Enteral nutrition in the treatment of moderate to severe acute pancreatitis

Abstract

Introduction: Enteral nutrition is thought to have beneficial effects on clinical outcomes in patients with acute pancreatitis. However, gained evidence is weak, based on a rather small number of patients and showing no statistically significant effect on complications and mortality. Objectives: To assess the beneficial and harmful effects of enteral nutrition in comparison to intravenous fluid replacement without nutritional support in patients with moderate to severe acute pancreatitis. Patients and Methods: A 162 consecutive patients with acute pancreatitis and APACHE II score ≥6 were randomized into one of two groups, enteral nutrition group (group I) and group with no nutritional support (group II ). Severity of acute pancreatitis was determined by APACHE II and Ranson scoring systems. Patients in group I received daily 105kJ (25kcal)/kg and 1, 5g/kg of proteins in the form of enteral nutrition preparation administered via a nasojejunal tube, while patients in group II received only fluid replacement with crystalloid solutions. The feeding tube was placed within 24 hours of admission. All cases were assessed by CT between days 5 to 10 after admission and graded according to CTSI classification. Results: Eighty-one patients were randomized in group I and 81 patients in group II . There were no significant differences in age, gender, BMI , etiology and disease severity between groups. There were no significant differences in local(p = 0, 102) and systemic (p = 0, 066) complications according to the revised Atlanta criteria between the two groups. No significant difference in mortality (p = 0, 369) was found either. Conclusion: We found no significant difference in the outcomes of acute pancreatitis between patients who received enteral nutrition compared to patients with nonutritional support.