P-P14 A multi-centre retrospective cohort study exploring weight loss and nutritional interventions in severe acute pancreatitis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
David Bourne ◽  
Neil Bibby ◽  
Emily Button ◽  
Tara Kenny ◽  
Marie Labaquere ◽  
...  
Keyword(s):  
Weight Loss ◽  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Nutritional Support ◽  
Tube Feeding ◽  
Exclusion Criterion ◽  
Inclusion Criteria ◽  
Nutritional Interventions ◽  
Number Of Patients ◽  
Patients With Diabetes

Abstract Background Acute pancreatitis is among the most common acute gastrointestinal diseases. Severe acute pancreatitis (SAP) develops in up to 20% of patients and is associated with increased morbidity and mortality. Patients may have long and complex hospital admissions; nutritional support is a cornerstone of management. Due to increased metabolic demands and development of pancreatic exocrine insufficiency (PEI) patients frequently endure excessive weight loss. There has been little research into the effect of SAP on nutritional status and necessary nutritional interventions. This project aimed to characterise weight loss in SAP, routes of feeding, and PEI - including pancreatic enzyme replacement therapy (PERT). Methods Participating centres were recruited via the Nutrition Interest group of PSGBI and were required to retrospectively recruit 5-10 consecutive patients admitted following January 1st 2018 using a predefined data collection tool. Inclusion criteria included; age ≥18 years and diagnosed SAP of any aetiology (defined by organ failure of > 48hrs). The exclusion criterion was where death occurred during hospital admission. Data were collected regarding, weight changes, anthropometric measures, nutritional interventions used, PERT administration and diabetic status, including insulin use. All analyses were performed with IBM SPSS 22 (IBM Corp. Armonk, NY), with p < 0.05 considered statistically significant. Results 34 patients (22 male) from five centres met the inclusion criteria and were included in data analysis. Most common aetiologies were gallstones (13/34) and alcohol (11/34). A mean weight reduction of 12.6% (SD ± 10.77) (p < 0.001) was observed. Multivariate analyses showed that higher premorbid weight (p = 0.02) and PERT administration with tube feeding (p = 0.005) were associated with weight loss. Most patients (29/34) received tube feeding; mean duration 56.8 (SD ± 58.29) days. There was a significant increase in patients with diabetes requiring insulin therapy from admission (n = 3) to discharge (n = 9) (p = 0.03). Most (29/31) patients required oral PERT prescription on discharge. Conclusions Patients with SAP lost significant weight during the course of their illness despite aggressive, extended nutritional support and the correction of PEI with PERT. The significant increase in insulin dependence among patients with diabetes, and the number of patients requiring PERT on discharge, reflects the destructive effect SAP has on pancreatic function. These multicentre findings could be used as a baseline for determining effectiveness of nutritional interventions in SAP and may provide a basis for further prospective research in this area.

scholarly journals Nutrition and Antibiotics for Acute Pancreatitis

2021 ◽  
Vol 26 (3) ◽  
pp. 176-180
Author(s):  
Hoonsub So ◽  
Hye Kyung Lee ◽  
Tae Jun Song
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Enteral Feeding ◽  
Broad Spectrum ◽  
Nutritional Support ◽  
Tube Feeding ◽  
Prophylactic Antibiotics ◽  
Nasojejunal Tube ◽  
Solid Diet ◽  
Systemic Infections

Acute pancreatitis is a sudden inflammatory disease that could be developed into a fatal condition. Traditional dogma was to rest the pancreas by fasting. However, evidence shows the benefits of early enteral feeding resulting in a shorter hospital stay, improved mortality, multi-organ failure, systemic infections, and the need for operative interventions. Clinicians should encourage enteral feeding as soon as possible even in severe acute pancreatitis if there are no contraindications. An immediate solid diet could be attempted. Regarding tube feeding, the nasojejunal tube did not show superiority to the nasogastric tube. Different formulas and probiotics need more investigation. Guidelines are against using prophylactic antibiotics, but Korean centers still report overuse of antibiotics. However, there is still a debate about using prophylactic antibiotics in severe acute pancreatitis. Broad-spectrum antibiotics should be initiated when an infection is suspected. In conclusion, enteral nutritional support and optimal use of antibiotics are the keys to the management of acute pancreatitis.

scholarly journals THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS

2016 ◽  
Vol 29 (1) ◽  
pp. 5-8 ◽  
Author(s):  
Murilo Gamba BEDUSCHI ◽  
André Luiz Parizi MELLO ◽  
Bruno VON-MÜHLEN ◽  
Orli FRANZON
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Severe Acute Pancreatitis ◽  
Predictive Value ◽  
High Specificity ◽  
Daily Practice ◽  
Severe Form ◽  
Inclusion Criteria ◽  
Positive Score

Background: About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. Objective: To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Methods: Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Results: Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. Conclusion: The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis.

