Clinical study on nutrition support in patients with severe acute pancreatitis

doi:10.3748/wjg.v9.i9.2105

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Sep 15, 2003 (publication date) through Nov 21, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Clinical Research

World J Gastroenterol. Sep 15, 2003; 9(9): 2105-2108
Published online Sep 15, 2003. doi: 10.3748/wjg.v9.i9.2105

Clinical study on nutrition support in patients with severe acute pancreatitis

Gang Zhao, Chun-You Wang, Fang Wang, Jiong-Xin Xiong

Gang Zhao, Chun-You Wang, Jiong-Xin Xiong, Pancreatic Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China

Fang Wang, Department of Pharmacology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China

Author contributions: All authors contributed equally to the work.

Correspondence to: Dr. Gang Zhao, Pancreatic Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China. zhaogang1427@yahoo.com.cn

Telephone: +86-27-85726273

Received: March 20, 2003
Revised: April 11, 2003
Accepted: April 22, 2003
Published online: September 15, 2003

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-α (TNF-α), 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.

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