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Impact of early enteral nutrition on the morbi-mortality of patients with severe acute pancreatitis

Background and objective

For many years total parenteral nutrition was considered the mainstay of nutritional support in patients with severe acute pancreatitis [1]. Recent studies with a limited number of cases have shown that early enteral nutrition is feasible and associated with a reduction of morbidity in these patients [2, 3]. The objective of this study was to evaluate the impact of early enteral nutrition on the morbi-mortality of patients with severe acute pancreatitis.

Methods

We compared two groups of patients with acute severe pancreatitis admitted to a general ICU in the period from 1994 to 2004. Patients admitted between 1994 and August 1999 systematically received total parenteral nutrition (TPN), while those admitted from September 1999 to December 2004 received enteral nutrition through a nasojejunal tube. All other aspects of treatment were similar between the two groups.

Results

Forty-four patients were included in the study. Eighteen of them, admitted between 1994 and 1999, received parenteral nutrition (TPN group), and 26 patients admitted between 1999 and 2004 received enteral nutrition (EN group). The two groups were comparable regarding age, gender, etiology of pancreatitis and APACHE III score. Thirteen patients were qualified as 'C' of Balthazar (seven in the TPN group and six in the EN group). Twenty-seven patients were qualified as 'D' or 'E' (eight in the TPN group and 19 in the EN group). Severe pancreatic necrosis was seen in 14 patients (three in the TPN group and 11 in the EN group). Morbidity and mortality data are presented in Table 1.

Table 1 Morbidity and mortality

Conclusion

This study contributes to reinforcing the conclusions from other authors that have shown a trend towards the reduction of morbi-mortality of patients with acute pancreatitis that received early enteral nutrition.

References

  1. 1.

    Grant JP, James S, Grabowxki V, et al.: Total parenteral nutrition in pancreatic disease. Ann Surg 1984, 200: 627-631. 10.1097/00000658-198411000-00012

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    McClave SA, Greene LM, Snider HL, et al.: Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. J Parenteral Enteral Nutr 1997, 21: 14-20.

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    Windsor ACJ, Kanwar S, Li AGK, et al.: Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 1998, 42: 431-435.

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Azevedo, J., Passos, L., Moreira, P. et al. Impact of early enteral nutrition on the morbi-mortality of patients with severe acute pancreatitis. Crit Care 11, P81 (2007). https://doi.org/10.1186/cc5868

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Keywords

  • Public Health
  • Pancreatitis
  • Emergency Medicine
  • Acute Pancreatitis
  • Parenteral Nutrition