Medical management of severe inflammatory disease of the rectum: nutritional aspects

Enteral nutrition in severe acute pancreatitis

Severe acute pancreatitis (SAP) patients often have high catabolism, negative nitrogen balance and high energy consumption, and the degree of negative nitrogen balance is directly related to the severity of the disease. The purpose of nutritional support is to establish positive nitrogen balance. In nearly a decade, evidence-based evidence suggests that enteral nutrition can reduce the incidence of pancreatic infection, organ failure and mortality. Enteral nutrition is not only a way of nutritional support, but also for the treatment of SAP. However, there are some debates over the timing, ways, nutrient solution composition and the use of ecological immune preparations. In this review, we focus on the proper timing, way and nutrient solution composition of EN.

A meta-analysis of enteral nutrition and total parenteral nutrition in patients with acute pancreatitis

Objective. To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis. Methods. Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in NCBI and CBM databases and The Cochrane Controlled Trials Register. Six studies were enrolled into the analysis, and the details about the trial designs, characters of the subjects, results of the studies were reviewed by two independent authors and analyzed by STATA 11.0 software. Results. Compared with TPN, EN was associated with a significantly lower incidence of pancreatic infection complications (RR = 0.556, 95% CI 0.436∼0.709, P = .000), MOF (RR = 0.395, 95% CI 0.272∼0.573, P = .003), surgical interventions (RR = 0.556, 95% CI 0.436∼0.709, P = .000), and mortality (RR = 0.426, 95% CI 0.238∼0.764, P = .167). There was no statistic significance in non-pancreatitis-related complications (RR = 0.853, 95% CI 0.490∼1.483, P = .017). However, EN had a significantly higher incidence of non-infection-related complications (RR = 2.697, 95% CI 1.947∼3.735, P = .994). Conclusion. EN could be the preferred nutrition feeding method in patients with acute pancreatitis.