Enteral Nutrition Support in Acute Pancreatitis

Erstad, Brian L.

doi:10.1345/aph.19144

Cited by 16 publications

(7 citation statements)

References 43 publications

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“…5,6 Enteral feeding seems more effective than parenteral nutrition, especially with respect to maintaining the structural and functional integrity of the gut. 12,13 However, (additional) parenteral nutrition seems indispensable in most patients with severe AP, when increased demand for calories and substrates cannot be met by enteral feeding, eg, in the presence of ileus. Thus, optimization of parenteral nutrition and immunonutrition remain an issue.…”

Section: Discussionmentioning

confidence: 99%

Omega‐3 fatty acid supplementation increases anti‐inflammatory cytokines and attenuates systemic disease sequelae in experimental pancreatitis

Foitzik¹,

Eibl²,

Schneider³

et al. 2002

J Parenter Enteral Nutr

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Section: Discussionmentioning

confidence: 99%

Omega‐3 fatty acid supplementation increases anti‐inflammatory cytokines and attenuates systemic disease sequelae in experimental pancreatitis

Foitzik¹,

Eibl²,

Schneider³

et al. 2002

J Parenter Enteral Nutr

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“…The presence of food in the stomach and duodenum elicits gastropancreatic and duodenopancreatic reflexes that result in the stimulation of pancreatic exocrine secretion. However, these effects are insignificant when nutrients are delivered directly into the jejunum [16][17][18][19][20][21][22][23][24][25] .…”

Section: Discussionmentioning

confidence: 99%

Effect of parenteral and early intrajejunal nutrition on pancreatic digestive enzyme synthesis, storage and discharge in dog models of acute pancreatitis

Qin

Su²,

Hu³

et al. 2007

WJG

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Qin HL, Su ZD, Hu LG, Ding ZX, Lin QT. Effect of parenteral and early intrajejunal nutrition on pancreatic digestive enzyme synthesis, storage and discharge in dog models of acute pancreatitis. World J Gastroenterol 2007; 13(7): 1123-1128http://www.wjgnet.com/1007-9327/13/1123.asp INTRODUCTIONBeneficial effects of total enteral nutrition (TEN) have been noted in a number of diseases, such as burn, trauma, and sepsis. In comparison with parenteral nutrition (PN), TEN can reduce nosocomial infection, multiple organ failure (MOF), and the length of hospitalization [1][2][3][4] . Early enteral nutritional (EEN) support in patients with acute pancreatitis (AP) has been evaluated by some authors who reported that it can moderate the acute phase response and improve disease severity and clinical outcome [5][6][7][8][9][10] . However, the commonly encountered problems of gastric atony and outlet obstruction have limited the successful delivery of enteral nutrition to patients with severe acute pancreatitis. In addition, many surgeons believe that EEN may lead to recurrence of symptoms and delayed complications, because EEN may increase the release of digestive enzymes and lysosomal hydrolases. This action of digestive enzymes and lysosomal hydrolases may be important in the development of acute pancreatitis, as lysosomal enzymes such as cathepsin B, are known to be capable of activating trypsinogen and intracellular digestive enzymes that may trigger the autodigestive phenomenon of the pancreas [11] . However, these problems may be overcome if enteral nutrition is delivered to the jejunum as distal as possible from Treitz's ligament, thereby avoiding stimulation of the cephalic and gastric phase. Therefore, it is necessary to investigate the effect of early intrajejunal nutrition (EIN) on pancreatic acinar cell uptake of 3 H phenylalanine, digestive enzyme synthesis, storage and discharge in dogs with AP. MATERIALS AND METHODS Materials Abstract AIM:To study the effect of early intrajejunal nutrition on enzyme-protein synthesis and secretion during acute pancreatitis. METHODS:Fifteen dogs were randomly divided into parenteral nutrition (n = 7) and early intrajejunal nutrition groups (n = 8). An acute pancreatitis model was induced by injecting 5% sodium taurocholate and trypsin into the pancreas via the pancreatic duct. Intrajejunal nutrition was delivered with a catheter via a jejunostomy t u b e a f t e r t h e m o d e l wa s e s t a b l i s h e d fo r 2 4 h . On d 1 and 7 and at the beginning of nutritional support, radioactive tracing and electron microscopes were used to evaluate the enzyme-protein synthesis in acinar cells, the subcellular fractionation and the change in zymogen granules after 1.85 × 10 6 Bq L-3 H phenylalanine was infused at 30, 60, 120, and 180 min. RESULTS:The 3 H radioactivity in pancreatic acinar cells reached its peak level at 60 min, and the contents in the early intrajejunal nutrition group were higher than those in the parenteral nutrition group, which were then decreased. The mean numbe...

