1.
Glutamine supported early enteral therapy for severe acute pancreatitis: A systematic review and meta-analysis.
Jiang, X, Pei, LY, Guo, WX, Qi, X, Lu, XG
Asia Pacific journal of clinical nutrition. 2020;(2):253-261
Abstract
BACKGROUND AND OBJECTIVES Several studies have shown that glutamine (Gln) may play an important role in energy metabolism, inflammatory reactions, and immune processes in patients with severe acute pancreatitis (SAP). Nevertheless, the results of individual randomized controlled trials (RCTs) on Gln nutrition support for SAP are contradictory. This systematic review and meta-analysis evaluated the clinical benefit of Gln-supported early enteral nutrition (G+EEN) in patients with SAP. METHODS AND STUDY DESIGN Cochrane Library, PubMed, Embase, CNKI, Wan Fang, and Chinese Biomedical Literature Database were searched for relevant studies published before December 2018. RCTs of G+EEN versus standard early enteral nutrition (EEN) for SAP were selected, with both started within 48 h of admission. RESULTS Seven clinical RCTs including a total of 433 patients (EEN group: 218 patients; G+EEN group: 215 patients) were included. Compared with EEN, G+EEN increased serum albumin (standard mean difference [SMD]=0.74; 95% confidence interval [CI], 0.33-1.15; p<0.01), reduced serum hypersensitive C-reactive protein (SMD=-1.62; 95% CI, -1.98 to -1.26; p<0.01) and risks of mortality risk (risk ratio= 0.38; 95% CI, 0.16-0.90; p=0.03) and multiple organ dysfunction syndrome (MODS)(risk ratio=0.37; 95% CI, 0.15-0.94; p<0.01), and shortened length of hospital stay (SMD=-1.19; 95% CI, -1.88 to 0.49; p<0.01); moreover, it did not significantly increase the incidence of infection-related complications, operative interventions, or APACHE II scores. CONCLUSIONS G+EEN is beneficial in SAP management.
2.
Nutritional support in acute pancreatitis.
Ong, JP, Fock, KM
Journal of digestive diseases. 2012;(9):445-52
Abstract
Acute pancreatitis can present as a mild or severe disease. Most patients have a mild disease and recover without requiring nutritional support. Patients with severe acute pancreatitis may develop systemic inflammatory response syndrome and progress to multi-organ failure. These ill patients have high metabolism and protein catabolism. Hence, the nutritional management of these patients can be challenging. The aim of nutritional support is to meet the elevated metabolic demands as far as possible without stimulating pancreatic secretion and yet maintaining the gut integrity. The concept of pancreatic rest has evolved over the years. To date, there is a substantial scientific proof that enteral nutrition (EN) in comparison to parenteral nutrition significantly reduces infectious complications, surgical interventions and mortality in predicted severe acute pancreatitis. EN may be able to improve outcome in these patients if given early. In this review, we summarized the current knowledge on nutrition in acute pancreatitis and shared our local experience.
3.
Bio-ecological control of acute pancreatitis: the role of enteral nutrition, pro and synbiotics.
Bengmark, S
Current opinion in clinical nutrition and metabolic care. 2005;(5):557-61
Abstract
PURPOSE OF REVIEW Increasing knowledge, both experimental and clinical, supports the fact that early and aggressive enteral nutrition has the capacity to reduce superinflammation and prevent infections in severe acute pancreatitis. Clearly, the main role of enteral nutrition is to boost the immune system, and not, at least initially, to provide calories. Whereas enteral nutrition improves, parenteral nutrition reduces immune functions. RECENT FINDINGS The content of enteral nutrition solutions is more important than the route of administration per se. Antioxidants, plant fibres and live lactic acid bacteria are especially important for boosting the immune system. Recent studies support the fact that enteral nutrition and the supply of fibres and live lactic acid bacteria may significantly reduce the rate of infections. So far none of the treatments has been able to reduce the incidence of the systemic inflammatory response syndrome and multiorgan dysfunction syndrome. A recent unpublished study indicates, however, that the systemic inflammatory response syndrome and multiorgan dysfunction syndrome can also be reduced if much higher doses of lactic acid bacteria and a combination of several bioactive lactic acid bacteria are used (synbiotics). SUMMARY Immunosupporting enteral nutrition with synbiotics is an important tool to control superinflammation and infection, and might also reduce the multiorgan dysfunction syndrome and systemic inflammatory response syndrome. It is essential that it is supplied early, if possible in the emergency room. New autopositioning regurgitation-resistant feeding tubes are available to facilitate such a policy.