scholarly journals Parenteral Nutrition Combined with Enteral Nutrition for Severe Acute Pancreatitis

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Akanand Singh ◽  
Ming Chen ◽  
Tao Li ◽  
Xiao-Li Yang ◽  
Jin-Zheng Li ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Severe Acute Pancreatitis ◽  
Nutritional Support ◽  
Combined Treatment ◽  
Apache Ii Score ◽  
Group I ◽  
Group Ii ◽  
The Cost

Background and Aims. Nutritional support in severe acute pancreatitis (SAP) is controversial concerning the merits of enteral or parenteral nutrition in the management of patients with severe acute pancreatitis. Here, we assess the therapeutic efficacy of gradually combined treatment of parenteral nutrition (PN) with enteral nutrition (EN) for SAP. Methods. The clinical data of 130 cases of SAP were analyzed retrospectively. Of them, 59 cases were treated by general method of nutritional support (Group I) and the other 71 cases were treated by PN gradually combined with EN (Group II). Results. The APACHE II score and the level of IL-6 in Group II were significantly lower than Group I (P<0.05). Complications, mortality, mean hospital stay, and the cost of hospitalization in Group II were 39.4 percent, 12.7 percent, 32 ± 9 days, and 30869.4 ± 12794.6 Chinese Yuan, respectively, which were significantly lower than those in Group I. The cure rate of Group II was 81.7 percent which is obviously higher than that of 59.3% in Group I (P<0.05). Conclusions. This study indicates that the combination of PN with EN not only can improve the natural history of pancreatitis but also can reduce the incidence of complication and mortality.

Management of acute pancreatitis in the critically ill

2016 ◽  
Author(s):  
Rajkumar Rajendram
Keyword(s):  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Severe Acute Pancreatitis ◽  
Specific Treatment ◽  
Morbidity And Mortality ◽  
Surgical Removal ◽  
Gallstone Pancreatitis ◽  
Nasogastric Feeding ◽  
Open Necrosectomy

The major causes of morbidity and mortality in acute pancreatitis are organ dysfunction and infection of necrotic tissue. Management should aim to prevent, or to diagnose and treat, the complications of pancreatic inflammation, and any predisposing factors to avoid recurrence. Medical management is essentially supportive with oxygen, intravenous fluids, analgesia, enteral or parenteral nutrition, and correction of metabolic abnormalities. Patients with severe acute pancreatitis are unlikely to resume prompt oral intake so nutritional support is also required. Post-pyloric feeding is not required if nasogastric feeding is tolerated. However, enteral nutrition, whether oral, gastric, or post-pyloric, can cause pain, recurrence of pancreatitis or an increase in fluid collections, so parenteral nutrition may be necessary. The necrotic pancreas becomes infected in a third of patients with severe acute pancreatitis. Treatment of infection includes systemic antimicrobials, enteral nutrition, percutaneous aspiration, and necrosectomy. However, compared with open necrosectomy, a minimally invasive step-up approach consisting of percutaneous drainage followed, if necessary, by open necrosectomy, reduces morbidity and mortality. The aetiology of the pancreatitis must also be treated to prevent recurrence and the complications of pancreatic failure. Gallstones are the most common cause of pancreatitis that requires specific treatment. Endoscopic or surgical removal of stones may reduce the severity of pancreatitis. Patients should also have cholecystectomy after recovery from gallstone pancreatitis. Effective management of acute pancreatitis requires multidisciplinary engagement. The mainstay of management involves supportive prevention and treatment of complications, infection, and organ failure to avoid or delay surgery.

