Nutritional Intervention in Pancreatitis

Pancreatitis is a disease in which the normal functioning of the pancreas is impaired due to an inflammatory condition. It can present in two forms - acute or chronic pancreatitis. The type of pancreatitis determines both the course of the disease and the therapeutic approach. In chronic pancreatitis, an inflammatory state causes damage to the pancreatic tissue, leading to permanent and irreversible damage. As the disease progresses, the organ's ability to produce digestive enzymes and release hormones becomes impaired. In acute pancreatitis, there is an overactivation of digestive enzymes that can damage the organ. The disease appears suddenly and can have serious consequences, including death in about 5% of cases.

Chronic pancreatitis is most commonly caused by excessive alcohol consumption (65-85% of patients), smoking, and other chronic conditions such as hyperparathyroidism or kidney disease. It can also have a genetic basis, with the first symptoms appearing before the age of 20. Symptoms include recurring abdominal pain (particularly after eating and drinking alcohol), feeling full, bloating, and diarrhea. In advanced stages, when the pancreas is no longer functioning properly, digestive and absorption disorders may occur, leading to fatty stools, weight loss, and signs of nutrient deficiencies (such as osteopenia and osteoporosis) as well as disturbances in carbohydrate metabolism, which can promote the development of type 3 diabetes. Diagnostic procedures for pancreatitis include imaging techniques such as traditional abdominal ultrasound, endoscopic ultrasound (an ultrasound device is inserted into the digestive tract through the esophagus), X-rays, and computed tomography. These enable the detection of characteristic changes - calcifications, deposits - in the pancreas.

Prevention and management of chronic pancreatitis at an early stage is based on responding to symptoms with painkillers. As the disease progresses, complications may arise, such as enlargement or narrowing of the pancreatic ducts that require surgical or endoscopic treatment (tools are inserted into the digestive tract by women with openings in the skin). In case of signs of pancreatic insufficiency associated with impaired digestion and nutrient absorption - such as weight loss, bloating, indigestion, abdominal pain, and fatty stools - enzymatic therapy is required to improve the function of the digestive tract. Patients who develop diabetes often require insulin therapy. The course of acute pancreatitis, on the other hand, requires hospitalization of the patient. Adequate hydration is crucial – especially in the first hours after the onset of symptoms. This allows for prevention of ischemia and necrosis of the pancreas. For this purpose, electrolyte solutions are administered to the patient. Pain-relieving agents are also used. In many cases, invasive treatment is required to widen the bile ducts or remove necrotic areas. This is performed endoscopically or surgically.

The matter of nutrition holds a key role in the treatment of both chronic and acute pancreatitis.

Patients with chronic pancreatitis often develop malnutrition, which is associated with progressive pancreatic insufficiency, gastrointestinal disorders reducing appetite (pain, nausea, vomiting), and the frequent occurrence of alcohol disease. In such cases, a high-calorie diet is recommended. In the past, a low-fat diet was also recommended; however, there is currently no evidence supporting the benefits of limiting this component. Data indicate that levels of 30-33% of the total energy intake of the diet are well tolerated by patients receiving enzyme supplementation. However, it is recommended to reduce the amount of fiber consumed, as large amounts may reduce the activity of pancreatic enzymes. It is advised to consume small, frequent meals: 5-6 daily. In case of severe malnutrition, oral nutritional supplements can be used, which provide a large amount of energy in a small volume. If, however, this intervention does not improve the patient's condition or there are problems with food intake, enteral feeding through a nasogastric tube may be necessary until the nutritional status improves. Patients should supplement vitamin D, which is in line with general recommendations for adults in Poland (taking 800-2000 IU in periods when adequate skin synthesis is not possible) (A. Rusińska i wsp. 2018). It may also be necessary to supplement other fat-soluble vitamins (A, E, K) and vitamin B12, whose deficiency may occur in the course of malabsorption syndrome. The decision to supplement should be based on individual test results. In case of well-nourished patients, a balanced, healthy diet is recommended. All patients with PZT are strictly prohibited from consuming alcohol.

The appearance of the first symptoms of OZT may lead to difficulties in taking in food with a liquid or semi-liquid consistency, such as due to discomfort and pain. However, the hunger period should not be extended after the relief or remission of symptoms. It is recommended to start the oral diet as soon as possible (if tolerated) after the relief or remission of symptoms. The first meals given should be low-fat with a liquid or semi-liquid consistency, such as porridge, cream soup, or a small volume cocktail. If they are tolerated, then the diet should be switched to solid foods and a low-fat diet. If the patient is unable to take food orally for 24-72 hours, enteral nutrition is administered through a nasojejunal or nasogastric tube. If this nutrition is not tolerated or there are contraindications to its administration (such as intestinal obstruction), energy should be provided in the form of parenteral nutrition (nutrients are injected directly into the bloodstream).