Pancreatitis Crónica (PC)

2.1 ¿Cuándo está Indicada la NP en Pancreatitis Crónica (PC)?

La desnutrición es frecuente en pacientes con PC debido a la anorexia inducida por el dolor y al abuso continuo de bebidas alcohólicas. Además, en tales personas no es raro el aumento en el gasto de energía en reposo.

En raras ocasiones puede estar indicada la Pancreatitis Crónica (NP) en pacientes con obstrucción del vaciamiento gástrico secundario a estenosis duodenal y en aquellos con enfermedad fistulosa compleja (C).

Comentarios:

Más del 80% de los pacientes que sufren PC pueden tratarse adecuadamente con alimentación normal suplementada con enzimas pancreáticas (B) y solo entre el 10 y 15% necesitan suplementos nutricionales orales. La alimentación por sonda está indicada en aproximadamente 5% de los pacientes con pancreatitis crónica (C).

En consecuencia, la Pancreatitis Crónica (NP) rara vez se utiliza en pacientes con PC, restringiéndola generalmente a quienes tienen obstrucción del tracto de salida gástrico y necesitan decompresión gástrica sin que se pueda llevar una sonda hasta el yeyuno. También puede estar indicada la NP en pacientes con pancreatitis crónica y fístula pancreática compleja (C). No se han informado series de pacientes con insuficiencia pancreática crónica que hayan sido tratados con nutrición endovenosa por períodos largos. La NP usualmente se administra durante corto tiempo, por ejemplo, en desnutrición grave aparente antes de cirugía pancreática si no es posible la alimentación enteral (1).

2.2 ¿Cuándo está Contraindicada la Pancreatitis Crónica (NP) en PC?

No hay contraindicaciones específicas.

No se tienen contraindicaciones específicas para la NP en PC, pero menos de 1% de los pacientes con pancreatitis crónica utilizan la NP (C) (1).

El síndrome de realimentación puede presentarse en esos pacientes desnutridos si se les suministran cantidades excesivas de calorías y nitrógeno en los días iniciales de una Pancreatitis Crónica.

Conflictos de interés

Los conflictos de interés se hallan documentados en los archivos de ESPEN.

Correspondencia: (espenjournals@espen.org)

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