Early Enteral Nutrition in Severe Acute Pancreatitis: A Prospective Randomized Controlled Trial Comparing Nasojejunal and Nasogastric Routes

Kumar, Ajay; Singh, Namrata; Prakash, Shyam; Saraya, Anoop; Joshi, Yogendra

doi:10.1097/00004836-200605000-00013

Cited by 237 publications

(160 citation statements)

References 13 publications

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“…Thirty-three articles (21 articles containing patients suffering from SAP as well as 12 articles with MAP patients) were selected. They contained two nonrandomized and 31 randomized controlled clinical trials (Table 2) [16][17][18][19][20][21][22][23][24][25][26][27]29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Finally, statistical analyses were performed on data from articles where both EN and NPO groups were presented, the trial was randomized, and the relevant data were available.…”

Section: Inclusions and Exclusionsmentioning

confidence: 99%

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

2017

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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.

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Section: Inclusions and Exclusionsmentioning

confidence: 99%

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

2017

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“…Neither feedings leads to recurrence or worsening of pain in patients with severe AP. They also reported that nutritional parameters remained unaffected because of inadequate caloric intake during the first week of feeding (Kumar A et al, 2006). Vu et al studied the activation of pancreatic secretion in 8 healthy volunteers in response to proximal or more distal jejunal delivery of nutrients into the small intestine.…”

Section: Nasojejunal (Nj) Vs Nasogastric Feeding (Ng)mentioning

confidence: 99%

Nutrition Assessment and Therapy in Acute Pancreatitis

Fuchs-Tarlovsky¹,

Sriram²

2012

Acute Pancreatitis

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“…75 Typically enteral feeds are given via the nasojejunal (NJ) route, though some data suggest that nasogastric (NG) feeding is also acceptable. 76,77 Despite good intentions by physicians to provide ''postpyloric'' feeding, often NJ tubes migrate back into the stomach, yet anecdotal reports showed patients continued to tolerate enteral feeding, prompting further studies. One randomized controlled trial of 49 patients showed NG feeds to be as good as NJ feeds in patients with SAP, plus they were less costly and easier to perform.…”

Section: Management Supportive Care and Nutritionmentioning

confidence: 99%

“…78 Similarly, this was demonstrated in 16 patients receiving NJ feeds and 15 patients receiving NG feeds with no worsening of SAP in either group. 77 In the 2 previous studies, patients with objective evidence of SAP were included and semielemental feeds were started within 24 to 72 hours after onset of pain. Presumably, NG feeds were given over oral feeds as semielemental feeds are not palatable.…”

Section: Management Supportive Care and Nutritionmentioning

confidence: 99%

Acute pancreatitis

Munsell

Buscaglia

2010

Journal of Hospital Medicine

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Acute pancreatitis is a common disease most frequently caused by gallstone disease or excess alcohol ingestion. Diagnosis is usually based on characteristic symptoms, often in conjunction with elevated serum pancreatic enzymes. Imaging is not always necessary, but may be performed for many reasons, such as to confirm a diagnosis of pancreatitis, rule out other causes of abdominal pain, elucidate the cause of pancreatitis, or to evaluate for complications such as necrosis or pseudocysts. Though the majority of patients will have mild, self‐limiting disease, some will develop severe disease associated with organ failure. These patients are at risk to develop complications from ongoing pancreatic inflammation such as pancreatic necrosis, fluid collections, pseudocysts, and pancreatic duct disruption. Validated scoring systems can help predict the severity of pancreatitis, and thus, guide monitoring and intervention.Treatment of acute pancreatitis involves supportive care with fluid replacement, pain control, and controlled initiation of regular food intake. Prophylactic antibiotics are not recommended in acute pancreatitis if there is no evidence of pancreatic infection. In patients who fail to improve, further evaluation is necessary to assess for complications that require intervention such as pseudocysts or pancreatic necrosis. Endoscopy, including ERCP and EUS, and/or cholecystectomy may be indicated in the appropriate clinical setting. Ultimately, the management of the patient with severe acute pancreatitis will require a multidisciplinary approach. Journal of Hospital Medicine 2010;5:241–250. © 2010 Society of Hospital Medicine.

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Early Enteral Nutrition in Severe Acute Pancreatitis: A Prospective Randomized Controlled Trial Comparing Nasojejunal and Nasogastric Routes

Abstract: EN at a slow infusion is well tolerated by both NJ and NG routes in patients with SAP. Neither NJ nor NG feeding leads to recurrence or worsening of pain in SAP. Nutritional parameters remained unaffected because of inadequate calorie intake during the first week of feeding.

Cited by 237 publications

References 13 publications

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

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

Nutrition Assessment and Therapy in Acute Pancreatitis

Acute pancreatitis

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