Pancreatitis results from the auto-digestion of the pancreas by activated pancreatic enzymes with the following characteristics.

•⁠  ⁠Acute pancreatitis: severe pain, nausea, vomiting leading to pseudocysts, fistulae, shock, renal failure.

•⁠  ⁠Chronic pancreatitis: severe pain, weight loss, malabsorption secondary to lack of pancreatic enzymes.

Nutritional management of pancreatitis

Patients are frequently very malnourished as a result of:

•⁠  ⁠Poor intake due to lack of appetite and severe pain;

•⁠  ⁠Malabsorption of nutrients consumed;

•⁠  ⁠Frequent episodes of nil by mouth during treatment;

•⁠  ⁠↑ Requirements due to catabolic state.

Providing adequate nutritional support is paramount in supporting these patients and, because of the difficulties associated with achieving this, input from a registered dietitian with expertise in this area is required.

Key points for nutrition support

•⁠  ⁠Patients with mild pancreatitis require no dietary restrictions and, if well enough to eat sufficient, will not benefit from enteral nutrition.

Key points for dietary advice

•⁠  ⁠Patients with a poor appetite may benefit from practical advice about increasing oral intake.

•⁠  ⁠If malabsorption is present, advice should be given about pancreatic enzyme replacement.

•⁠  ⁠Low fat diets have little role to play in the treatment of pancreatitis as they will exacerbate energy depletion and steatorrhoea should be controlled by pancreatic enzyme replacement.

•⁠  ⁠Approximately one-third of patients with chronic pancreatitis will develop diabetes mellitus; a compromise should be reached between dietary advice to optimize blood sugar and to enhance intake to maintain body weight or reverse weight loss.

•⁠  ⁠Abstaining from alcohol is advisable as continuing alcoholism is associated with ↑ morbidity and mortality.