Related Articles

Nutrition support in acute pancreatitis.

JOP. 2008;9(4):375-90

Authors: Ioannidis O, Lavrentieva A, Botsios D

In the majority (80%) of patients with acute pancreatitis, the disease is self limiting and, after a few days of withholding feeding and intravenous administration of fluids, patients can again be normally fed orally. In a small percentage of patients, the disease progresses to severe necrotic pancreatitis, with an intense systemic inflammatory response and often with multiple organ dysfunction syndrome. As mortality is high in patients with severe disease and as mortality and morbidity rates are directly related to the failure of establishing a positive nitrogen balance, it is assumed that feeding will improve survival in patients with severe disease. The aim of nutritional support is to cover the elevated metabolic demands as much as possible, without stimulating pancreatic secretion and maximizing self-digestion. The administration of either total parenteral nutrition or jejunal nutrition does not stimulate pancreatic secretion. Recently, a series of controlled clinical studies has been conducted in order to evaluate the effectiveness of enteral nutrition with jejunal administration of the nutritional solution. The results have shown that enteral nutrition, as compared to total parenteral nutrition, was cheaper, safer and more effective as regards the suppression of the immunoinflammatory response, the decrease of septic complications, the need for surgery for the management of the complications of acute pancreatitis and the reduction of the total hospitalization period. It did not seem to affect mortality or the rate of non-septic complications. In conclusion, enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.

PMID: 18648127 [PubMed - indexed for MEDLINE]

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Related Articles

Nasogastric tube feeding in predicted severe acute pancreatitis. A systematic review of the literature to determine safety and tolerance.

JOP. 2008;9(4):440-8

Authors: Petrov MS, Correia MI, Windsor JA

CONTEXT: Nasogastric tube feeding is safe and well tolerated in most critically ill patients. However, its safety and tolerance in the setting of severe acute pancreatitis is debatable. OBJECTIVE: We aimed to review all available studies on nasogastric feeding in patients with severe acute pancreatitis to determine the safety and tolerance of this approach. A further aim was to perform a meta-analysis of the available randomized controlled trials regarding nasogastric versus nasojejunal feeding. METHODS: Three electronic databases (Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE) and the abstracts of major gastroenterological meetings were reviewed. Meta-analysis was performed using the random effects model. MAIN OUTCOME MEASURES: The summary estimates were reported as risk ratio (RR) with 95% confidence interval (95% CI). RESULTS: A total of four studies on nasogastric tube feeding in 92 patients with predicted severe acute pancreatitis were identified. Documented infected pancreatic necrosis developed in 11 patients (16.9%) and multiple organ failure in 10 (15.4%) out of 65 patients with available data. Overall, there were 15 deaths (16.3%). An exacerbation of pain after initiation of feeding occurred in 3 (4.3%) out of 69 patients with available data. Full tolerance was achieved in 73 (79.3%) patients who did not require temporary reduction, stoppage or withdrawal of nasogastric feeding. The results of nasogastric feeding as compared to nasojejunal feeding, were no worse in terms of mortality (RR=0.77; 95% CI: 0.37 to 1.62; P=0.50) or intolerance of feeding (RR=1.09; 95% CI: 0.46 to 2.59; P=0.84). CONCLUSION: Nasogastric feeding appears safe and well tolerated in patients with predicted severe acute pancreatitis. An adequately powered randomized trial on nasogastric versus nasojejunal feeding is required to support this approach as routine clinical management.

PMID: 18648135 [PubMed - indexed for MEDLINE]

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