Effect of continuous jejunal perfusion of elemental and complex nutritional solutions on pancreatic enzyme secretion in human subjects.

Abstract

SUMMARY Pancreatic secretion of lipase and chymotrypsin in response to elemental diets and a crushed food homogenate was studied in normal subjects. The solutions were infused at constant flow rates at the ligament of Treitz with polyethylene glycol as a nonabsorbable marker. A triple lumen tube was used, enabling collection of secretions at 35 and 70 cm from the infusion point. The results show that a crushed food homogenate has a greater stimulative effect on pancreatic enzyme secretion than the elemental solutions and that this can be directly related to its greater nitrogen content. The osmolality of the infused solutions does not appear to be important. The relative merits of the solutions tested and total parental nutrition in reducing pancreatic enzyme secretion are discussed.

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

“…In contrast, elemental diets infused distal to the ligament of Treitz in animals [58, 60]and humans [57, 61, 62], induce at most a weak pancreatic exocrine response, with a secretion that is watery and low in volume and enzyme concentration. Although the relative stimulation varies with the type of enteral formula delivered distal to the ligament of Treitz, the relative amount of stimulated exocrine secretion was extremely low.…”

“…Many studies in animals and man have shown a marked stimulatory effect on pancreatic juice secretion when enteral feedings are delivered as oral, gastric, or duodenal infusions, either as an elemental diet or a complex formula; these routes of infusion would appear to be contraindicated [55, 56, 57, 58, 59]. In contrast, elemental diets infused distal to the ligament of Treitz in animals [58, 60]and humans [57, 61, 62], induce at most a weak pancreatic exocrine response, with a secretion that is watery and low in volume and enzyme concentration.…”

Parenteral versus early intrajejunal nutrition: Effect on pancreatitic natural course, entero-hormones release and its efficacy on dogs with acute pancreatitis

“…In particular, there is an increased risk of central catheter infection, severe hyperglycaemia, and other metabolic and electrolyte disturbances and a possible exacerbation of metabolic disturbances. TPN may also result in gut barrier function alterations due to increasing intestinal permeability [1][2][3][4][5][6][7][8][9][10] . Benefits from the use of total enteral nutrition (TEN) have been noted in a number of other diseases, such as burns, trauma, and sepsis.…”

Acute pancreatitis

“…Semielemental formulas seem to pose the advantage of less pancreatic stimulation while not requiring the presence of pancreatic enzymes for absorption. 81,82 Studies, however, have not uniformly supported this hypothesis. 83 …”