The Use of Nasojejunal Nutrition in Patients with Chronic Pancreatitis

  • James Robert Anthony Skipworth Department of Hepatobiliary and Pancreatic Surgery, University College Hospital NHS Trust. London, United Kingdom
  • Dimitri Aristotle Raptis
  • Shalini Wijesuriya
  • Zudin Puthucheary
  • Steven W M Olde Damink
  • Charles Imber
  • Massimo Malagò
  • Arjun Shankar
Keywords: Enteral Nutrition, Jejunum, Nutritional Status, Pancreatitis, Chronic


Context Abdominal pain, malabsorption and diabetes all contribute to a negative impact upon nutritional status in chronic pancreatitis and no validated standard for the nutritional management of patients exists. Objective To assess the effect of nasojejunal nutrition in chronic pancreatitis patients. Design All consecutive chronic pancreatitis patients fed via the nasojejunal route between January 2004 and December 2007 were included in the study. Patients were assessed via retrospective review of case notes. Results Fifty-eight chronic pancreatitis patients (35 males, 23 females; median age 46 years) were included. Patients were discharged after a median of 14 days and nasojejunal nutrition continued for a median of 47 days. Forty-six patients (79.3%) reported resolution of their abdominal pain and cessation of opioid analgesia intake over the study period and median weight gain at 6 weeks following nutritional cessation was +1 kg (range -24 to +27 kg; P=0.454). Twelve (20.7%) patients reported recurrence of their pain during the follow-up period and complications were both minor and infrequent. Significant improvements were noted in most blood parameters measured, including: sodium (from 134.8 to 138.1 mEq/L; P<0.001); urea (from 3.4 to 5.1 mmol/L; P<0.001); creatinine (from 58.3 to 60.3 μmol/L; P<0.001); corrected calcium (from 2.24 to 2.35 mmol/L; P=0.018); albumin (from 34.5 to 38.7 g/L; P=0.002); CRP (from 73.0 to 25.5 mg/L; P=0.006); and haemoglobin (from 11.8 to 12.4 g/dL; P=0.036). Conclusion Nasojejunal nutrition, commenced in hospital and continued at home, is safe, efficacious and well tolerated in patients with severe chronic pancreatitis and is effective in helping to relieve pain and diminish analgesic requirements.


Download data is not yet available.


Meier R, Ockenga J, Pertkiewicz M, Pap A, Milinic N, Macfie J, et al. ESPEN Guidelines on Enteral Nutrition: Pancreas. Clin Nutr 2006; 25:275-84. [PMID 16678943]

Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963-98: database study of incidence and mortality. BMJ 2004; 328:1466-9. [PMID 15205290]

Gachago C, Draganov PV. Pain management in chronic pancreatitis. World J Gastroenterol 2008; 14:3137-48. [PMID 18506917]

Giger U, Stanga Z, DeLegge MH. Management of chronic pancreatitis. Nutr Clin Pract 2004; 19:37-49. [PMID 16215095]

Abdel Aziz AM, Lehman GA. Current treatment options for chronic pancreatitis. Curr Treat Options Gastroenterol 2007; 10:355-68. [PMID 17897574]

Havala T, Shronts E, Cerra F. Nutritional support in acute pancreatitis. Gastroenterol Clin North Am 1989; 18:525-42. [PMID 2509354]

Di Carlo V, Nespoli A, Chiesa R, Staudacher C, Cristallo M, Bevilacqua G, Staudacher V. Hemodynamic and metabolic impairment in acute pancreatitis. World J Surg 1981; 5:329-39. [PMID 7293195]

Shaw JH, Wolfe RR. Glucose, fatty acid, and urea kinetics in patients with severe pancreatitis. The response to substrate infusion and total parenteral nutrition. Ann Surg 1986; 204:665-72. [PMID 3098198]

Curtis CS, Kudsk KA. Nutrition support in pancreatitis. Surg Clin North Am 2007; 87:1403-15, viii. [PMID 18053838]

Dickerson RN, Vehe KL, Mullen JL, Feurer ID. Resting energy expenditure in patients with pancreatitis. Crit Care Med 1991; 19:484-90. [PMID 2019133]

Hébuterne X, Hastier P, Péroux JL, Zeboudj N, Delmont JP, Rampal P. Resting energy expenditure in patients with alcoholic chronic pancreatitis. Dig Dis Sci 1996. 41: 533-9. [PMID 8617130]

Helton WS. Intravenous nutrition in patients with acute pancreatitis. In: Rombeau JL (Ed). Clinical Nutrition: Parenteral Nutrition. W.B. Saunders 1990. p. 442-461.

