Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis

Wang, Guiliang; Wen, Jianbo; Xu, Li; Zhou, Shu‐Feng; Gong, Min; Wen, Ping; Xiao, Xianzhong

doi:10.1016/j.jss.2012.12.010

Cited by 88 publications

(91 citation statements)

References 19 publications

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“…We identified a total of 10 trials with 2888 patients that were conducted in heterogeneous critically ill and surgical patients, trauma and traumatic brain injury, and those with severe acute pancreatitis [550][551][552][553][554][555][556][557][558][559]. No evidence showed that early parenteral nutrition reduced mortality (RR 0.97; 95% CI 0.87-1.08; n = 2745) or infection risk (RR 1.52; 95% CI 0.88-2.62; n = 2526), but ICU LOS was increased (MD, 0.90; 95% CI 0.38-1.42; n = 46).…”

Section: T Nutritionmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: T Nutritionmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Several meta-analyses have shown similar results, with significant reductions in infectious complications, mortality and multiorgan dysfunction when enteral nutrition is commenced within the first 48 hours following admission. 61,63,64 A meta-analysis 65 of 4 prospective studies of patients with predicted severe acute pancreatitis (n = 92) demonstrated no change in intolerance of feeding (RR 1.09, 95% CI 0.46-2.59, p = 0.84) or in mortality (RR 0.77, 95% CI 0.37-1.62, p = 0.5) when given enteral feeds by nasogastric feeding tube versus nasojejunal feeding tube. In a more recent metaanalysis of 3 RCTs (n = 157), Chang While no high-quality RCTs exist on this topic, to date there has been no evidence to suggest that enteral feeds should be delayed for the purposes of acquiring a nasojejunal feeding tube, especially in light of morbidity and mortality benefits of commencing enteral feeds within the first 48 hours.…”

Section: Nutritionmentioning

confidence: 99%

Clinical practice guideline: management of acute pancreatitis

Greenberg¹,

Hsu²,

Bawazeer³

et al. 2016

cjs

340

352

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There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone-induced pancreatitis.Une hausse de l'incidence de pancréatite aiguë a été constatée à l'échelle mondiale. Malgré l'amélioration de l'accès aux soins et aux techniques d'imagerie et d'intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu'il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l'importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu'elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire.A cute pancreatitis can range from a mild, self-limiting disease that requires no more than supportive measures to severe disease with lifethreatening complications. The most common causes of acute pan creatitis are gallstones and binge alcohol consumption.1 There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality.A systematic review of clinical practice guidelines for the management of acute pancreatitis revealed 14 guidelines published between 2004 and 2008 alone.2 Although these guidelines have significant overlap in their recommendations for diagnosing and managing acute pancreatitis, there is disagreement in some aspects of both the timing and types of interventions that should be used for both mild and severe acute pancreatitis. The availability of new imaging modalities and noninvasive therapies has also changed clinical practice. Finally, despite the availability of guidelines, recent studies auditing clinical management of acute pancreatitis have sh...

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“…Seven out of seven articles contained analyzable data on mortal [16][17][18][19][20][21][22] Risk differences and CI were calculated in each article to analyze the effects of EN compared to the NPO nutrition. The calculated average risk difference (RD) was −0.050 (lower limit (LI): −0.134; upper limit (UI): 0.035; p-value: 0.249) (Figure 1).…”

Section: Severe Acute Pancreatitis (Sap) Groupmentioning

confidence: 99%

“…Thirty-three articles (21 articles containing patients suffering from SAP as well as 12 articles with MAP patients) were selected. They contained two nonrandomized and 31 randomized controlled clinical trials (Table 2) [16][17][18][19][20][21][22][23][24][25][26][27]29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Finally, statistical analyses were performed on data from articles where both EN and NPO groups were presented, the trial was randomized, and the relevant data were available.…”

Section: Inclusions and Exclusionsmentioning

confidence: 99%

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

2017

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Abstract:The recently published guidelines for acute pancreatitis (AP) suggest that enteral nutrition (EN) should be the primary therapy in patients suffering from severe acute pancreatitis (SAP); however, none of the guidelines have recommendations on mild and moderate AP (MAP). A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). The following PICO (problem, intervention, comparison, outcome) was applied: P: nutrition in AP; I: enteral nutrition (EN); C: nil per os diet (NPO); and O: outcome. There were 717 articles found in Embase, 831 in PubMed, and 10 in the Cochrane database. Altogether, seven SAP and six MAP articles were suitable for analyses. In SAP, forest plots were used to illustrate three primary endpoints (mortality, multiorgan failure, and intervention). In MAP, 14 additional secondary endpoints were analyzed (such as CRP (C-reactive protein), WCC (white cell count), complications, etc.). After pooling the data, the Mann-Whitney U test was used to detect significant differences. Funnel plots were created for testing heterogeneity. All of the primary endpoints investigated showed that EN is beneficial vs. NPO in SAP. In MAP, all of the six articles found merit in EN. Analyses of the primary endpoints did not show significant differences between the groups; however, analyzing the 17 endpoints together showed a significant difference in favor of EN vs. NPO. EN is beneficial compared to a nil per os diet not only in severe, but also in mild and moderate AP.

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Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis

Cited by 88 publications

References 19 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Clinical practice guideline: management of acute pancreatitis

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

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