Enteral nutrition formulations for acute pancreatitis.

Systematic review and meta-analysis of randomized trials in hospitalized adults with acute pancreatitis, including mild to severe disease and different etiologies. Comparisons assessed active enteral nutrition formulations against alternative enteral formulas, placebo, or no intervention, with outcomes summarized at the latest available follow-up.

This systematic review evaluated several enteral nutrition formulations used in acute pancreatitis, including immunonutrition, probiotic-enriched formulas, fibre-enriched formulas, semi-elemental formulas, and enteral nutrition versus no intervention or other formulas. Regimens varied by trial and included supplements such as glutamine, arginine, omega-3 fatty acids, probiotics, and fibre added to polymeric or elemental enteral feeds, generally started early after admission and delivered via nasojejunal or nasogastric tube.

Overall, there was no firm evidence supporting one enteral nutrition formulation over another in acute pancreatitis, and the evidence was low to very low quality for most outcomes. Immunonutrition reduced all-cause mortality in pooled analysis, RR 0.49 (0.29 to 0.80), while probiotics showed no mortality benefit overall, RR 1.13 (0.66 to 1.91), and raised safety concerns because bowel ischaemia was increased in the Besselink 2008 trial, RR 17.89 (1.05 to 304.59). Fibre-enriched formulas showed possible benefit in small datasets, including shorter hospital stay, MD -9.28 ( -13.21 to -5.35 ), but the data were limited. Enteral nutrition versus no intervention suggested lower mortality, RR 0.50 (0.29 to 0.86), but the review still concluded that more well-designed trials are needed before any specific formulation can be recommended.

The evidence base was small, heterogeneous, and largely low to very low quality, with different formulations, comparators, doses, and outcome definitions across trials. Several comparisons were driven by single studies or small subgroups, safety reporting was incomplete, and some results changed in sensitivity analyses. Generalizability is limited because the review combined diverse acute pancreatitis populations and enteral nutrition regimens.