Importance of nutritional management in diseases with exocrine pancreatic insufficiency

Abstract

Exocrine pancreatic insufficiency (EPI) resulting from conditions such as chronic pancreatitis (CP), acute pancreatitis (AP) and upper gastrointestinal (GI) surgery increases risk for malnutrition and metabolic problems. Poor nutrition is associated with more complications and higher mortality. Therefore, effective nutritional management should be a high priority in these patients. In CP, poor nutrition has been shown to significantly affect quality of life and functional status. Clinical study data show that dietary counselling combined with pancreatic enzyme replacement therapy is effective in improving nutritional status and is therefore recommended in these patients. In AP, early enteral nutrition reduces complications and mortality. However, EPI persists in many cases after the resolution of AP; these patients remain at increased risk for malnutrition and require further nutritional support. In patients undergoing surgery, preoperative weight loss is a risk factor for postoperative morbidity and mortality; outcomes can be improved considerably by preoperative screening to identify high-risk patients and by providing appropriate perioperative nutritional support. Pre- and perioperative enteral nutrition are cost-effective interventions that can improve outcomes in patients undergoing GI surgery. In all of these patient populations, nutritional management, including risk assessment and individualized nutritional support, is a key component of an effective multimodal therapeutic approach.

Figures

Figure 1

Association between nutritional risk (according to Nutritional Risk Screening [NRS] 2002) and clinical outcome in hospitalized patients. A prospective survey in 26 European hospitals (n= 5051)

Figure 2

Effect of dietary counselling (n= 29) or commercial dietary supplementation (n= 31) for 3 months on body mass index (BMI), body weight and faecal fat in undernourished patients with chronic pancreatitis receiving pancreatic enzyme replacement therapy. *P= 0.007 and †P= 0.001 vs. baseline

Figure 3

Comparison of preoperative oral supplementation (arginine, omega-3 fatty acids and ribonucleotide) for 5 days (n= 102) with the same preoperative therapy plus postoperative jejunal infusion (n= 101) and no artificial nutrition before or after surgery (n= 102). *P < 0.05 and †P < 0.01 vs. no nutrition

Figure 4

Role of nutritional management in diseases with exocrine pancreatic insufficiency