Acute pancreatitis - The role of nutrition, probiotics and antibiotics

A specific management of the acute pancreatitis (AP) does not exist. The most important therapeutic approach beside a sufficient analgesia is an early adequate fluid and nutritional therapy. Concerning the nutritional support a paradigm change has occurred in the last two decades. With a mild or moderate course of an AP oral feeding should be started immediately if there is either no abdominal pain or no signs of bowel paralysis. In severe AP an early administration of enteral nutrition is beneficial, a parenteral nutrition should be avoided because of potential side effects. With this nutritional management the morbidity and mortality rates can be decreased. The use of probiotics cannot is highly debated. Routine use of prophylactic antibiotics is not recommended. An antibiotic treatment is indicated only in the presence of cholangitis or of infected pancreatic necrosis or pseudocysts.