DOI: https://doi.org/10.22141/2224-0586.8.95.2018.155153

Formula of enteral nutrition in patients with severe acute pancreatitis

S.M. Chuklin, S.S. Chuklin, G.V. Shershen, P.M. Popyk

Abstract


Despite the absence of special therapy in the treatment of patients with acute pancreatitis, recent advances that use nonspecific early treatments have resulted in improved outcomes. These results are derived from studies on the use of rehydration, analgesia, prophylactic antibiotics and the limitation of endoscopic retrograde cholangiopancreatography in patients with concomitant acute cholangitis. However, a marked and consistent improvement in patient outcomes over the past decade has been noted in researches that have studied the use of artificial nutrition, both enteral and parenteral, in patients with acute pancreatitis. The available data, taking into account the current state of the pathophysiology of acute pancreatitis, emphasize that nutritional support with appropriate nutritional supplements are key elements for limiting local inflammation and preventing or treating pancreatitis-associated complications. This review of the literature obtained from the PubMed database focuses on the latest advances in the optimal enteral feeding strategy in patients with severe acute pancreatitis, as well as the role of nutritional supplements such as probiotics, prebiotics, synbiotics, glutamine, arginine, omega-3 fatty acids and vitamins, to evaluate the improvement of treatment outcomes for these patients and the prospects for further research.

Keywords


acute pancreatitis; enteral nutrition; nutrients; nutritional supplements

References


Forsmark CE, Swaroop Vege S, Wilcox CM. Acute pancreatitis. N Engl J Med. 2016;375:1972–1981. doi: 10.1056/NEJMra1505202

Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1–15. doi: 10.1016/j.pan.2013.07.063

Criddle DN. The role of fat and alcohol in acute pancreatitis: a dangerous liaison. Pancreatology. 2015;15(4 Suppl):S6–12. doi:10.1016/j.pan.2015.02.009

Maleth J, Hegyi P, Rakonczay Z, Jr, Venglovecz V. Breakdown of bioenergetics evoked by mitochondrial damage in acute pancreatitis: Mechanisms and consequences. Pancreatology. 2015;15:18–22. doi: 10.1016/j.pan.2015.06.002.

Mukherjee R, Mareninova OA, Odinokova IV, et al. Mechanism of mitochondrial permeability transition pore induction and damage in the pancreas: inhibition prevents acute pancreatitis by protecting production of ATP. Gut. 2016;65:1333–1346. doi:10.1136/gutjnl-2014-308553

Biczo G, Vegh ET, Shalbueva N, et al. Mitochondrial Dysfunction, Through Impaired Autophagy, Leads to Endoplasmic Reticulum Stress, Deregulated Lipid Metabolism, and Pancreatitis in Animal Models. Gastroenterology. 2018;154(3):689–703. doi: 10.1053/j.gastro.2017.10.012

Judak L, Hegyi P, Rakonczay Z, Jr, Maleth J, Gray MA, Venglovecz V. Ethanol and its non-oxidative metabolites profoundly inhibit CFTR function in pancreatic epithelial cells which is prevented by ATP supplementation. Pflugers Arch. 2014;466:549–562. doi: 10.1007/s00424-013-1333-x

Párniczky A, Kui B, Szentesi A, et al. Prospective, Muticentre, Nationwide clinical data from 600 cases of acute pancreatitis. PLoS One 2016;11:e0165309 doi:10.1371/journal.pone.0165309

Márta K, Farkas N, Szabó I, et al. 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. Int J Mol Sci. 2016;17:1691. doi: 10.3390/ijms17101691

Muftuoglu MA, Isikgor S, Tosun S, Saglam A. Effects of probiotics on the severity of experimental acute pancreatitis. Eur J Clin Nutr. 2006;60:464–468. doi: 10.1038/sj.ejcn.1602338

Karen M, Yuksel O, Akyurek N, et al. Probiotic agent Saccharomyces boulardii reduces the incidence of lung injury in acute necrotizing pancreatitis induced rats. J Surg Res. 2010; 160:139–144. doi: 10.1016/j.jss.2009.02.008

Barraud D, Bollaert PE, Gibot S. Impact of the administration of probiotics on mortality in critically ill adult patients a meta-analysis of randomized controlled trials. Chest. 2013; 143:646–655. doi: 10.1378/chest.12-1745

Gou S, Yang Z, Liu T, Wu H, Wang C. Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2014;18:R57. doi: 10.1186/cc13809

Thomson A, Subramaniam K, Davies A. Nutritional therapy in acute pancreatitis – time to take stock. Nutrition. 2012;28:731–732. doi: 10.1016/j.nut.2011.12.011

Lei QC, Wang XY, Xia XF, et al. The role of omega-3 fatty acids in acute pancreatitis: a meta-analysis of randomized controlled trials. Nutrients. 2015;7:2261–2273. doi: 10.3390/nu7042261

Jafari T, Feizi A, Askari G, Fallah AA. Parenteral immunonutrition in patients with acute pancreatitis: a systematic review and meta-analysis. Clin Nutr. 2015;34:35–43. doi: 10.1016/j.clnu.2014.05.008

Perez S, Pereda J, Sabater L, Sastre J. Redox signaling in acute pancreatitis. Redox Biol. 2015;5:1–14.

