1101.
  2. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13 e1-e15.