In the past, parenteral nutrition was often prescribed for those

diagnosed with acute pancreatitis. This methodology allowed for

an extented time of rest for an individuals pancreas, while
concurrently restricting the activiation of exocrine pancreatic
secretion. This strategy effectively mitigated the occurrence of
inflammation caused by enzyme activity, while yet ensuring the
provision of the necessary nutrients to an individual. Parenteral
nutrition provides the advantage of supplying exogenous
nutrients to support the preservation of lean body mass and to
prevent the occurrence of adynamic ileus.
However, despite the acknowledged possibility for greater risk
of catheter- related infections, electrolyte imbalances,
multiorgan dysfunction, and higher expenses, this particular
school of thinking has been widely accepted. While it
(parenteral nutrition) may seem beneficial in principle, research
has shown that the absence of luminal nutrients has the capacity
to contribute to the development of intestinal atrophy.
Furthermore, the use of brief intervals of recovery in acute
pancreatitis, along with the emergence of new insights in the
significance of gut trophism in the pathophysiology of
pancreatitis, had led to a change in the strategy to providing an
individual with nutrition support. It is noteworthy that a
Randomized Controlled Trial conducted a comparison between
early nasoenteral feeding and on-demand oral feeding at the 72-
hour mark. The findings revealed that around seventy- percent
of patients diagnosed with severe or expected severe acute
pancreatitis were able to tolerate oral nourishment during the
first phases of the illness. Moreover, new research in the field of
trauma and burn patient treatment indicates that enteral nutrition
is linked to a reduced occurrence of complications.
Additionally, enteral nutrition may provide the advantage of
immunological modulation, a lower likelihood of sytemic
inflammatory response (SIRS) and sepsis, as well as enhanced
cost- effectiveness.
An immune modulating formula is comprised of substrates that
are designed to regulate and modify immune activity. Hence,
patients are administered immune modifying nutrients in
excessive quantities in order to elicit a pharmacological impact
on the body's reaction to surgical procedures, traumatic events,
or infections. Several nutrients possess immune-modulating
characteristics, such as omega-3 fatty acids, nucleotides,
arginine, and glutamine. Nevertheless, it is worth noting that the
patient's white blood cell (WBC) levels were found to be raised,
suggesting the presence of an immunological response, most
likely attributable to the pancreatitis. Consequently, it may be
inferred that the administration of an immune modifying
formula is unnecessary in this case.
The use of probiotics and glutamine in the context of acute
pancreatitis has been a subject of investigation, with varied and
even conflicting outcomes.
To begin with probiotics, the use of probiotics in the context of
acute pancreatitis is grounded on the notion that they possess the
ability to facilitate the restoration of gut microbiota equilibrium,
which is susceptible to disruption in this particular pathological
state (acute pancreatitis).
Nevertheless, the avaible data lacks definitive clarity. Several
research have shown a possible advantage, although contrasting
findings have been reported by other investigations. An
illustrative instance may have been seen in the PROPATRIA
research, a substantial randomized controlled trial, which
revealed that the use of probiotics did not provide a reduction in
the likelihood of infection complications among individuals
diagnosed with severe acute pancreatitis. Furthermore, the
investigation indicated that the adminstration of probiotics was
linked to an elevated risk of death. Hence, the use of probiotics
in cases of acute pancreatitis is now not endorsed in clinical
practice recommendations.
Additionally, glutamine is an amino acid that functions as a vital
energy substate for cells inside the gastrointestinal tract and the
immune system. There exists a hypothesis suggesting that the
adminstration of supplementary glutamine may have the
potential to mitigate inflammation and facilitate the process of
healing in cases of acute pancreatitis.
Nevertheless, the available information presents a varied and
inconclusive picture. Several research have shown a possible
advantage, although contrasting findings have been reported by
other investigations. In a study conducted in 2018, a systemic
review and meta-analysis revealed that the adminstration of
glutamine supplements did not provide statisitically significant
effects on death rates, infectious complications, or duration of
hospitalization amoing individuals diagnosed with acute
pancreatitis. Hence, the use of glutamine in cases of acute
pancreatitis is now also not endorsed in clinical practice
recommendations.
In summary, while the concept of using probiotics and
glutamine in the treatment of acute pancreatitis has theoretical
promise, the existing body of data does not substantiate their
regular use for this particular ailment. Furthere investigation is
therefore required in order to better understand their possible
involvement.