Lodewijkx PJ, Besselink MG, Witteman BJ, et al. Nutrition in acute pancreatitis: a critical review. Expert Rev Gastroenterol Hepatol. 2016;10:571–580. doi: 10.1586/17474124.2016.1141048

Reddy BR. Enteral nutrition: whom, why, when, what and where to feed? Nestle Nutr Inst Workshop Ser. 2015;82:53–59. doi: 10.1159/000382002

Tiengou LE, Gloro R, Pouzoulet J, et al. Semi-elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study. JPEN. Journal of parenteral and enteral nutrition. 2006;30:1–5. doi: 10.1177/014860710603000101

Makola D, Krenitsky J, Parrish C, et al. Efficacy of enteral nutrition for the treatment of pancreatitis using standard enteral formula. Am J Gastroenterol. 2006;101:2347–2355. doi: 10.1111/j.1572-0241.2006.00779.x

Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut. 1998;42:431–435. PMID: 9577354

Pupelis G, Selga G, Austrums E, Kaminski A. Jejunal feeding, even when instituted late, improves outcomes in patients with severe pancreatitis and peritonitis. Nutrition. 2001;17: 91–94. PMID: 11240334

Petrov MS, Loveday BP, Pylypchuk RD, McIlroy K, Phillips AR, Windsor JA. Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis. Br J Surg. 2009;96:1243–1252. doi: 10.1002/bjs.6862

Poropat G, Giljaca V, Hauser G, Štimac D. Enteral nutrition formulations for acute pancreatitis. Cochrane Database Syst Rev. 2015;3:CD010605. doi: 10.1002/14651858.CD010605.pub2

Endo A, Shiraishi A, Fushimi K, Murata K, Otomo Y. Comparative effectiveness of elemental formula in the early enteral nutrition management of acute pancreatitis: a retrospective cohort study. Ann Intensive Care. 2018;8:69. doi: 10.1186/s13613-018-0414-6.

Mirtallo JM, Forbes A, McClave SA, et al. International consensus guidelines for nutrition therapy in pancreatitis. JPEN J Parenter Enteral Nutr. 2012;36:284–291. doi: 10.1177/0148607112440823

Meier R, Ockenga J, Pertkiewicz M, et al. ESPEN Guidelines on Enteral Nutrition: Pancreas. Clin Nutr. 2006;25:275–284. doi: 10.1016/j.clnu.2006.01.019

McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract. 2009;24:305–315. doi: 10.1177/0884533609335176

Singh P, Garg PK. Pathophysiological mechanisms in acute pancreatitis: Current understanding. Indian J Gastroenterol. 2016;35:153–166. doi: 10.1007/s12664-016-0647-y

Kota RK, Ambati RR, Yalakurthi AK, Srirama K, Reddy PN. Recent advances in probiotics as live biotherapeutics against gastrointestinal diseases. Curr Pharm Des. 2018 Jul 16. doi: 10.2174/1381612824666180717105128.

Qin HL, Zheng JJ, Tong DN, et al. Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis. Eur J Clin Nutr. 2008;62:923–930. doi: 10.1038/sj.ejcn.1602792

Besselink MG, van Santvoort HC, Renooij W, et al. Intestinal barrier dysfunction in a randomized trial of a specific probiotic composition in acute pancreatitis. Ann Surg. 2009;250:712–719. doi: 10.1097/SLA.0b013e3181bce5bd

Sharma B, Srivastava S, Singh N, Sachdev V, Kapur S, Saraya A. Role of probiotics on gut permeability and endotoxemia in patients with acute pancreatitis: a double-blind randomized controlled trial. J Clin Gastroenterol. 2011;45:442–448. doi: 10.1097/MCG.0b013e318201f9e2

Oláh A, Belágyi T, Issekutz A, Gamal ME, Bengmark S. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis. Br J Surg. 2002;89:1103–1107. PMID: 12190674

Oláh A, Belágyi T, Pótó L, Romics L, Jr, Bengmark S. Synbiotic control of inflammation and infection in severe acute pancreatitis: a prospective, randomized, double blind study. Hepatogastroenterology. 2007;54:590–594. PMID: 17523328

