Evidence-based use of enteral nutrition in acute pancreatitis

Oláh, Attila; Romics, László

doi:10.1007/s00423-010-0631-4

Cited by 27 publications

(24 citation statements)

References 59 publications

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“…59 The major benefits from early feeding appear to be effective only if feeding is commenced within the first 48 hours following admission, 60 and the current recommendation based on a 2010 meta-analysis of 32 RCTs is to commence oral feeding at the time of admission if tolerated or within the first 24 hours. 60,61 Finally, a low-fat diet was shown to be preferable to clear fluids on admission for mild acute pancreatitis owing to a higher caloric intake with no associated adverse effects. 57,58 There is no evidence to suggest that a low-fat diet is preferable to a regular diet.…”

Section: Nutritionmentioning

confidence: 99%

“…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%

“…Although semi-elemental, immune-enhanced and probiotic enteral feeds showed initial promise in the management of severe acute pancreatitis, meta-analyses still indicate that there is insufficient evidence to recommend the use of any of these nutritional formulations at this time. 61,67,68 Given its promise in the context of other critically ill and septic patients, [69][70][71] the use of probiotics in the management of acute pancreatitis may yet prove effective as research continues.…”

Section: Nutritionmentioning

confidence: 99%

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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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Section: Nutritionmentioning

confidence: 99%

Section: Nutritionmentioning

confidence: 99%

Section: Nutritionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical practice guideline: management of acute pancreatitis

Greenberg¹,

Hsu²,

Bawazeer³

et al. 2016

cjs

340

352

View full text Add to dashboard Cite

show abstract

“…Em quase todos os desfechos estudados nessa metanálise, a NE foi superior à NP, com razão de chances de 0,5 para mortalidade (intervalo de confiança de 95% -IC 95% 0,26-0,97), 0,33 para infecções (IC 95% 0,2-0,54) e 0,32 para disfunção orgânica (IC 95% 0,18-0,56). O risco muito reduzido de infecções encontrado em pacientes com NE pode justificar a redução da mortalidade do mesmo grupo, tendo em vista a gravidade da infecção e sepse como complicadores dos casos de PA. Oláh et al 80 atualizaram a metanálise em 2010 incluindo mais oito ensaios clínicos, encontrando amplo benefício na redução da mortalidade em pacientes em vigência de NE na grande maioria dos estudos. Disfunção orgânica também foi estudada por Wu et al 81 , que encontraram em estudo de coorte retrospectivo de 107 pacientes adultos incidência quatro vezes maior de disfunção orgânica em pacientes que receberam NP prolongada quando comparados aos que receberam NE.…”

Section: Aspectos Nutricionaisunclassified

Acute pancreatitis in pediatrics: a systematic review of the literature

2012

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Objective: To describe the main epidemiological, clinical, diagnostic and treatment aspects of children with acute pancreatitis.Sources: Systematic review of MEDLINE and SciELO databases in the last 5 years on acute pancreatitis in children, as well as consultation of relevant references on the texts obtained. Summary of the findings:Cases of acute pancreatitis in children have received growing attention in recent years, and an increase in the number of cases has been reported in several studies. The main etiologies in children involve biliary disease, drug-induced pancreatitis, recurrent hereditary pancreatitis and trauma, and up to 30% of cases have no defined etiology. The diagnosis is based on the combination of clinical and laboratory aspects with the increase of acinar enzymes and radiologic tests. Initial support treatment, with proper volume replacement and correction of the metabolic disturbances, besides specific nutritional therapy, are the fundamental points in the handling of acute conditions. Long term complications are unusual, and mortality rates are inferior to the rates for the adult population. Conclusions:The early diagnosis and the appropriate handling can contribute to a better outcome for the child with pancreatitis and to prevent the immediate and late complications related to the disease. More studies are required to better explain aspects related to the clinical and radiological diagnosis of pancreatitis in children, as well as aspects related to the nutritional therapy for this age group. J Pediatr (Rio J). 2012;88(2):101-14: Pancreatitis, pediatrics, nutritional support, morbidity, enteral nutrition. ResumoObjetivo: Descrever os principais aspectos epidemiológicos, clínicos, diagnósticos e do tratamento de crianças com pancreatite aguda. Fontes dos dados:Realizada revisão sistemática das bases de dados MEDLINE e SciELO nos últimos 5 anos sobre pancreatite aguda em crianças, bem como consultadas referências relevantes dos textos obtidos. Síntese dos dados:Os casos de pancreatite aguda em crianças recebem crescente atenção nos últimos anos, sendo verificado um aumento na incidência da doença em diversos estudos. As principais etiologias em crianças envolvem doença biliar, pancreatite secundária a medicamentos, pancreatite hereditária recorrente e trauma, sendo até 30% dos casos sem etiologia definida. O diagnóstico baseia-se na combinação de aspectos clínicos, laboratoriais com elevação das enzimas acinares e testes radiológicos. Tratamento de suporte inicial, com reposição volêmica adequada e correção dos distúrbios metabólicos, além de terapêutica nutricional específica, são os pontos fundamentais no manejo dos quadros agudos. Complicações a longo prazo são incomuns, e as taxas de mortalidade, inferiores às da população adulta. Conclusões:O diagnóstico precoce e o manejo apropriado podem contribuir para a melhor evolução da criança com pancreatite e prevenir as complicações imediatas e tardias relacionadas à doença. Mais estudos são necessários para melhor elucidar aspectos re...

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“…5,7,12,13 EN remains an integral part of management, which has been associated with a lower incidence of infection, multiorgan failure, lower mortality rates, and a shorter hospital stay in adult patients with AP according to recent meta-analyses. [14][15][16] In a state of AP, there is increased gut permeability that promotes the development of systemic inflammation and could allow bacterial translocation, which could lead to more severe disease course.…”

Section: Discussionmentioning

confidence: 98%