What is the best treatment for pancreatitis

Nutritional therapy: recommendations for acute and chronic pancreatitis

Acute pancreatitis is a sudden onset disease caused by the premature activation of intrapancreatic digestive enzymes. A number of noxae (e.g. alcohol abuse, gallstones) can activate the digestive enzymes and initiate a self-digestion process of the organ via mechanisms that are still incompletely known. The severity of the course depends on the extent of the autodigestion.

The clinical picture of acute pancreatitis is characterized by acute, severe epigastric pain accompanied by nausea and vomiting. The severe course is characterized by hemorrhagic-necrotizing inflammation with high mortality. If the acute pancreatitis heals, the exocrine function is completely normalized, so that no indigestion remains.

Therapy of acute pancreatitis

The aim of treatment is the secretory immobilization of the pancreas by inhibiting enzyme synthesis and secretion. Oral hydration and food intake should be avoided at the start of treatment. After the pain has subsided, the intestinal peristalsis and amylase and lipase activity have largely normalized, a gradual increase in diet takes place.

Depending on the extent of the abdominal discomfort, a diet consisting mainly of carbohydrates is given every few days, starting with tea. If the tolerance is good, protein-rich, largely fat-free foods are added. If these are tolerated without discomfort, the fat is added, starting with small amounts of fat, which are gradually increased. If abdominal complaints reappear or if there is an increase in enzymes, a phase of oral food abstinence is usually taken again. After acute pancreatitis has healed, no further dietary measures are required; everything can be eaten and drunk again. The only thing to note is an alcohol abstinence.

Gradual plan of nutrition in acute pancreatitis

Level 1: No oral intake of food and fluids. Depending on the duration of this phase, parenteral water and electrolyte supply and / or parenteral nutrition with high energy supply. Stage 2: Oral fluid intake consisting of small amounts of unsweetened tea and parenteral nutrition. Level 3: Sweetened tea (table sugar, grape sugar, maltodextrin) and parenteral nutrition. Stage 4: Administration of foods mainly containing carbohydrates, for example oat and rice gruel soups, starch soups and porridges made from water and diluted fruit juices (flavored with dextrose), vermicelli and starch noodles cooked in vegetable broth, jelly dishes, whipped bananas, rusks, honey, biscuits and parenteral biscuits Partial nutrition. Level 5: Carbohydrate-protein diet: largely fat-free, e.g. B. low-fat quark, boiled poultry, steamed fish, egg sticks, noodles, mashed potatoes (prepared with skimmed milk), white bread, steamed tomatoes, spinach, carrots, asparagus tips, fruit soups, fruit groats and fruit sauces, pudding and porridges made with skimmed milk. Level 6: Carbohydrate-protein diet with increasing fat intake. The increase in the daily amount of dietary fat and protein depends on the clinical picture and the behavior of the amylase and lipase activity. Then you can slowly switch to a "light full diet". The amount of food should also be divided into many small meals (6 - 8 per day).

Alcohol abuse is the leading cause of chronic pancreatitis

Chronic pancreatitis progresses in phases and is accompanied by progressive tissue destruction, which ultimately leads to exocrine and endocrine pancreatic insufficiency. In most cases (70-80%), chronic alcohol abuse is the cause of the disease. If the function of the organ is increasingly restricted in chronic pancreatitis, at a certain stage there is insufficient enzyme activity in the upper small intestine for digestion and thus insufficient nutrient utilization.

In advanced chronic pancreatitis, insufficiency of the islets of Langerhans also develops, resulting in diabetes mellitus. If diabetes mellitus is present, it must be treated according to the criteria of type 1 diabetes. The main symptoms of chronic pancreatitis are intermittent or persistent upper abdominal pain, often occurring after meals. With increasing pancreatic insufficiency, symptoms of maldigestion such as flatulence, diarrhea, steatorrhea and weight loss can also occur.

Therapy of chronic pancreatitis

Nutritional therapy for chronic pancreatitis consists of a low-fat, easily digestible diet. It is believed that such a diet slows the progression of the chronic inflammatory process. Since the utilization of dietary fat is the first to be disturbed, the selection and reduction of this nutrient is of particular importance. It should be noted that the lower the melting point of the administered fat, the easier it is to digest.

The optimal amount of fat in a diet is determined by the fat balance; H. the fat excretion with the stool is determined if the fat absorption is known. If the steatorrhea cannot be adequately eliminated by reducing the fat content in combination with a pancreatic fermentation substitution, the dietary fat must be partially replaced by MCT fats. It is also important to ensure that the food is served in small portions evenly distributed throughout the day. Furthermore, a sufficient supply of fat-soluble vitamins must be ensured, since a deficiency of vitamins A and E may occur in the case of pancreatic insufficiency. Food that is difficult to digest, high in fiber should not be offered.

Conclusion

Nutritional therapy for acute pancreatitis depends on the severity of the disease and the nutritional status of the patient. Inadequate fat digestion caused by lipase deficiency plays an essential role in dietary therapy.

Nutritional therapy for chronic pancreatitis is required whenever exocrine and / or endocrine pancreatic insufficiency occurs. In these cases, the diet is adapted to the remaining organ function. Dietary treatment consists primarily of adapting the intake of fat to the stage of excretory insufficiency. A "light whole diet" with a controlled fat intake is recommended. Alcohol should be strictly avoided in acute and chronic pancreatitis.

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