Besselink MG, Timmerman HM, Buskens E, et al. Probiotic prophylaxis in patients with predicted severe acute pancreatitis (PROPATRIA): design and rationale of a double-blind, placebo-controlled randomised multicenter trial [ISRCTN38327949]. BMC Surg. 2004;4:12. doi: 10.1186/1471-2482-4-12

Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;371:651–659. doi: 10.1016/S0140-6736(08)60207-X

van Baal MC, Kohout P, Besselink MG, et al. Probiotic treatment with Probioflora in patients with predicted severe acute pancreatitis without organ failure. Pancreatology. 2012;12:458–462. doi: 10.1016/j.pan.2012.08.004

Lata J, Juránková J, Stiburek O, Pribramská V, Senkyrik M, Vanásek T. Probiotics in acute pancreatitis – a randomised, placebo-controlled, double-blind study. Vnitr Lek. 2010;56:111–114. (in Czech). PMID: 20329580

Cui LH, Wang XH, Peng LH, Yu L, Yang YS. The effects of early enteral nutrition with addition of probiotics on the prognosis of patients suffering from severe acute pancreatitis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013;25:224–228. (in Chinese). doi: 10.3760/cma.j.issn.2095-4352.2013.04.011

Tian X, Pi YP, Liu XL, Chen H, Chen WQ. Supplemented Use of Pre-, Pro-, and Synbiotics in Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis of 13 Randomized Controlled Trials. Front Pharmacol. 2018;9:690. doi: 10.3389/fphar.2018.00690.

Kecskés G, Belágyi T, Oláh A. Early jejunal nutrition with combined pre- and probiotics in acute pancreatitis – prospective, randomized, double-blind investigations. Magy Seb (2003) 56:3–8. (in Hungarian). PMID: 12764986

Karakan T, Ergun M, Dogan I, Cindoruk M, Unal S. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: a prospective randomized double-blind study. World J Gastroenterol. 2007;13:2733–2737. PMID: 17569144

van Zanten AR, Dhaliwal R, Garrel D, Heyland DK. Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis. Crit Care. 2015;19:294. doi: 10.1186/s13054-015-1002-x.

Monseni Salehi Monfared SS, Vahidi H, Abdolghaffari AH, Nikfar S, Abdollahi M. Antioxidant therapy in the management of acute, chronic and post-ERCP pancreatitis: a systematic review. World J Gastroenterol. 2009;15:4481–4490. PMID: 19777606

Ockenga J, Borchert K, Rifai K, Manns MP, Bischoff SC. Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis. Clin Nutr. 2002;21:409–416. PMID: 12381339

Fuentes-Orozco C, Cervantes-Guevara G, Mucino-Hernández I, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis. JPEN J Parenter Enteral Nutr. 2008;32:403–411. doi: 10.1177/0148607108319797

Asrani V, Chang WK, Dong Z, Hardy G, Windsor JA, Petrov MS. Glutamine supplementation in acute pancreatitis: a meta-analysis of randomized controlled trials. Pancreatology. 2013;13:468–474. doi: 10.1016/j.pan.2013.07.282

Huang XX, Wang XP, Ma JJ, Jing DD, Wang PW, Wu K. Effects of enteral nutrition supplemented with glutamine and arginine on gut barrier in patients with severe acute pancreatitis: a prospective randomized controlled trial. Zhonghua Yi Xue Za Zhi. 2008;88:2407–2409. (in Chinese). PMID: 19087716

Hajdu N, Belagyi T, Issekutz A, Bartek P, Gartner B, Olah A. [Intravenous glutamine and early nasojejunal nutrition in severe acute pancreatitis – a prospective randomized clinical study]. Magy Seb (2012) 65:44–51.

Xue P, Deng LH, Xia Q, et al. Impact of alanyl-glutamine dipeptide on severe acute pancreatitis in early stage. World J Gastroenterol. 2008;14:474–488. PMID: 18200673

Zhao G, Zhang JG, Wu HS, et al. Effects of different resuscitation fluid on severe acute pancreatitis. World J Gastroenterol. 2013;19:2044–2052. doi: 10.3748/wjg.v19.i13.2044

Jeurnink SM, Nijs MM, Prins HA, Greving JP, Siersema PD. Antioxidants as a treatment for acute pancreatitis: a meta-analysis. Pancreatology. 2015;15:203–208. doi: 10.1016/j.pan.2015.03.009

Singh N, Mishra SK, Sachdev V, et al. Effect of oral glutamine supplementation on gut permeability and endotoxemia in patients with severe acute pancreatitis: a randomized controlled trial. Pancreas. 2014;43:867–873. doi: 10.1097/MPA.0000000000000124