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 Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis

2018 ◽  
Vol 46 (9) ◽  
pp. 3948-3958 ◽  
Author(s):  
Wen Li ◽  
Jixi Liu ◽  
Shuqiao Zhao ◽  
Jingtao Li
Keyword(s):  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Severe Acute Pancreatitis ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Safety And Efficacy ◽  
Pubmed Database ◽  
Total Enteral Nutrition

Objective This study was performed to systematically compare the safety and efficacy of total enteral nutrition (TEN) and total parenteral nutrition (TPN) for patients with severe acute pancreatitis (SAP). Methods The PubMed database was searched up to January 2017, and nine studies were retrieved. These studies were selected according to specific eligibility criteria. The methodological quality of each trial was assessed, and the study design, interventions, participant characteristics, and final results were then analyzed by Review Manager 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). Results Nine relevant randomized controlled trials involving 500 patients (244 patients in the TEN group and 256 patients in the TPN group) were included in the meta-analysis. Pooled analysis showed a significantly lower mortality rate in the TEN than TPN group [odds ratio (OR), 0.31; 95% confidence interval (CI), 0.18–0.54]. The duration of hospitalization was significantly shorter in the TEN than TPN group (mean difference, −0.59; 95% CI, −2.56–1.38). Compared with TPN, TEN had a lower risk of pancreatic infection and related complications (OR, 0.41; 95% CI, 0.22–0.77), organ failure (OR, 0.17; 95% CI, 0.06–0.52), and surgical intervention (OR, 0.17; 95% CI, 0.05–0.62). Conclusions This meta-analysis indicates that TEN is safer and more effective than TPN for patients with SAP. When both TEN and TPN have a role in the management of SAP, TEN is the preferred option.

956 Enteral Nutrition Is Superior to Total Parenteral Nutrition in Severe Acute Pancreatitis: A Systematic Review and Meta-Analysis

2008 ◽  
Vol 134 (4) ◽  
pp. A-141 ◽  
Author(s):  
Nadim S. Jafri ◽  
Suhal S. Mahid ◽  
Swapna K. Gopathi ◽  
Carlton A. Hornung ◽  
Susan Galandiuk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Severe Acute Pancreatitis ◽  
Meta Analysis

scholarly journals Increased activity of group II phospholipase A2 in plasma in rat sodium deoxycholate induced acute pancreatitis

Gut ◽  
1997 ◽  
Vol 41 (6) ◽  
pp. 826-831 ◽  
Author(s):  
S Furue ◽  
Y Hori ◽  
K Kuwabara ◽  
J Ikeuchi ◽  
H Onoyama ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Specific Inhibitor ◽  
Sodium Deoxycholate ◽  
Multiple Organ ◽  
Group I ◽  
The Common ◽  
Group Ii ◽  
Increased Activity ◽  
Specific Polyclonal Antibody

Background—Two different types of secretory phospholipase A2 (PLA2), pancreatic group I (PLA2-I) and non-pancreatic group II (PLA2-II), have been identified and postulated to be associated with the pathogenesis of various diseases, such as acute pancreatitis, septic shock, and multiple organ failure. Aims—To investigate the type of secretory PLA2 responsible for its catalytic activity found in plasma and ascites of experimental acute pancreatitis. Methods—Acute pancreatitis of differing severity was induced by the injection of different concentrations (1% or 10%) of sodium deoxycholate (DCA) into the common biliopancreatic duct in rats, and catalytic PLA2 activity in plasma and ascites were differentiated by anti-PLA2-I antibody and specific inhibitor of PLA2-II. Survival rate and plasma amylase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were also measured.Results—In 1% and 10% DCA induced acute pancreatitis, plasma amylase values as well as PLA2activity in ascites were greatly increased. PLA2 activity in plasma was also notably increased in 10% DCA induced acute pancreatitis, but not in 1% DCA induced acute pancreatitis. PLA2-I specific polyclonal antibody significantly inhibited PLA2 activity in ascites but not that in plasma. In contrast, plasma PLA2 activity was completely suppressed by PLA2-II specific inhibitor. In addition, a high mortality (93% at five hours) and a significant increase in plasma AST and ALT were noted in 10% DCA induced pancreatitis. Conclusion—Ascites PLA2 activity is mainly derived from PLA2-I, whereas plasma PLA2activity is mostly derived from PLA2-II in severe acute pancreatitis, suggesting that increased plasma PLA2-II activity might be implicated in hepatic failure arising after severe acute pancreatitis.

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