ON CONTROVERSIAL TOPICS / NA KONTROVERZNÍ TÉMA

It is often sufficient for mild to moderate acute pancreatitis to be managed with only intravenous hydratation since recovery occurs rapidly. On the other hand, severe acute pancreatitis is always associated with significant hypercatabolism and thus early nutritional support is an indispensable part of complex treatment. The use of parenteral or enteral nutrition is still a matter subject to controversial discussion. The clinical trials pub- lished to date are mostly of a small size and the results must be interpreted with caution. Clinical heterogeneity in the form of age, aetiology and especially severity of pancreatitis point to the possibility of bias. Many beliefs are derived from physiological studies and are not supported by evidence from prospective trials. In nutritional treatment, the enteral route should be attempted in all patients. Many patients will require a combination of par- enteral and (parallel or subsequent) enteral nutrition after initial intensive fluid resuscitation.