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Early nasogastric feeding in predicted severe acute pancreatitis: a clinical, randomized study.

Eckerwall, Gunilla LU ; Axelsson, Jakob B LU and Andersson, Roland LU (2006) In Annals of Surgery 244(6). p.959-967
Abstract
Objective: To compare the efficacy and safety of early, nasogastric enteral nutrition (EN) with total parenteral nutrition (TPN) in patients with predicted severe acute pancreatitis (SAP). Summary Background Data: In SAP, the magnitude of the inflammatory response as well as increased intestinal permeability correlates with outcome. Enteral feeding has been suggested superior to parenteral feeding due to a proposed beneficial effect on the gut barrier. Methods: Fifty patients who met the inclusion criteria were randomized to TPN or EN groups. The nutritional regimen was started within 24 hours from admission and EN was provided through a nasogastric tube. The observation period was 10 days. Intestinal permeability was measured by excretion... (More)
Objective: To compare the efficacy and safety of early, nasogastric enteral nutrition (EN) with total parenteral nutrition (TPN) in patients with predicted severe acute pancreatitis (SAP). Summary Background Data: In SAP, the magnitude of the inflammatory response as well as increased intestinal permeability correlates with outcome. Enteral feeding has been suggested superior to parenteral feeding due to a proposed beneficial effect on the gut barrier. Methods: Fifty patients who met the inclusion criteria were randomized to TPN or EN groups. The nutritional regimen was started within 24 hours from admission and EN was provided through a nasogastric tube. The observation period was 10 days. Intestinal permeability was measured by excretion of polyethylene glycol (PEG) and concentrations of antiendotoxin core antibodies (Endocab). Interieukins (IL)-6 IL-8, and C-reactive protein (CRP) were used as markers of the systemic inflammatory response. Morbidity and feasibility of the nutritional route were evaluated by the frequency of complications, gastrointestinal symptoms, and abdominal pain. Results: PEG, Endocab, CRP, IL-6, APACHE II score, severity according to the Atlanta classification (22 patients), and gastrointestinal symptoms or abdominal pain did not significantly differ between the groups. The incidence of hyperglycemia was significantly higher in TPN patients (21 of 26 vs. 7 of 23; P < 0.001). Total complications (25 vs. 52; P = 0.04) and pulmonary complications (10 vs. 21; P = 0.04) were significantly more frequent in EN patients, although complications were diagnosed dominantly within the first 3 days. Conclusion: In predicted SAP, nasogastric early EN was feasible and resulted in better control of blood glucose levels, although the overall early complication rate was higher in the EN group. No beneficial effects on intestinal permeability or the inflammatory response were seen by EN treatment. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Surgery
volume
244
issue
6
pages
959 - 967
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000242474700015
  • scopus:33748453461
ISSN
1528-1140
DOI
10.1097/01.sla.0000246866.01930.58
language
English
LU publication?
yes
id
66cb7f57-21ee-4286-ab1b-c6e2a87049f6 (old id 163024)
date added to LUP
2007-07-23 08:36:16
date last changed
2019-09-22 03:36:06
@article{66cb7f57-21ee-4286-ab1b-c6e2a87049f6,
  abstract     = {Objective: To compare the efficacy and safety of early, nasogastric enteral nutrition (EN) with total parenteral nutrition (TPN) in patients with predicted severe acute pancreatitis (SAP). Summary Background Data: In SAP, the magnitude of the inflammatory response as well as increased intestinal permeability correlates with outcome. Enteral feeding has been suggested superior to parenteral feeding due to a proposed beneficial effect on the gut barrier. Methods: Fifty patients who met the inclusion criteria were randomized to TPN or EN groups. The nutritional regimen was started within 24 hours from admission and EN was provided through a nasogastric tube. The observation period was 10 days. Intestinal permeability was measured by excretion of polyethylene glycol (PEG) and concentrations of antiendotoxin core antibodies (Endocab). Interieukins (IL)-6 IL-8, and C-reactive protein (CRP) were used as markers of the systemic inflammatory response. Morbidity and feasibility of the nutritional route were evaluated by the frequency of complications, gastrointestinal symptoms, and abdominal pain. Results: PEG, Endocab, CRP, IL-6, APACHE II score, severity according to the Atlanta classification (22 patients), and gastrointestinal symptoms or abdominal pain did not significantly differ between the groups. The incidence of hyperglycemia was significantly higher in TPN patients (21 of 26 vs. 7 of 23; P &lt; 0.001). Total complications (25 vs. 52; P = 0.04) and pulmonary complications (10 vs. 21; P = 0.04) were significantly more frequent in EN patients, although complications were diagnosed dominantly within the first 3 days. Conclusion: In predicted SAP, nasogastric early EN was feasible and resulted in better control of blood glucose levels, although the overall early complication rate was higher in the EN group. No beneficial effects on intestinal permeability or the inflammatory response were seen by EN treatment.},
  author       = {Eckerwall, Gunilla and Axelsson, Jakob B and Andersson, Roland},
  issn         = {1528-1140},
  language     = {eng},
  number       = {6},
  pages        = {959--967},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Annals of Surgery},
  title        = {Early nasogastric feeding in predicted severe acute pancreatitis: a clinical, randomized study.},
  url          = {http://dx.doi.org/10.1097/01.sla.0000246866.01930.58},
  volume       = {244},
  year         = {2006},
}