Early versus delayed enteral feeding in acute pancreatitis: A literature review

Background: Acute pancreatitis is a common cause of hospital admission and is associated with significant morbidity and healthcare burden. Traditional management strategies often involved prolonged periods of nil by mouth; however, increasing evidence suggests that early enteral feeding may improve outcomes by preserving gut integrity and reducing infectious complications. This literature review aims to compare the clinical outcomes of early versus delayed enteral feeding in adult patients with acute pancreatitis.
Methods: A literature search was conducted using PubMed and Google Scholar. Search terms included “acute pancreatitis,” “early enteral feeding,” and “delayed feeding.” Studies published in English between 2015 and 2025 were included. Eligible studies involved adult patients with acute pancreatitis and compared early enteral feeding (within 24-48 hours of admission) with delayed feeding. Paediatric studies, chronic pancreatitis, case reports, and opinion articles were excluded. Included study designs comprised randomised controlled trials, systematic reviews, and meta-analyses.
Results: Ten relevant studies met the inclusion criteria. Across multiple study designs, early enteral feeding was associated with improved clinical outcomes compared with delayed feeding. Reported benefits included reduced rates of infectious complications, shorter hospital length of stay, and lower incidence of organ failure. Several studies demonstrated no significant increase in feeding intolerance, pain, or nausea with early feeding. Meta-analyses reported reductions in mortality and septic complications among patients receiving early enteral nutrition. Benefits were most consistently observed in patients with mild to moderately severe acute pancreatitis.
Conclusion: Current evidence supports the early initiation of enteral feeding in acute pancreatitis as a safe and effective intervention associated with improved clinical outcomes. Routine prolonged fasting may be unnecessary in the absence of contraindications, and early enteral nutrition should be considered part of standard acute medical management.