Nutritional Management of Acute Pancreatitis

Veterinary ECC Small Talk

This episode focuses on the nutritional management of acute pancreatitis in dogs and cats answering questions such as:

• When should we be providing nutrition to dogs and cats with acute pancreatitis?
• Should we be using enteral or parenteral nutrition?
• Should we be using post-pyloric jejunal feeding or is oral or gastric feeding okay?

The episode is largely based around the following clinical practice review article:

Jensen KB, Chan DL. Nutritional management of acute pancreatitis in dogs and cats. J Vet Emerg Crit Care 2014. 24(3):240-250.

As mentioned in the episode, if you would like a FREE copy of some general notes on acute pancreatitis in dogs and cats that cover more than 'just' the nutritional aspects, please click the link below and follow the instructions:

Get your FREE copy of notes on acute pancreatitis

In the episode I also mention a blog post on syringe feeding which you can find HERE.

One paragraph from the paper that I read out in the episode and promised to include here was as follows:

“The traditional approach to AP centered on the premise that withholding food would reduce pancreatic autodigestion by decreasing pancreatic stimulation and enzyme release. However, the pathogenesis of pancreatitis more likely involves premature intracellular activation of proteolytic enzymes rather than pancreatic stimulation. Avoidance of feeding as a means to decrease pancreatic stimulation may be unwarranted and could lead to malnutrition and impaired gastrointestinal barrier function. Lack of enteral nutrition results in the loss of normal physiologic intestinal motility, is associated with intestinal villus atrophy, and compromises intestinal mucosal blood flow. If sustained, the lack of enteral nutrition could lead to a compromise of local immunoglobulin and biliary salt production with consequent disruption of normal internal bacterial flora and gastrointestinal barrier function. It also has been demonstrated in experimental rodent models and in people with naturally occurring disease that exocrine pancreatic secretion actually decreases during pancreatitis and that the decrease is more pronounced with increasing severity of inflammation. The practice of withholding food for several days from the time of initiation of therapy may prove detrimental as a period of anorexia often precedes the initial clinical presentation to veterinarians in patients with AP. Implementation of nutritional support may be critical for successful management of patients with AP.”

And the list of summary points from the paper is as follows:

• There is increasing evidence supporting the important role of early EN (ideally within 48 h of diagnosing pancreatitis) in positively impacting outcome in patients with AP.
• Nutritional support is an integral and key aspect of the successful management of AP.
• The use of enteral feeding in veterinary medicine is now considered to be safe, effective, and well-tolerated in severe AP.
• Enteral nutrition is less expensive than parenteral feeding and helps to maintain gastrointestinal mucosal function, and therefore is likely to have a bene?cial in?uence on the disease course.
• Use of NG, nasoesophageal, jejunal, and oesophagostomy feeding tubes is effective and safe in dogs and cats and should be used unless speci?c contraindications are identi?ed. There is no evidence at this time to support the superiority of post-pyloric jejunal feeding over oral or gastric feeding.
• The optimal enteral diet for patients with AP has not been identi?ed, but diets commonly used for convalescing dogs and cats can be used.
• Avoidance of enteral diets with high fat content does not appear to be necessary in the majority of patients.
• Despite the growing evidence that EN can be used effectively in the management of patients with AP, there may still be patients that require some form of PN until suf?cient EN can be tolerated.
• And of course we have the usual and completely reasonable conclusion that future veterinary studies investigating feeding routes, dietary composition, and optimal timing of nutritional support in AP are warranted.