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“…Perhaps less clear is the route by which nutrition should be administered. [92][93][94][95] Total parenteral nutrition (TPN) has been the standard of therapy for many years because it accomplished 'pancreatic rest,' a concept eluding to the reduction of pancreatic secretions, and thereby limiting peripancreatic release of digestive enzymes. Some studies also suggested that early oral feeding or nasogastric feeding may increase risk of pancreatic infection and worsening the disease.…”

Section: Nutritional Supportmentioning

confidence: 99%

“…The culmination of these detrimental effects has been associated with a greater risk for septic complications and adds significant expense. [92][93][94][95] With the potential pitfalls of parenteral nutrition (PN), several randomized clinical trials have shown that enteral nutrition (EN) can be safely administered via nasojejunal feeding tubes in patients with AP with no significant detrimental effects. [97][98][99] Jejunal feeding was demonstrated not to increase pancreatic secretions, as nutrient delivery occurs in areas devoid of cholecystokinin (CCK)-releasing cells.…”

Section: Nutritional Supportmentioning

confidence: 99%

Acute pancreatitis in dogs

Holm

Chan

Rozanski

2003

J Vet Emergen Crit Care

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Objective: To summarize current information regarding severity assessment, diagnostic imaging, and treatment of human and canine acute pancreatitis (AP). Human-based studies: In humans, scoring systems, advanced imaging methods, and serum markers are used to assess the severity of disease, which allows for optimization of patient management. The extent of pancreatic necrosis and the presence of infected pancreatic necrosis are the most important factors determining the development of multiple organ failure (MOF) and subsequent mortality. Considerable research efforts have focused on the development of inexpensive, easy, and reliable laboratory markers to assess disease severity as early as possible in the course of the disease. The use of prophylactic antibiotics, enteral nutrition, and surgery have been shown to be beneficial in certain patient populations. Veterinary-based studies: The majority of what is currently known about naturally occurring canine AP has been derived from retrospective evaluations. The identification and development of inexpensive and reliable detection kits of key laboratory markers in dogs with AP could dramatically improve our ability to prognosticate and identify patient populations likely to benefit from treatment interventions. Treatment remains largely supportive and future studies evaluating the efficacy of surgery, nutritional support and other treatment modalities are warranted. Data sources: Current human and veterinary literature. Conclusions: Pancreatitis can lead to a life-threatening severe systemic inflammatory condition, resulting in MOF and death in both humans and dogs. Given the similarities in the pathophysiology of AP in both humans and dogs, novel concepts used to assess severity and treat people with AP may be applicable to dogs. (J Vet Emerg Crit Care 2003; 13(4): 201-213)

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Enteral Nutrition Support in Acute Pancreatitis

Abstract: Current evidence suggests that the enteral rather than parenteral route should be used to provide nutrition to patients with acute pancreatitis. Parenteral nutrition should be reserved for patients in whom nasojejunal feeding is not possible.

Cited by 16 publications

References 43 publications

Omega‐3 fatty acid supplementation increases anti‐inflammatory cytokines and attenuates systemic disease sequelae in experimental pancreatitis

Omega‐3 fatty acid supplementation increases anti‐inflammatory cytokines and attenuates systemic disease sequelae in experimental pancreatitis

Effect of parenteral and early intrajejunal nutrition on pancreatic digestive enzyme synthesis, storage and discharge in dog models of acute pancreatitis

Acute pancreatitis in dogs

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