Randomised prospective multicentre trial on the effect of early enteral nutrition on gut barrier permeability in severe acute pancreatitis

INTERVENTION: Group one: Enteral nutrition via nasogastric/nasojejunal tube, or sip feed, composition as stratified for each centre. To start immediately after randomisation. Group two: ?Standard? fluid replacement, oral or via intravenous line, composition as stratified for each centre. CONDITION: Severe acute pancreatitis ; Digestive System ; Acute pancreatitis PRIMARY OUTCOME: Reduction of proportion of patients with increased gut permeatbility from 80% by half to 40%. SECONDARY OUTCOME: 1. Reduction in persistent organ failure (3 days) from 35% to 15%; 2. Complications (with specific emphasis on infective complications).; 3. Length of hospital/ICU stay; 4. Return of normal GI function; 5. Markers of intestinal ischaemia (Intestinal fatty acid binding protein) and other markers of gut permeability (endocAb), immune/inflammatory response INCLUSION CRITERIA: Patients aged 18 or over with a proven diagnosis of acute pancreatitis (pain and raised enzymes or computed tomography [CT] evidence) together with systemic inflammatory response syndrome (SIRS) or organ failure (Marshall score 2 or more for any organ system except liver, or Atlanta criteria) present for 24 hours or more, and within 72 hours of onset of symptoms.