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Enteral nutrition in severe acute pancreatitis.
JOP. 2009 Mar 09; 10(2):157-62.JOP

Abstract

CONTEXT

There is controversy concerning the merits of enteral and parenteral nutrition in the management of patients with severe acute pancreatitis.

OBJECTIVE

This study was undertaken to evaluate the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis.

SETTING

Tertiary care centre in North India.

DESIGN

A prospective clinical trial.

METHODS

Fifty consecutive patients with severe acute pancreatitis were randomized in a prospective trial to receive total enteral nutrition (n=25) or total parenteral nutrition (n=25). Enteral nutrition was delivered distal to the ligament of Treitz. Serum C-reactive protein, transferrin levels, albumin, surgical intervention, infections, duration of hospital stay and mortality were compared in the two groups.

RESULTS

The mean age in the enteral nutrition group was 38.4+/-13.8 years and in the total parenteral nutrition group 41.1+/-11.3 years. The etiological factors were alcohol (n=19), gallstones (n=23), idiopathic (n=7) and drug-induced (n=1). There was a significant decrease in serum C-reactive protein values in both the enteral nutrition group and the total parenteral nutrition group at one week and two weeks (P<0.001 for both). Serum albumin rose from a prenutritional value of 2.82+/-0.51 g/dL to 3.34+/-0.45 g/dL on day 14 of nutritional support in the enteral nutrition group (P=0.003); in the total parenteral nutrition group, the level rose from 3.10+/-0.59 g/dL to 3.21+/-0.30 g/dL (P=0.638). A significant rise in transferrin value was observed from day 0 to day 14 in enteral nutrition group (169+/-30 to 196+/-36 mg/dL; P<0.001) whereas, in the total parenteral nutrition group, a less significant difference (191+/-41 to 201+/-29 mg/dL; P=0.044) was observed. There was no significant difference in surgical intervention (56.0% versus 60.0%; P=1.000), infective complications (64.0% versus 60.0%; P=1.000), hospital stay (42 days, 15-108 days, versus 36 days, 20-77 days; median, range; P=0.755), or mortality (20.0% versus 16.0%; P=1.000) in enteral nutrition versus total parenteral nutrition, respectively.

CONCLUSION

Enteral nutrition and total parenteral nutrition are comparable in the management of severe acute pancreatitis in terms of hospital stay, need for surgical intervention, infections and mortality.

Authors+Show Affiliations

Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19287109

Citation

Doley, Rudra Prasad, et al. "Enteral Nutrition in Severe Acute Pancreatitis." JOP : Journal of the Pancreas, vol. 10, no. 2, 2009, pp. 157-62.
Doley RP, Yadav TD, Wig JD, et al. Enteral nutrition in severe acute pancreatitis. JOP. 2009;10(2):157-62.
Doley, R. P., Yadav, T. D., Wig, J. D., Kochhar, R., Singh, G., Bharathy, K. G., Kudari, A., Gupta, R., Gupta, V., Poornachandra, K. S., Dutta, U., & Vaishnavi, C. (2009). Enteral nutrition in severe acute pancreatitis. JOP : Journal of the Pancreas, 10(2), 157-62.
Doley RP, et al. Enteral Nutrition in Severe Acute Pancreatitis. JOP. 2009 Mar 9;10(2):157-62. PubMed PMID: 19287109.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enteral nutrition in severe acute pancreatitis. AU - Doley,Rudra Prasad, AU - Yadav,Thakur Deen, AU - Wig,Jai Dev, AU - Kochhar,Rakesh, AU - Singh,Gurpreet, AU - Bharathy,Kishore Gurumoorthy Subramanya, AU - Kudari,Ashwini, AU - Gupta,Rajesh, AU - Gupta,Vikas, AU - Poornachandra,Kuchhangi Sureshchandra, AU - Dutta,Usha, AU - Vaishnavi,Chetna, Y1 - 2009/03/09/ PY - 2009/3/17/entrez PY - 2009/3/17/pubmed PY - 2009/5/30/medline SP - 157 EP - 62 JF - JOP : Journal of the pancreas JO - JOP VL - 10 IS - 2 N2 - CONTEXT: There is controversy concerning the merits of enteral and parenteral nutrition in the management of patients with severe acute pancreatitis. OBJECTIVE: This study was undertaken to evaluate the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis. SETTING: Tertiary care centre in North India. DESIGN: A prospective clinical trial. METHODS: Fifty consecutive patients with severe acute pancreatitis were randomized in a prospective trial to receive total enteral nutrition (n=25) or total parenteral nutrition (n=25). Enteral nutrition was delivered distal to the ligament of Treitz. Serum C-reactive protein, transferrin levels, albumin, surgical intervention, infections, duration of hospital stay and mortality were compared in the two groups. RESULTS: The mean age in the enteral nutrition group was 38.4+/-13.8 years and in the total parenteral nutrition group 41.1+/-11.3 years. The etiological factors were alcohol (n=19), gallstones (n=23), idiopathic (n=7) and drug-induced (n=1). There was a significant decrease in serum C-reactive protein values in both the enteral nutrition group and the total parenteral nutrition group at one week and two weeks (P<0.001 for both). Serum albumin rose from a prenutritional value of 2.82+/-0.51 g/dL to 3.34+/-0.45 g/dL on day 14 of nutritional support in the enteral nutrition group (P=0.003); in the total parenteral nutrition group, the level rose from 3.10+/-0.59 g/dL to 3.21+/-0.30 g/dL (P=0.638). A significant rise in transferrin value was observed from day 0 to day 14 in enteral nutrition group (169+/-30 to 196+/-36 mg/dL; P<0.001) whereas, in the total parenteral nutrition group, a less significant difference (191+/-41 to 201+/-29 mg/dL; P=0.044) was observed. There was no significant difference in surgical intervention (56.0% versus 60.0%; P=1.000), infective complications (64.0% versus 60.0%; P=1.000), hospital stay (42 days, 15-108 days, versus 36 days, 20-77 days; median, range; P=0.755), or mortality (20.0% versus 16.0%; P=1.000) in enteral nutrition versus total parenteral nutrition, respectively. CONCLUSION: Enteral nutrition and total parenteral nutrition are comparable in the management of severe acute pancreatitis in terms of hospital stay, need for surgical intervention, infections and mortality. SN - 1590-8577 UR - https://www.unboundmedicine.com/medline/citation/19287109/Enteral_nutrition_in_severe_acute_pancreatitis_ L2 - http://www.diseaseinfosearch.org/result/9663 DB - PRIME DP - Unbound Medicine ER -