Heyland D, Muscedere J, Wischmeyer PE, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013;368:1489–1497. doi: 10.1056/NEJMoa1212722

Doley RP, Yadav TD, Wig JD, et al. Enteral nutrition in severe acute pancreatitis. JOP. 2009;10:157–162. PMID: 19287109

Patel JJ, Miller KR, Rosenthal C, et al. When is it appropriate to use arginine in critical illness? Nutr Clin Pract. 2016;31:438–444. doi: 10.1177/0884533616652576

Skulas-Ray AC. Omega-3 fatty acids and inflammation: a perspective on the challenges of evaluating efficacy in clinical research. Prostaglandins Other Lipid Mediat. 2015; 116-117:104–111. doi: 10.1016/j.prostaglandins.2015.02.001.

Oskarsson V, Orsini N, Sadr-Azodi O, Wolk A. Fish consumption and risk of non-gallstone-related acute pancreatitis: a prospective cohort study. Am J Clin Nutr. 2015;101:72–78. doi: 10.3945/ajcn.113.076174

Lasztity N, Hamvas J, Biro L, et al. Effect of enterally administered n-3 polyunsaturated fatty acids in acute pancreatitis – a prospective randomized clinical trial. Clin Nutr. 2005;24:198–205. doi: 10.1016/j.clnu.2004.12.008

Wang X, Li W, Li N, Li J. Omega-3 fatty acids-supplemented parenteral nutrition decreases hyperinflammatory response and attenuates systemic disease sequelae in severe acute pancreatitis: a randomized and controlled study. JPEN J Parenter Enteral Nutr. 2008;32:236–241. doi: 10.1177/0148607108316189

Wang X, Li W, Zhang F, Pan L, Li N, Li J. Fish oil-supplemented parenteral nutrition in severe acute pancreatitis patients and effects on immune function and infectious risk: a randomized controlled trial. Inflammation. 2009;32:304–309. doi: 10.1007/s10753-009-9136-0

Xiong J, Zhu S, Zhou Y, Wu H, Wang C. Regulation of omega-3 fish oil emulsion on the SIRS during the initial stage of severe acute pancreatitis. J Huazhong Univ Sci Technolog Med Sci. 2009;29:35–38. doi: 10.1007/s11596-009-0107-3

Pearce CB, Sadek SA, Walters AM, et al. A double-blind, randomised, controlled trial to study the effects of an enteral feed supplemented with glutamine, arginine, and omega-3 fatty acid in predicted acute severe pancreatitis. JOP. 2006;7:361–371. PMID: 16832133

Setiawan VW, Pandol SJ, Porcel J, et al. Dietary factors reduce risk of acute pancreatitis in a large multiethnic cohort. Clin Gastroenterol Hepatol. 2017;15:257–265.e3. doi: 10.1016/j.cgh.2016.08.038

Musil F, Zadak Z, Solichova D, et al. Dynamics of antioxidants in patients with acute pancreatitis and in patients operated for colorectal cancer: a clinical study. Nutrition. 2005;21:118–124. doi: 10.1016/j.nut.2004.07.003

Al Samaraee A, McCallum IJ, Coyne PE, Seymour K. Nutritional strategies in severe acute pancreatitis: a systematic review of the evidence. Surgeon. 2010;8:105-110. doi: 10.1016/j.surge.2009.10.006

Esrefoglu M. Experimental and clinical evidence of antioxidant therapy in acute pancreatitis. World J Gastroenterol. 2012;18:5533-5541. doi: 10.3748/wjg.v18.i39.5533

Siriwardena AK, Mason JM, Balachandra S,et al. Randomised, double blind, placebo controlled trial of intravenous antioxidant (N-acetylcysteine, selenium, vitamin C) therapy in severe acute pancreatitis. Gut. 2007;56:1439–1444. Doi: 10.1136/gut.2006.115873

Sateesh J, Bhardwaj P, Singh N, Saraya A. Effect of antioxidant therapy on hospital stay and complications in patients with early acute pancreatitis: a randomised controlled trial. Trop Gastroenterol. 2009;30:201–206. PMID: 20426279

Du WD, Yuan ZR, Sun J, et al. Therapeutic efficacy of high-dose vitamin C on acute pancreatitis and its potential mechanisms. World J Gastroenterol. 2003;9:2565–2569. PMID: 14606098

Bansal D, Bhalla A, Bhasin DK, et al. Safety and efficacy of vitamin-based antioxidant therapy in patients with severe acute pancreatitis: a randomized controlled trial. Saudi J Gastroenterol. 2011;17:174–179. doi: 10.4103/1319-3767.80379




Copyright (c) 2019 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2019

 

   Seo анализ сайта