Sitzmann JV, Steinborn PA, Zinner MJ, Cameron JL. Total parenteral nutrition and alternate energy substrates in treatment of severe acute pancreatitis. Surg Gynecol Obstet 1989; 168:311-7. [PMID 2494706]

Petersen JM, Forsmark CE. Chronic pancreatitis and maldigestion. Semin Gastrointest Dis 2002; 13:191-9. [PMID 12462705]

DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme ouputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 1973; 288:813-5. [PMID 4693931]

Twersky Y, Bank S. Nutritional deficiencies in chronic pancreatitis. Gastroenterol Clin North Am 1989; 18:543-65. [PMID 2680966]

Marulendra S, Kirby DF. Nutrition support in pancreatitis. Nutr Clin Pract 1995; 10:45-53. [PMID 7731424]

Holt S. Chronic pancreatitis. South Med J 1993; 86:201-7. [PMID 8434293]

Latifi R, McIntosh JK, Dudrick SJ. Nutritional management of acute and chronic pancreatitis. Surg Clin North Am 1991; 71:579-95. [PMID 1904645]

Cerra FB. Hypermetabolism, organ failure, and metabolic support. Surgery 1987; 101:1-14. [PMID 3541266]

Kohn CL, Brozenec S, Foster PF. Nutritional support for the patient with pancreatobiliary disease. Crit Care Nurs Clin North Am 1993; 5:37-45. [PMID 8448001]

DiMagno EP. Medical treatment of pancreatic insufficiency. Mayo Clin Proc 1979; 54:435-42. [PMID 36518]

Stanga Z, Giger U, Marx A, DeLegge MH. Effect of jejunal long-term feeding in chronic pancreatitis. JPEN J Parenter Enteral Nutr 2005; 29:12-20. [PMID 15715269]

Windsor AC, Kanwar S, Li AG, Barnes E, Guthrie JA, Spark JI, Welsh F, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 1998; 42:431-5. [PMID 9577354]

Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study. Ann Surg 2006; 244:959-65. [PMID 17122621]

Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Dig Surg 2006; 23:336-44. [PMID 17164546]

McClave SA, Chang WK, Dhaliwal R, Heyland DK. Nutrition support in acute pancreatitis: a systematic review of the literature. JPEN J Parenter Enteral Nutr 2006; 30:143-56. [PMID 16517959]

Gupta R, Patel K, Calder PC, Yaqoob P, Primrose JN, Johnson CD. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE II > or =6). Pancreatology 2003; 3:406-13. [PMID 14526151]

De Beaux AC, Plester C, Fearon KC. Flexible approach to nutritional support in severe acute pancreatitis. Nutrition 1994; 10:246-8. [PMID 7919677]

Hamvas J, Schwab R, Pap A. Jejunal feeding in chronic pancreatitis with severe necrosis. JOP. J Pancreas (Online) 2001; 2:112-6. [PMID 11870333]

Hamvas J, Pap A. The role of jejunal feeding in the treatment of acute necrotizing pancreatitis and in recurrence of chronic pancreatitis with severe necrosis. Orv Hetil 1998: 139:945-9. [PMID 9595928]

Ogara M, Fang JC, Peterson KA, Disario JA. Jejunal feeding in chronic pancreatitis. Gastrointest Endosc 2007; 65:AB248.

Toskes PP. Update on diagnosis and management of chronic pancreatitis. Curr Gastroenterol Rep 1999; 1:145-53. [PMID 10980942]

Corcoy R, Sanchez JM, Domingo P, Net A. Nutrition in the patient with severe acute pancreatitis. Nutrition 1988; 4:269-75.

