Manual of Clinical Nutrition

Pancreatitis

Manual of Clinical Nutrition Management III- 93 Copyright © 2013 Compass Group, Inc.

Approach Rationale
Self-management
training

Avoid alcohol.

Small feedings.

Pancreatic enzymes must be taken at the same time as food, at all meals and snacks (no

more than 30 minutes prior to eating to maximize effectivenesss) (1).

A low fat diet is not routinely required, unless symptoms are poorly controlled on

enzyme therapy or if pain persists on both enzyme supplementation and narcotic

analgesia (1).

Pancreatic
enzymes

Typical dose is 2 tablets taken orally (30,000 IU of lipase) per meal and/or snacks
(1,21,22)a.
Must be taken while eating (no more than 30 minutes prior to eating to maximize
effectivenesss)(1)..
Do not crush enteric coated enzyme capsules. The use of H2 receptor antagonists (eg,
cimetidine, ranitidine, famotidine) or proton-pump inhibitors (omeprazole) increases
the efficiency of non-enteric coated pancreatic enzyme supplements by decreasing
gastric acid production (1).
aThe dose of enzymes usually required to treat steatorrhea should contain the concentration of enzymes that approximates 10% of what
the pancreas normally produce (1)

References

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2. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Arch Surg. 1993;128:586-590.


3. Saluja AK, Steer MLP. Pathophysiology of pancreatitis. Role of cytokines and other mediators of inflammation. Digestion.
   1999;60(suppl 1):27-33.


4. Norman JG. New approaches to acute pancreatitis: role of inflammatory mediators. Digestion. 1999;60(suppl 1):57-60.


5. Holt S. Chronic pancreatitis. South Med J. 1993;86:201-207.


6. Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in
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7. Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet. 1989;2:201-205.


8. Sax H, Warner B, Talawini M. Early total parenteral nutrition in acute pancreatitis: lack of beneficial effects. Am J. Surg.
   1987;153:117-124.


9. Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical
   assessment and multiple factor scoring systems. Br J Surg. 1990;77:1260-1264.


10. Dickerson RN, Vehe KL, Mullen JL, Feurer ID. Resting energy expenditure in patients with pancreatitis. Crit Care Med.
    1991;19:484-490.


11. Marulendra S, Kirby D. Nutrition support in pancreatitis. Nutr Clin Pract. 1995;10:45-53.


12. Havala T, Shronts E, Cerra F. Nutritional support in acute pancreatitis. Gastroenterol Clin North Am. 1989;18:525-542.


13. Kohn CL, Brozenec S, Foster PF. Nutritional support for the patient with pancreatobiliary disease. Crit Care Nurs Clin North
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14. Dickerson RN, Alexander KH, Minard G, Croce MA, Brown RO. Accuracy of methods to estimate ionized and corrected serum
    calcium concentrations in critically ill multiple trauma patients receiving specialized nutrition support. J Parenter Enteral
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15. McClave SA, Chang WK, Dhaliwal R, Heyland DK. Nutrition support in acute pancreatitis: a systematic review of the literature.
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16. Marik PE, Zaloga GPL. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ.
    2004;328:1407-1412.


17. Pancreatitis. In: Nutrition Care Manual. Chicago, Il: The Academy of Nutrition and Dietetics; Updated annually. Available at
    http://www.nutritioncaremanual. org. Accessed January 16, 2013.


18. Mirtallo JM, Forbes A, McClave SA, Jensen GL, Waitzberg DL, Davies AR; International Consensus Guideline Committee
    Pancreatitis Task Force. International consensus guidelines for nutrition therapy in pancreatitis. J Parenter Enteral Nutr.
    2012; 36:284-291.


19. Anand N, Park JH, Wu Bu. Modern management of acute pancreatitis. Gastroenterol Clin North Am. 2012; 41:1-8.


20. Moraes, JM, Felga, GE, Chebli LA, Franco MB, Gomes CA, Gaburri PD, Zanin A, Chebli JM. A full solid diet as the initial meal in
    mild acute pancreatitis is safe and results in shorter length of hospitalization: results from a prospective, randomized,
    controlled, double-blind clinical trial. J Clin Gastroenterol. 2010;44:517-522.


21. Shea JC, Bishop MD, Parker EM, Gelrud A, Freedman SD. An enteral therapy containing medium-chain triglycerides and
    hydrolyzed peptides reduces postprandial pain associated with chronic pancreatitis. Pancreatology. 2003;3:36-40.


22. Stanga Z, Giger U, Marx A, DeLegge MH. Effect of jejunal long-term feeding in chronic pancreatitis. J Parenter Enteral Nutr.
    2005;29:12-20.