Early Enteral Feeding in Severe Acute Pancreatitis: Can It Prevent Secondary Pancreatic (Super) Infection?

Lehocky, Peter; Sarr, Michael G.

doi:10.1159/000051964

Cited by 33 publications

(19 citation statements)

References 52 publications

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“…It has been suggested that intestinal permeability is markedly increased after burns and is positively correlated to the gut-derived endotoxinemia. Early enteral feeding in severely burned patients and in acute pancreatitis may decrease intestinal permeability, preserve the IMB and have a beneficial effect on the reduction of enterogenic infection [36,37]. …”

Section: Bacterial Translocationmentioning

confidence: 99%

Artificial Nutrition and Intestinal Mucosal Barrier Functionality

Anastasilakis¹,

Ioannidis

Gkiomisi

et al. 2013

Digestion

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The gastrointestinal tract has a major role in digestion and absorption of nutrients while playing a leading role in defense of the body. It forms a shield against the invasion of various microorganisms or their products (e.g. antigens, toxins) and therefore it is important to establish its integrity and functionality. That depends on the route of administration and the composition of the artificial nutrition. This study concentrates on the influences of different kinds of artificial nutrition in the functionality of the intestinal mucosal barriers. It seems that full macromolecular solutions of enteral nutrition ensure an adequate mucous immune response, while a lack of nutritional stimulus in the lumen leads rapidly to a dysfunction of gastric-associated lymphatic tissue and mucosal immune system. This dysfunction renders the patients susceptible to infections in distant organs, hospital pneumonia, and multiorgan failure of non-infectious etiology. In patients with indication of total parenteral nutrition administration, addition of bombesin or glutamine preserves mucosal immune response and may limit the adverse effects.

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Section: Bacterial Translocationmentioning

confidence: 99%

Artificial Nutrition and Intestinal Mucosal Barrier Functionality

Anastasilakis¹,

Ioannidis

Gkiomisi

et al. 2013

Digestion

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“…Until recently there was limited clinical interest in prediction of severity for individual patients, because no effective treatment other than supportive care was available. Now, there is increasing evidence for a variety of therapeutic strategies which may improve outcome if instituted early in the course of the illness, including prophylactic antibacterial therapy [4][5][6][7], enteral nutrition [8][9][10], and, in gallstone-related acute pancreatitis, endoscopic sphincterotomy [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis

2004

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“…The presence of food in the stomach and duodenum elicits gastropancreatic and duodenopancreatic reflexes that result in the stimulation of pancreatic exocrine secretion. However, these effects are insignificant when nutrients are delivered directly into the jejunum [16][17][18][19][20][21][22][23][24][25] .…”

Section: Discussionmentioning

confidence: 99%

Effect of parenteral and early intrajejunal nutrition on pancreatic digestive enzyme synthesis, storage and discharge in dog models of acute pancreatitis

Qin

Su²,

Hu³

et al. 2007

WJG

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Qin HL, Su ZD, Hu LG, Ding ZX, Lin QT. Effect of parenteral and early intrajejunal nutrition on pancreatic digestive enzyme synthesis, storage and discharge in dog models of acute pancreatitis. World J Gastroenterol 2007; 13(7): 1123-1128http://www.wjgnet.com/1007-9327/13/1123.asp INTRODUCTIONBeneficial effects of total enteral nutrition (TEN) have been noted in a number of diseases, such as burn, trauma, and sepsis. In comparison with parenteral nutrition (PN), TEN can reduce nosocomial infection, multiple organ failure (MOF), and the length of hospitalization [1][2][3][4] . Early enteral nutritional (EEN) support in patients with acute pancreatitis (AP) has been evaluated by some authors who reported that it can moderate the acute phase response and improve disease severity and clinical outcome [5][6][7][8][9][10] . However, the commonly encountered problems of gastric atony and outlet obstruction have limited the successful delivery of enteral nutrition to patients with severe acute pancreatitis. In addition, many surgeons believe that EEN may lead to recurrence of symptoms and delayed complications, because EEN may increase the release of digestive enzymes and lysosomal hydrolases. This action of digestive enzymes and lysosomal hydrolases may be important in the development of acute pancreatitis, as lysosomal enzymes such as cathepsin B, are known to be capable of activating trypsinogen and intracellular digestive enzymes that may trigger the autodigestive phenomenon of the pancreas [11] . However, these problems may be overcome if enteral nutrition is delivered to the jejunum as distal as possible from Treitz's ligament, thereby avoiding stimulation of the cephalic and gastric phase. Therefore, it is necessary to investigate the effect of early intrajejunal nutrition (EIN) on pancreatic acinar cell uptake of 3 H phenylalanine, digestive enzyme synthesis, storage and discharge in dogs with AP. MATERIALS AND METHODS Materials Abstract AIM:To study the effect of early intrajejunal nutrition on enzyme-protein synthesis and secretion during acute pancreatitis. METHODS:Fifteen dogs were randomly divided into parenteral nutrition (n = 7) and early intrajejunal nutrition groups (n = 8). An acute pancreatitis model was induced by injecting 5% sodium taurocholate and trypsin into the pancreas via the pancreatic duct. Intrajejunal nutrition was delivered with a catheter via a jejunostomy t u b e a f t e r t h e m o d e l wa s e s t a b l i s h e d fo r 2 4 h . On d 1 and 7 and at the beginning of nutritional support, radioactive tracing and electron microscopes were used to evaluate the enzyme-protein synthesis in acinar cells, the subcellular fractionation and the change in zymogen granules after 1.85 × 10 6 Bq L-3 H phenylalanine was infused at 30, 60, 120, and 180 min. RESULTS:The 3 H radioactivity in pancreatic acinar cells reached its peak level at 60 min, and the contents in the early intrajejunal nutrition group were higher than those in the parenteral nutrition group, which were then decreased. The mean numbe...

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Early Enteral Feeding in Severe Acute Pancreatitis: Can It Prevent Secondary Pancreatic (Super) Infection?

Cited by 33 publications

References 52 publications

Artificial Nutrition and Intestinal Mucosal Barrier Functionality

Artificial Nutrition and Intestinal Mucosal Barrier Functionality

Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis

Effect of parenteral and early intrajejunal nutrition on pancreatic digestive enzyme synthesis, storage and discharge in dog models of acute pancreatitis

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