Keith RG. Effect of a low fat elemental diet on pancreatic secretion during pancreatitis. Surg Gynecol Obstet 1980; 151:337-43. [PMID 7404299]

Ranson JH. Acute pancreatitis: pathogenesis, outcome and treatment. Clin Gastroenterol 1984; 13:843-63. [PMID 6386241]

Kirby DF, Craig RM. The value of intensive nutritional support in pancreatitis. JPEN J Parenter Enteral Nutr 1985; 9:353-7. [PMID 3925181]

Povoski SP, Nussbaum MS. Nutrition support in pancreatitis: fertile ground for prospective clinical investigation. Nutr Clin Pract 1995; 10:43-4. [PMID 7731423]

Chowdhury RS, Forsmark CE, Davis RH, Toskes PP, Verne GN. Prevalence of gastroparesis in patients with small duct chronic pancreatitis. Pancreas 2003; 26:235-8. [PMID 12657948]

Davies AR, Froomes PR, French CJ, Bellomo R, Gutteridge GA, Nyulasi I, et al. Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 2002; 30:586-90. [PMID 11990920]

Montejo JC, Grau T, Acosta J, Ruiz-Santana S, Planas M, García-De-Lorenzo A, et al. Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients. Crit Care Med 2002; 30:796-800. [PMID 11940748]

Neviackas JA, Kerstein MD. Pancreatic enzyme response with an elemental diet. Surg Gynecol Obstet 1976; 142:71-4. [PMID 801]

McArdle AH, Echave W, Brown RA, Thompson AG. Effect of elemental diet on pancreatic secretion. Am J Surg 1974; 128:690-2. [PMID 4440810]

Guan D, Ohta H, Green GM. Rat pancreatic secretory response to intraduodenal infusion of elemental vs polymeric defined-formula diet. JPEN J Parenter Enteral Nutr 1994; 18:335-9. [PMID 7933441]

Vison N, Hecketsweiler P, Butel J, Bernier JJ. Effect of continuous jejunal perfusion of elemental and complex nutritional solutions on pancreatic enzyme secretion in human subjects. Gut 1978; 19:194-8. [PMID 631640]

Voitk A, Brown RA, Echave V, McArdle AH, Gurd FN, Thompson AG. Use of an elemental diet in the treatment of complicated pancreatitis. Am J Surg 1973; 125:223-7. [PMID 4688003]

Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med 2000; 342:1581-9. [PMID 10824078]

Gheorghiade M, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O'Connor CM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007; 28:980-8. [PMID 17309900]

Nair V, Niederman MS, Masani N, Fishbane S. Hyponatremia in community-acquired pneumonia. Am J Nephrol 2007; 27:184-90. [PMID 17356253]

Murakami T, Matoba H, Kuga Y, Ozawa S, Kubota K, Yoshida S. Hyponatremia in a patient with chronic inflammatory disease. Intern Med 1998; 37:792-5. [PMID 9804092]

Seres DS. Surrogate nutrition markers, malnutrition, and adequacy of nutrition support. Nutr Clin Pract 2005; 20:308-13. [PMID 16207668]

McClave SA, Snider HL, Spain DA. Preoperative issues in clinical nutrition. Chest 1999: 115(5 Suppl.):64S-70S. [PMID 10331336]

Seymour JM, Ward K, Sidhu PS, Puthucheary Z, Steier J, Jolley CJ, et al. Ultrasound measurement of rectus femoris cross-sectional area and the relationship with quadriceps strength in COPD. Thorax 2009; 64:418-23. [PMID 19158125]

Crook MA, Hally V, Panteli JV. The importance of the refeeding syndrome. Nutrition 2001; 17:632-7. [PMID 11448586]

Gariballa S. Refeeding syndrome: a potentially fatal condition but remains underdiagnosed and undertreated. Nutrition 2008; 24:604-6. [PMID 18359196]

The outcome following nasojejunal nutrition in a cohort of patients with chronic pancreatitis
How to Cite
SkipworthJ., RaptisD., WijesuriyaS., PuthuchearyZ., Olde DaminkS., ImberC., MalagòM., & ShankarA. (2011). The Use of Nasojejunal Nutrition in Patients with Chronic Pancreatitis. JOP. Journal of the Pancreas, 12(6), 574-580.