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

Abstract

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.

Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States

“…Based on these findings, 8 TAs with the best‐quality evidence were selected for further analysis, as prioritized by points on rubric scores (Table ). They included cross‐disease malnutrition, sepsis, surgical complications, HACs, congestive heart failure, COPD, GI cancer, and pancreatitis …”

“…They included cross-disease malnutrition, 7,24-33 sepsis, 27,34-41 surgical complications, [42][43][44][45][46][47][48][49][50] HACs, [51][52][53][54][55][56][57][58] congestive heart failure, 9,[59][60][61][62][63][64][65][66][67][68] COPD, 8,9,16,[69][70][71][72][73] GI cancer, [74][75][76][77][78][79][80][81][82] and pancreatitis. [83][84][85][86][87][88]…”

Nutrición enteral temprana en pacientes con pancreatitis agudas leves: estudio clínico randomizado

“…En un metaanálisis de Márta y cols se analizaron estudios clínicos randomizados acerca de NET en PAL y moderadas, dicho estudio concluyó que si bien no existen diferencias en la morbimortalidad entre pacientes que reciben NET y los que reciben tratamiento estándar de NXB, algunos parámetros secundarios como la estadía hospitalaria serían ventajas en los grupos con NET. Por los resultados obtenidos y la bibliografía consultada, podemos sostener que la NET es segura y puede formar parte del tratamiento de las PAL (36) . También según el presente trabajo debemos rechazar nuestra hipótesis, ya que la NET aumentó la respuesta inflamatoria medida por PCR y disminuyó los valores de albuminemia en el G1.…”

High versus low energy administration in the early phase of acute pancreatitis (GOULASH trial): protocol of a multicentre randomised double-blind clinical trial

“… 34 Importantly, EN decreases mortality but also reduces the frequency of multiorgan failure and the need for interventions in patients with SAP. 35 No data are available on whether early or on-demand nutrition/energy supply is beneficial in SAP. The recently published Dutch PYTHON study suggests that there is no difference between early and on-demand enteral tube feeding in SAP, but patients may have received an insufficient amount of energy at the early phase of the disease.…”

“… 42 In order to obtain stronger evidence of the usefulness of early EN in MAP and SAP, we performed a systematic review and meta-analysis which showed that early EN can be beneficial in both MAP and SAP. 35 However, we also realised the lack of multicentre randomised control trials addressing energy intake in the early phase of AP.…”