<scp>l</scp>‐Alanyl‐<scp>l</scp>‐Glutamine‐Supplemented Parenteral Nutrition Decreases Infectious Morbidity Rate in Patients With Severe Acute Pancreatitis

Fuentes-Orozco, Clotilde; Cervantes-Guevara, Gabino; Muciño-Hernández, Ivette; López-Ortega, Alejandro; Ambriz-González, Gabriela; Gutiérrez-de-la-Rosa, José Luis; Gómez-Herrera, Efraín; Hermosillo-Sandoval, José Manuel; González-Ojeda, Alejandro

doi:10.1177/0148607108319797

Cited by 73 publications

(59 citation statements)

References 51 publications

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“…Eight trials were in patients undergoing elective gastrointestinal surgery, for whom parenteral nutrition support post-operatively would not normally be provided. One trial Parenteral nutrition Estivariz et al (16) Fuentes-Orozco et al (18) Fuentes-Orozco et al (17) Goeters et al (20) Griffiths et al (21) Sahin et al (38) Wischmeyer et al (42) Subtotal (95 % CI)…”

Section: Resultsmentioning

confidence: 99%

“…High-dose glutamine Conejero et al (13) Estivariz et al (16) Fuentes-Orozco et al (17) Garrel et al (19) Goeters et al (20) Houdijk et al (23) McQuiggan et al (29) Schulman et al (39) Subtotal (95 % CI) Total events: 44 (treatment), 60 (control) Test for heterogeneity: χ 2 16·1, df 7 (P=0·02), I 2 56·6 % Test for overall effect: Z 1·90 (P=0·06)…”

Section: Discussionmentioning

confidence: 99%

“…Critical illness PN de Beaux et al (14) Déchelotte et al (15) Estivariz et al (16) Fuentes-Orozco et al (18) Fuentes-Orozco et al (17) Griffiths et al (21) Ockenga et al (33) Perez-Barcena et al (36) Sahin et al (38) Wischmeyer et al (42) Subtotal (95 % CI) Total events: 104 (treatment), 136 (control) Test for heterogeneity: χ 2 12·9, df 9 (P=0·17), I 2 30·4 % Test for overall effect: Z 2·24 (P=0·03)…”

Section: Methodsmentioning

confidence: 99%

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Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Avenell

2009

Proc. Nutr. Soc.

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The amino acid glutamine has numerous important roles including particularly antioxidant defence, immune function, the inflammatory response, acid–base balance and N economy. The present systematic review of randomised controlled trials of nutrition support with glutamine up to August 2008 has found that parenteral glutamine in critical illness is associated with a non-significant reduction in mortality (risk ratio 0·71 (95% CI 0·49, 1·03)) and may reduce infections. However, poor study quality and the possibility of publication bias mean that these results should be interpreted with caution. There is no evidence to suggest that glutamine is harmful in terms of organ failure and parenteral glutamine may reduce the development of organ failure.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Avenell

2009

Proc. Nutr. Soc.

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“…Although glutamine is an antioxidant, in conditions of excess glutamine utilization such as sepsis, trauma, major surgery or severe AP, endogenous glutamine production may not be adequate and glutamine depletion occurs [23] . In four studies [17,18,22,23] glutamine was supplemented to standard total parenteral nutrition (TPN) in AP patients. In one randomized controlled study (n = 28), glutamine was used in AP in combination with standard TPN and demonstrated a decrease in the duration of TPN therapy and hospitalization without a change in the total www.wjgnet.com Xue et al [17] [18] 2008 Uden et al [28,29] In the non-high-risk group (n = 520), the crude PEP rates were 5.4% for allopurinol and 1.5% for placebo (P = 0.017), favoring placebo, indicating harm associated with allopurinol, whereas in the high-risk group (n = 66), the PEP rates were 6.3% for allopurinol and 23.5% for placebo (P = 0.050), favoring allopurinol Milewski et al [31] 2006 N-acetylcysteine [35] 2004 Natural β-carotene …”

Section: Antioxidants In Ap and Cpmentioning

confidence: 99%

Antioxidant therapy in the management of acute, chronic and post-ERCP pancreatitis: A systematic review

