Nutritional Management of Recurrent Acute Pancreatitis: Navigating Evidence, Uncertainty, and Clinical Decision-Making

Abstract Purpose of Review This review aims to examine evidence-based nutrition management strategies across the continuum of disease in patients with recurrent acute pancreatitis (RAP), a population characterized by repeated inflammatory episodes, cumulative nutritional decline, and increased risk of progression to chronic pancreatitis (CP). It addresses key questions regarding optimal timing and delivery of nutrition support, as well as the identification and treatment of exocrine pancreatic insufficiency (EPI), gastrointestinal complications, metabolic derangements, and micronutrient deficiencies. Recent Findings Although current evidence demonstrates reduced infectious complications and improved clinical outcomes with early enteral nutrition in AP, important gaps persist regarding nutritional management between recurrent episodes. Across recurrent episodes, cumulative effects of EPI, persistent gastrointestinal symptoms, and metabolic derangements may contribute to progressive malnutrition, sarcopenia, and declining quality of life. Recognition of EPI during and after AP has increased; however, recurring pancreatic injury in RAP places patients at particularly high risk for persistent or progressive exocrine and endocrine dysfunction necessitating ongoing surveillance and optimization of PERT. Repeated inflammatory events may accelerate structural pancreatic damage and progression toward CP, underscoring the need for early identification and treatment of nutritional complications. Summary Overall, nutritional management is a critical, yet underdeveloped component of RAP care. Future research and stronger study designs are necessary to understand how nutritional management of RAP impacts the frequency and severity of recurrent attacks. Disclosure No potential conflicts of interest relevant to this article were reported.