Because enteral nutrition can stimulate pancreatic and intestinal secretions, the pancreatic rest concept has been a dogma in managing severe AP. However, bowel rest is associated with intestinal atrophy, bacterial overgrowth, and is responsible for elevated endotoxin and cytokines levels, bacterial translocation and SIRS induction. This is associated with a higher risk of infected pancreatic necrosis. So, because of its beneficial effects on tissue of the intestinal mucosa and the splanchnic blood flow, the concept that enteral nutrition ‘worsens’ pancreatitis has diminished greatly over recent years. In a recent meta-analysis including eight randomized controlled studies and 381 patients, enteral nutrition compared with parenteral nutrition decreased infectious complications and mortality [
11]. The use of early enteral nutrition (within 48 h of admission) has proven to be beneficial in patients with AP as it improves clinical outcomes by reducing the number of infections, particularly pancreatic infections (OR 0.49; 95 % CI 0.31–0.78) [
12]. Recently, in less severe illness (APACHE II score 11; 6 % of the patients with multiple organ failure), a trial did not show the superiority of enteral nutrition within 24 h compared with oral diet after 72 h, in reducing the rate of infection or death [
13]. On the basis of the assumption that gastric food administration increases the risk of abdominal pain exacerbation, nasojejunal feeding has long been favoured. However, exclusive gastric feeding succeeds with the delivery of nutritional targets in 90 % of patients [
14]. The type of dietary mixture used did not appear decisive, and the effect of immunonutrition, glutamine supplementation and probiotics has not been demonstrated (Cochrane Database Syst Rev Mar 23;3:CD010605).