The effect of immunonutrition in patients with acute pancreatitis: a systematic review and meta‐analysis

Abstract

Background: The effect of immunonutrition is controversial compared to standard supplementation with respect to the management of patients with acute pancreatitis. Methods: An online literature search on four databases (PubMed, Cochrane, Embase and Web of Science) was performed to identify all of the randomised controlled trials assessing the effects of enteral or parenteral immunonutrition in acute pancreatitis. A fixed or random effects model was chosen using REV-MAN, version 5.3 (https://revman.cochrane.org). The count data were analysed using the risk ratio (RR) and 95% confidence interval (CI). Results: Five hundred and sixty-eight patients were included via our search in which 14 articles matched our criteria for enrolling the meta-analysis. Immunonutrition significantly reduced the risk of organ failure (RR = 0.42; 95% CI = 0.26-0.70, P = 0.0008), infectious complications (RR = 0.78; 95% CI = 0.62-0.99; P = 0.04) and mortality (RR = 0.37; 95% CI = 0.21-0.66; P = 0.006). Length of hospital stay was also shorter in patients who received immunonutrition (mean difference = À1.73 days; 95% CI = À2.36 to À1.10; P < 0.00001). Total interventions of patients were decreased (RR = 0.73; 95% CI = 0.55-0.97; P = 0.03). Body mass index in patients with immunonutrition was reduced more than standard nutrition (mean difference = À2.00; 95% CI = À3.96 to À0.04; P = 0.05). Conclusions: Immunonutrition support such as glutamine and x-3 fatty acids is potentially beneficial with respect to improving clinical outcomes in patients with acute pancreatitis.

Acute Pancreatitis: Diagnosis and Treatment

“…The disappointing phase 3 ACCESS trial of eritoran in severe sepsis targeting toll-like receptor 4 included heterogenous infective pathologies [253]. Meta-analyses suggest potential merit in intravenous heparin, glutamine, ω-3 fatty acids and/or traditional Chinese medicine in severe acute pancreatitis [254][255][256][257][258][259], but the majority of included trials have been compromised by the absence of allocation concealment and double-blinding, awaiting well-designed, large-scale, double-blind, placebocontrolled, multicentre trials with patient inclusion appropriate to primary outcome.…”

Evaluación y tratamiento nutricional en pacientes con pancreatitis aguda: estudio observacional en el Hospital Nacional Alejandro Posadas

“…Se recolectaron un total de 73 pacientes, de los cuales 18 fueron excluidos por falta de datos o egreso hospitalario precoz, asumiendo una muestra final de 55. La mediana de edad fue de 40 años (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). El 70,9 % correspondió al sexo femenino.…”

Effects of enteral glutamine supplementation on intestinal permeability in acute pancreatitis: A literature review

“…11,12 Several meta-analysis have been performed assessing the effects of parenteral and enteral administration of glutamine compared with conventional methods. 10,13,14 Studies confirm the improvements in serum albumin, C-reactive protein (CRP), 13,14 incidence of infection and mortality rate. 10,13,14 To our knowledge, there are no review yet discussing the effects of enteral administration of glutamine on intestinal integrity.…”

“…10,13,14 Studies confirm the improvements in serum albumin, C-reactive protein (CRP), 13,14 incidence of infection and mortality rate. 10,13,14 To our knowledge, there are no review yet discussing the effects of enteral administration of glutamine on intestinal integrity. This review will investigate the role of enteral glutamine supplementation on intestinal integrity in acute pancreatitis, along with mortality and morbidity in terms of infectious complication and hospital length of stay (LOS).…”

“…Moreover, systematic review by McClave, et al 9 also suggested that patients with SAP should begin EN early as it allows a trophic action on the intestinal wall, which maintain the intestinal barrier and prevent the bacterial translocation and results in better outcome. 6 Recent meta-analysis by Zhou, et al 10 showed beneficial effect of adding immune-enhanced formulas to the standard nutrition therapy in patients with AP either via the enteral or parenteral route. Glutamine, as one of the immunonutrition, which is also the major substrate for intestinal cells, have been investigated for its protective effects on intestinal mucosal integrity and modulation of inflammatory response.…”