Gang Zhao1, Chun-You Wang, Fang Wang, Jiong-Xin Xiong. 1. Pancreatic Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China. zhaogang1427@yahoo.com.cn
Abstract
AIM: To investigate the effect of nutritional support therapy on severe acute pancreatitis (SAP). METHODS: A total of 96 patients with severe acute pancreatitis were divided randomly into control and treatment groups. The former group received total parenteral nutrition (TPN) via central venous infusion, while parenteral nutrition (PN) and enteral nutrition (EN) therapies were applied in different phases for the latter group. The nutrition status, acute phase responses, pancreas lesions, enteric mucosa penetrability and immune functions were monitored. RESULTS:Body weight and prealbumin concentration were increased in treatment group, compared to those in the control group, but albumin concentration did not change significantly. Acute physiology and chronic health evaluation II (APACHE II) scores decreased after 7 d of treatment, whereas the scores of the control group decreased on the 11(th) day. Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukine-6 (IL-6) and serum C reactive protein (CRP) dropped earlier in the treatment group (on the 4(th) day) than that in the control group (on the 7(th) day). No difference was observed in pancreatic lesions between the control and treatment groups. Concentration of endotoxin and lactulose/manicol (L:M) ratio of urine did not change in treatment group, but those in the control group were elevated markedly. Compared with the treatment group, CD4:CD8 T cells ratio and immunoglobulin G (IgG) concentration in the control group decreased significantly. CONCLUSION: Compared to TPN, the combined therapy of EN and PN could improve the nutrition status and moderate the acute phase response obviously. Moreover, the integrity of enteric mucosa and immune function were protected more effectively in treatment group than in the control one. On the other hand, EN did not simulate the excretion of pancreas and avoid exaggerating the inflammation of pancreas. Thus, appropriate application of PN and EN appears to be more effective for patients with SAP.
RCT Entities:
AIM: To investigate the effect of nutritional support therapy on severe acute pancreatitis (SAP). METHODS: A total of 96 patients with severe acute pancreatitis were divided randomly into control and treatment groups. The former group received total parenteral nutrition (TPN) via central venous infusion, while parenteral nutrition (PN) and enteral nutrition (EN) therapies were applied in different phases for the latter group. The nutrition status, acute phase responses, pancreas lesions, enteric mucosa penetrability and immune functions were monitored. RESULTS: Body weight and prealbumin concentration were increased in treatment group, compared to those in the control group, but albumin concentration did not change significantly. Acute physiology and chronic health evaluation II (APACHE II) scores decreased after 7 d of treatment, whereas the scores of the control group decreased on the 11(th) day. Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukine-6 (IL-6) and serum C reactive protein (CRP) dropped earlier in the treatment group (on the 4(th) day) than that in the control group (on the 7(th) day). No difference was observed in pancreatic lesions between the control and treatment groups. Concentration of endotoxin and lactulose/manicol (L:M) ratio of urine did not change in treatment group, but those in the control group were elevated markedly. Compared with the treatment group, CD4:CD8 T cells ratio and immunoglobulin G (IgG) concentration in the control group decreased significantly. CONCLUSION: Compared to TPN, the combined therapy of EN and PN could improve the nutrition status and moderate the acute phase response obviously. Moreover, the integrity of enteric mucosa and immune function were protected more effectively in treatment group than in the control one. On the other hand, EN did not simulate the excretion of pancreas and avoid exaggerating the inflammation of pancreas. Thus, appropriate application of PN and EN appears to be more effective for patients with SAP.
Authors: M Sahin; S Ozer; C Vatansev; M Aköz; H Vatansev; F Aksoy; A Dilsiz; O Yilmaz; M Karademir; M Aktan Journal: Am J Surg Date: 1999-11 Impact factor: 2.565
Authors: T Foitzik; M Stufler; H G Hotz; J Klinnert; J Wagner; A L Warshaw; J D Schulzke; M Fromm; H J Buhr Journal: J Gastrointest Surg Date: 1997 Jan-Feb Impact factor: 3.452
Authors: Maisam Abu-El-Haija; Soma Kumar; Jose Antonio Quiros; Keshawadhana Balakrishnan; Bradley Barth; Samuel Bitton; John F Eisses; Elsie Jazmin Foglio; Victor Fox; Denease Francis; Alvin Jay Freeman; Tanja Gonska; Amit S Grover; Sohail Z Husain; Rakesh Kumar; Sameer Lapsia; Tom Lin; Quin Y Liu; Asim Maqbool; Zachary M Sellers; Flora Szabo; Aliye Uc; Steven L Werlin; Veronique D Morinville Journal: J Pediatr Gastroenterol Nutr Date: 2018-01 Impact factor: 2.839
Authors: Gang Zhao; Jun-Gang Zhang; He-Shui Wu; Jin Tao; Qi Qin; Shi-Chang Deng; Yang Liu; Lin Liu; Bo Wang; Kui Tian; Xiang Li; Shuai Zhu; Chun-You Wang Journal: World J Gastroenterol Date: 2013-04-07 Impact factor: 5.742