According to guidelines (2013 American College of Gastroenterology), what is the recommended route of nutrition in severe acute pancreatitis?

• A. PN is the preferred route
• B. EN is the preferred route to prevent infectious complications, with PN only if EN not available, tolerated, or insufficient
• C. EN should be avoided
• D. No guidelines exist

Answer: (B)

Starting with the main idea: in severe acute pancreatitis, enteral nutrition is preferred over parenteral nutrition because it lowers infectious complications and supports gut integrity. The 2013 American College of Gastroenterology guidelines advocate early enteral feeding, typically within 24 to 72 hours of admission, as soon as it is tolerated. If enteral nutrition cannot be started, cannot meet needs, or is not tolerated, then parenteral nutrition is used, but only after attempting enteral feeding. Enteral nutrition helps maintain the gut mucosal barrier, reduces bacterial translocation, and modulates the immune response, leading to fewer infections and better outcomes.