Effects of enteral nutrition on pro-inflammatory factors and intestinal barrier function in patients with acute severe pancreatitis

Abstract

The main objective of this study was to explore the effect of enteral nutrition on serum pro-inflammatory cytokines, tumor necrosis factor, and intestinal barrier function in patients with acute severe pancreatitis. A total number of 140 patients were recruited and divided randomly into parenteral nutrition (PN) and enteral nutrition (EN) groups. They received parenteral nutrition and enteral nutrition, respectively. The levels of serum total protein (TP) and albumin (ALB) in peripheral blood were detected in the two groups. Interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFα) in the two groups were comparatively analyzed. The levels of pro-inflammatory factors (IL-1β, IL-6, and TNFα) for both groups were same, and there was no significant difference ( P < 0.05) between the two groups before treatment. However, after treatment, a significant reduction was found in EN group which were 31.16 ± 1.95, 36.09 ± 9.44, and 29.21 ± 3.85 ng/L, respectively, showing significant lower values as compared to PN group. The levels of TP and ALB in EN group were 64.46 ± 3.77 and 27.19 ± 1.56 g/L, respectively, after treatment, showing significantly ( P < 0.05) elevated values than PN group. The incidence rates of pancreatic necrosis and pancreatic abscess in EN group were 28.57% and 11.43%, respectively, which were found to be lower significantly than PN group. Enteral nutrition is found to be more effective than parenteral nutrition in the treatment of severe acute pancreatitis, which can significantly reduce the level of pro-inflammatory factors as well as the degree of systemic inflammatory response and protect the intestinal barrier function; thus, this study is worthy for awareness and application in clinical practice.

Clinical efficacy of duodenoscopy combined with laparoscopy in the treatment of patients with severe acute pancreatitis and pancreatic pseudocyst, and the effects on IL‑6 and CRP

“…A recent study has reported that the prognosis of patients with SAP and PP is relevant to local or systemic stress reactions and inflammatory reactions induced during surgery. Further expression of a large number of cytokines can also cause pathological damage (20). TNF-α in serum is a vital regulatory factor in the process of inflammatory reaction.…”

Fire in the belly: A scoping review of the immunopathological mechanisms of acute pancreatitis

“…Finally, in terms of clinical outcomes, compared to TPN, EN was associated with lower rate of complications end organ dysfunction, as well as improved outcomes ( 173 , 199 , 202 , 209 ).…”

“…fish oil was associated with reduced IL-8 and ICAM-1 ( 243 ), and increased IL-10 ( 204 ), however no difference was seen in sTNFR levels ( 194 ) or IL-6 ( 206 ). In comparing TPN and enteral nutrition (EN), EN was frequently demonstrated to be superior in respect to cytokine response - with reduced pro-inflammatory IL-6 ( 173 , 202 , 205 ), IL-1b ( 173 ), and TNFα ( 173 , 205 ), and increased anti-inflammatory IL-11 and IL-10 ( 202 , 205 ).…”

Comparison of the Effectiveness of Enteral and Parenteral Nutrition in Patients with Acute Pancreatitis

“…Одной из основных причин смерти у пациентов с острым панкреатитом, является развитие иммунного воспалительного ответа на инфицированный панкреонекроз [1,2]. Данный иммунный воспалительный ответ, как правило, манифестирует в таких формах, как синдром системного воспалительного ответа (SIRS), сепсис, а также в развитии недостаточности органов и систем [2]. Желудочно-кишечный тракт, выключенный из процесса пищеварения, является одним из важнейших факторов в развитии такого иммунного воспалительного ответа.…”

“…Другие исследования показали снижение тяжести и частоты развития септических осложнений, у пациентов на энтеральном питании, после тяжелых механических и термических травм [5][6][7], а также после объёмных оперативных вмешательств [8]. Кроме того, результаты исследований свидетельствуют о том, что энтеральное питание поддерживает нормальную барьерную функцию кишечника, что снижает риски транслокации кишечной флоры и всасывания токсинов в кишечнике [2,7]. Учитывая вышесказанное, можно предположить, что энтеральное питание у пациентов с острым панкреатитом также снизит тяжесть и частоту развития иммунного воспалительного ответа, что в свою очередь улучшит результаты лечения.…”