Early enteral nutrition in acute pancreatitis - how beneficial is it?

Authors

  • Shruthikamal Venkat Department of General Surgery, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  • Rajesh Subramaniam Department of General Surgery, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  • Vijai Raveendran Department of General Surgery, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20214047

Keywords:

Acute pancreatitis, Enteral nutrition, Nutrition, Parenteral, Severe pancreatitis

Abstract

Background: Acute pancreatitis is an inflammatory disease of pancreas and is one of the leading cause of acute abdomen requiring hospital admission. Nutritional support plays a crucial role in this hypercatabolic state in not only providing calories but also in preventing complications and decreasing recovery time.

Methods: This prospective study was done among 120 patients with acute moderate and severe pancreatitis who got admitted in department of general surgery at Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India between 2018 and 2019.

Results: 67 (55.8%) patients were in early enteral and 53 (44.2%) were in parenteral/delayed enteral group. Maximum number of patients were in 30-40 years age group. The mean of patient age was 40.33. Mean duration of hospital stay in enteral group was 7.06 and in parenteral/delayed enteral group it was 14.09 (p<0.001). Mean pain score in enteral group was 2.69 and in parenteral group it was 6.51 (p<0.001).

Conclusions: There was significant (p<0.001) decrease in hospital stay duration and pain score in early enteral group compared to parenteral/delayed enteral group. Infections related to feeding route was found high in parenteral group. No significant difference found in complications of acute pancreatitis. Hence early enteral feeding is more beneficial in terms of shortened hospital stay, decreased pain score leading to reduction in usage of analgesics and reducing the recovery time and less nutrition related complications in management of acute moderate and severe pancreatitis.

Author Biography

Rajesh Subramaniam, Department of General Surgery, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Associate professor,

Department of General Surgery

References

Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006;33:323-30.

Banks PA, Bollen TL, Dervenis C. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.

Pandol SJ, Saluja AK, Imrie CW, Banks PA. Acute pancreatitis: bench to the bedside. Gastroenterol. 2007;133(3):1056.

Spanier BM, Dijkgraaf MG, Bruno MJ. Epidemiology, aetiology and outcome of acute and chronic pancreatitis: An update. Best Pract Res Clini Gastroenterol. 2008;22(1):45-63.

Singh VK, Bollen TL, Wu BU. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol. 2011;9:1098-103.

Whitcomb DC. Acute pancreatitis. N Engl J Med. 2006;354:2142-50.

Besselink MG, van Santvoort HC, Boermeester MA. Timing and impact of infections in acute pancreatitis. Br J Surg. 2009;96:267-73.

Wu BU, Johannes RS, Kurtz S, Banks PA. The impact of hospital-acquired infection on outcome in acute pancreatitis. Gastroenterol. 2008;135:816-20.

Rodriguez JR, Razo AO, Targarona J. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg. 2008;247:294-9.

Beger HG, Rau B, Mayer J, Pralle U. Natural course of the acute pancreatitis. World J Surg. 1997;21:130-5.

Eckerwall GE, Tingstedt BB, Bergenzaun PE, Andersson RG. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery—a randomized clinical study. Clin Nutr. 2007;26(6):758-63.

Schietroma M, Pessia B, Carlei F, Mariani P, Sista F, Amicucci G. Intestinal permeability and systemic endotoxemia in patients with acute pancreatitis. Ann Ital Chir. 2016;87(1):138-44.

Shen QX, Xu GX, Shen MH. Effect of early enteral nutrition (EN) on endotoxin in serum and intestinal permeability in patients with severe acute pancreatitis. Eur Rev Med Pharmacol Sci. 2017;21(11):2764-8.

Capurso G, Zerboni G, Signoretti M. Role of the gut barrier in acute pancreatitis. J Clin Gastroenterol. 2012;46(1):46-51.

Petrov MS. Gastric feeding and “gut rousing” in acute pancreatitis. Nutr Clin Pract. 2014;29(3):287-90.

Faghih M, Fan C, Singh VK. New advances in the treatment of acute pancreatitis. Curr Treat Options Gastroenterol. 2019;17(1):146-60.

Feng P, He C, Liao G, Chen Y. Early enteral nutrition versus delayed enteral nutrition in acute pancreatitis: A PRISMA compliant systematic review and meta-analysis. Medicine (Baltimore). 2017;96(46):8648.

Qi D, Yu B, Huang J, Peng M. Meta-analysis of early enteral nutrition provided within 24 hours of admission on clinical outcomes in acute pancreatitis. JPEN J Parenter Enteral Nutr. 2018;42(7):1139-47.

Landahl P, Ansari D, Andersson R. Severe acute pancreatitis: gut barrier failure, systemic inflammatory response, acute lung injury, and the role of the mesenteric lymph. Surg Infect (Larchmt). 2015;16(6):651-6.

Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ. 2004;328(7453):1407.

Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400-15.

Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4):1-15.

Endo A, Shiraishi A, Fushimi K, Murata K, Otomo Y. Comparative effectiveness of elemental formula in the early enteral nutrition management of acute pancreatitis: a retrospective cohort study. Ann Intensive Care. 2018;8(1):69.

Sun JK, Mu XW, Li WQ, Tong ZH, Li J, Zheng SY. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol. 2013;19:917-22.

Petrov MS, McIlroy K, Grayson L, Phillips AR, Windsor JA. Early nasogastric tube feeding versus nil per oral in mild to moderate acute pancreatitis: a randomized controlled trial. Clin Nutr. 2013;32(5):697-703.

Farooq O, Khan AZ, Hussain I. Comparison of outcome between early enteral and total parenteral nutrition in patients with acute pancreatitis. J Fatima Jinnah Med Univ. 2017;11(1).

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Published

2021-10-28

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Original Research Articles