Monfared¹,

Vahidi²,

Abdolghaffari³

et al. 2009

WJG

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We systematically reviewed the clinical trials which recruited antioxidants in the therapy of pancreatitis and evaluated whether antioxidants improve the outcome of patients with pancreatitis. Electronic bibliographic databases were searched for any studies which investigated the use of antioxidants in the management of acute pancreatitis (AP) or chronic pancreatitis (CP) and in the prevention of post-endoscopic retrograde cholangio-pancreatography (post-ERCP) pancreatitis (PEP) up to February 2009. Twenty-two randomized, placebo-controlled, clinical trials met our criteria and were included in the review. Except for a cocktail of antioxidants which showed improvement in outcomes in three different clinical trials, the results of the administration of other antioxidants in both AP and CP clinical trials were incongruent and heterogeneous.Furthermore, antioxidant therapy including allopurinol and N-acetylcysteine failed to prevent the onset of PEP in almost all trials. In conclusion, the present data do not support a benefit of antioxidant therapy alone or in combination with conventional therapy in the management of AP, CP or PEP. Further double blind, randomized, placebo-controlled clinical trials with large sample size need to be conducted.

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“…Since severe acute pancreatitis (SAP) and obstructive jaundice (OJ) are common diseases, the study on their pathogenesis and treatment has been a hot spot in clinic for a long time (Fuentes-Orozco et al, 2008;Gencay et al, 2008;Morioka et al, 2008;Muñoz-Castañeda et al, 2008;Tsuyuguchi et al, 2008). SAP is a systemic disease resulted from pancreatic self-digestion and characterized by pancreatic necrosis.…”

Section: Introductionmentioning

confidence: 99%

Protective effects of Salvia miltiorrhizae on the hearts of rats with severe acute pancreatits or obstructive jaundice

Zhang

Gao

Zhang

et al. 2009

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To investigate the therapeutic effects and mechanisms of Salvia miltiorrhizae (Danshen) in the treatment of severe acute pancreatitis (SAP)-or obstructive jaundice (OJ)-induced heart injury. Methods: A total of 288 rats were used for SAP-(n=108) and OJ-associated (n=180) experiments. The rats were randomly divided into sham-operated, model control, and Salvia miltiorrhizae-treated groups. According to the difference of time points after operation, SAP rats in each group were subdivided into 3, 6 and 12 h subgroups (n=12), whereas OJ rats were subdivided into 7, 14, 21, and 28 d subgroups (n=15). At the corresponding time points after operation, the mortality rates of the rats, the contents of endotoxin and phospholipase A 2 (PLA 2 ) in blood, and pathological changes of the hearts were investigated. Results: The numbers of dead SAP and OJ rats in the treated groups declined as compared with those in the model control group, but not significantly (P>0.05). The contents of endotoxin (at 6 and 12 h in SAP rats and on 7, 14, 21, and 28 d in OJ rats, respectively) and PLA 2 (at 6 and 12 h in SAP rats and on 28 d in OJ rats, respectively) in the treated group were significantly lower than those in the model control group (P<0.01 and P<0.001, respectively). Besides, myocardial pathological injuries were mitigated in SAP and OJ rats. Conclusion: In this study, we found that Salvia miltiorrhizae improved myocardial pathological changes, reduced the content of PLA 2 in blood, and decreased the mortality rates of SAP and OJ rats, exerting protective effects on the hearts of the rats.

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l‐Alanyl‐l‐Glutamine‐Supplemented Parenteral Nutrition Decreases Infectious Morbidity Rate in Patients With Severe Acute Pancreatitis

Abstract: The results suggest that treatment of patients with GLN-supplemented PN may decrease infectious morbidity rate compared with those who treated with nonenriched PN.

Cited by 73 publications

References 51 publications

Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Antioxidant therapy in the management of acute, chronic and post-ERCP pancreatitis: A systematic review

Protective effects of Salvia miltiorrhizae on the hearts of rats with severe acute pancreatits or obstructive jaundice

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