Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation

Ragins, Herzl; Levenson, Stanley Μ.; Signer, Richard D.; Stamford, William; Seifter, Eli

doi:10.1016/s0002-9610(73)80007-8

Cited by 140 publications

(42 citation statements)

References 21 publications

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“…Enteral nutrition, on the other hand, can maintain the integrity and function of the intestinal mucosal barrier 6 . The degree of pancreatic stimulation is determined by the location in the gastrointestinal tract where food is administered 7 , i.e., pancreatic rest can be achieved if food is administered in the small intestine, distal to the angle of Treitz, which results in minimal or negligible stimulation of pancreatic secretion 8 . Randomized clinical studies comparing parenteral vs. enteral nutrition in severe acute pancreatitis have demonstrated clear advantages of enteral nutrition.…”

Section: Introductionmentioning

confidence: 99%

Parenteral nutrition versus enteral nutrition in severe acute pancreatitis

et al. 2010

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Purpose:To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. Methods: The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. Results: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. Conclusion: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support. Key words: Nutritional Support. Parenteral Nutrition. Enteral Nutrition. Pancreatitis. RESUMO Objetivo:Comparar o efeito do suporte nutricional parenteral versus enteral, em pancreatite aguda grave, com relação à eficácia, à segurança, à morbi-mortalidade e ao tempo de internação. Métodos: Foram estudados 31 pacientes distribuídos em grupo parenteral (n=16), no período de 1995 a 1998 e grupo enteral (n=15), no período de 1999 a 2002, que preencheram os critérios de gravidade pela tomografia de abdome (Balthazar C,D,E). Os pacientes foram comparados quanto aos dados demográficos, etiologia, antibioticoprofilaxia, somatostatina, suporte nutricional, complicações e evolução. Resultados: A maioria dos pacientes era Balthazar E, principalmente no grupo enteral, porém sem significado estatístico (p=0,21). Também não houve diferença estatística nos dois grupos em relação ao tempo médio de uso de suporte nutricional, somatostatina e antibiótico. O imipenem foi a droga de escolha para profilaxia da infecção pancreática nos dois grupos. Houve mais complicações gerais no grupo parenteral, sem significado estatístico (p=0,10). As complicações infecciosas do tipo sépsis do cateter e infecção do tecido pancreático foram mais frequentes no grupo parenteral, com significância estatística (p=0,06). Não houve diferença na média de internação nos dois grupos. Houve três óbitos no grupo parenteral e nenhum no enteral. Conclusão: O suporte nutricional enteral está associado à menor taxa de complicações sépticas do que o parenteral. Descritores: Apoio Nutricional. Nutrição Parenteral. Nutrição Enteral. Pancreatite.

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Section: Introductionmentioning

confidence: 99%

Parenteral nutrition versus enteral nutrition in severe acute pancreatitis

et al. 2010

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“…A few reports have shown that ED was useful in the management of pancreatitis since it is less simulating to the pancreas [5,17,18]. In particular, the Elental preparation used in the present study contains an extremely small amount of fat (0.17 g/100 kcal).…”

Section: Discussionmentioning

confidence: 91%

Medical Management of Chronic Pancreatitis: What Can Physicians Do?

Lee¹

2017

Korean J Pancreas Biliary Tract

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Background & Aims. Chronic pancreatitis (CP) is often associated with abdominal pain, which impairs quality of life. The aim of this prospective study was to clarify whether the use of a low-fat elemental diet (ED) is beneficial for managing pain in patients with CP. Methods. Seventeen CP patients with pain despite fat-restricted dietary and conventional medical treatments were enrolled in this prospective study. These patients received low-fat ED therapy in addition to restricting fat intake for 8 weeks. The change of pain severity was examined by interviewing the patient and status of analgesic use. Results. Mean serum levels of amylase and lipase at 8 weeks after the beginning of low-fat ED therapy decreased compared to those before the therapy. At 8 weeks, pain alleviation after low-fat ED therapy was reported in 15 out of 17 patients (88%). Of these 15 patients, 10 patients reported complete pain disappearance. One of 3 patients with severe or moderate pain requiring analgesic was relieved of analgesic use after low-fat ED therapy. Conclusion. Low-fat ED therapy is useful as means of pain control in CP. The therapy is recommended in outpatients with CP who present with pain despite conventional dietary and medical treatments.

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“…Various animal and human studies have shown conflicting results. [99][100][101] However, pancreatic stimulation appears to be lessened as nutrients are infused more distally in the intestine. It appears that jejunal feeds reduce pancreatic secretion to clinically insignificant levels but do not eliminate pancreatic secretion completely.…”

Section: Nutritional Supportmentioning

confidence: 99%

“…It appears that jejunal feeds reduce pancreatic secretion to clinically insignificant levels but do not eliminate pancreatic secretion completely. 100,101 Studies showing that the combination of TPN and nil per os increases intestinal mucosal permeability and bacterial translocation and decreases gastrointestinal immunoglobulin levels have served as further stimulus to reevaluate the manner in which nutritional supplementation is provided to patients with acute pancreatitis. [102][103][104] Until recently, most of the studies in this area have been limited to case series.…”

Section: Nutritional Supportmentioning

confidence: 99%