Impact Of Undesirable Effects Of The Parenteral Nutrition On The Nutritional Support And The Disease Progression

2012 ◽  
Vol 4 ◽  
Author(s):  
Shpata Vjollca ◽  
Kuneshka Loreta ◽  
Kurti Floreta ◽  
Ohri Ilir
Keyword(s):  
Acute Pancreatitis ◽  
Case Report ◽  
Parenteral Nutrition ◽  
Disease Progression ◽  
Severe Acute Pancreatitis ◽  
Nutritional Support ◽  
Negative Impact ◽  
Necrotizing Pancreatitis ◽  
Negative Energy ◽  
Protein Catabolism

We report the case of a 52-year old man with severe acute pancreatitis. In this case report we discuss the undesirable effects of parenteral nutrition and the importance of nutritional support at patients with severe necrotizing pancreatitis. Severe acute pancreatitis is usually accompanied by systemic inflammatory response syndrome, which results in hypermetabolism with prominent protein catabolism. Providing nutrition to these patients is of paramount importance. An adequate nutritional support is crucial in patients with severe and complicated pancreatitis. A negative energy balance has a negative impact on the nutritional status and the disease progression.

scholarly journals Parenteral nutrition versus enteral nutrition in severe acute pancreatitis

2010 ◽  
Vol 25 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Josiel Paiva Vieira ◽  
Gutemberg Fernandes de Araújo ◽  
José Raimundo Araújo de Azevedo ◽  
Alberto Goldenberg ◽  
Marcelo Moura Linhares
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Nutritional Support ◽  
Average Length ◽  
Infectious Complications ◽  
Pancreatic Tissue ◽  
Septic Complications ◽  
Disease Etiology ◽  
The Difference ◽  
Length Of Hospitalization

PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.

scholarly journals Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

2010 ◽  
Vol 103 (9) ◽  
pp. 1287-1295 ◽  
Author(s):  
Maxim S. Petrov ◽  
Kevin Whelan
Keyword(s):  
Acute Pancreatitis ◽  
Parenteral Nutrition ◽  
Severe Acute Pancreatitis ◽  
Meta Analysis ◽  
Tube Feeding ◽  
Infectious Complications ◽  
Cochrane Library ◽  
Randomised Controlled ◽  
The Cochrane Library ◽  
Complications And Mortality

Enteral nutrition (EN) reduces infectious complications and mortality compared with parenteral nutrition (PN) in patients with predicted severe acute pancreatitis. However, to date the complications attributable to the administration of EN and PN in this patient group have not been comprehensively studied. The aim of the study was to systematically review the complications related to the use of nutrition in patients with predicted severe acute pancreatitis receiving EN v. PN. The Cochrane Library, MEDLINE and Scopus were searched. Randomised controlled trials (RCT) of EN v. PN in predicted severe acute pancreatitis were selected. Pooled estimates of complications were expressed as OR with corresponding 95 % CI. Data from five RCT were meta-analysed. Diarrhoea occurred in six of ninety-two (7 %) patients receiving PN and twenty-four of eighty-two (29 %) patients receiving EN (OR 0·20; 95 % CI 0·09, 0·43; P < 0·001). Hyperglycaemia developed in twenty-one of ninety-two (23 %) patients receiving PN and nine of eighty-two (11 %) receiving EN (OR 2·59; 95 % CI 1·13, 5·94; P = 0·03). Given a significant reduction in infectious complications and mortality associated with the use of EN over PN that has been consistently demonstrated in previous studies, the former should be the treatment of choice in acute pancreatitis. Further clinical studies should investigate the strategies to mitigate the complications of enteral tube feeding in patients with acute pancreatitis.

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