Early nasogastric feeding versus parenteral nutrition in severe acute pancreatitis: A retrospective study

Effect of probiotics combined with Ulinastatin and Somatostatin in the treatment of severe acute pancreatitis

Objective

To evaluate the clinical effect of probiotics combined with Ulinastatin and Somatostatin in the treatment of severe acute pancreatitis.

Methods

A retrospective study was conducted on 160 patients with severe acute pancreatitis treated in the First Affiliated Hospital of Bengbu Medical College from July 2021 to June 2023. There were 78 patients received Ulinastatin and Somatostatin treatment (Control group), and 82 patients received probiotics in addition to Ulinastatin and Somatostatin treatment (Observation group). The treatment effect and the time required to alleviate clinical symptoms were compared between the two groups. Serum levels of inflammatory factors, intestinal mucosal indexes and the incidence of adverse reactions before and after treatment were analyzed.

Results

The total efficacy of the Observation group (95.12%) was higher than that of the Control group (85.90%) (P<0.05). Combined probiotic/Ulinastatin + Somatostatin treatment was associated with shorter time to remission of the clinical symptoms (P<0.05). After the treatment, serum levels of inflammatory factors in the two groups were decreased, and was significantly lower in the Observation group compared to the Control group (P<0.05). Similarly, post-treatment serum levels of intestinal mucosal indexes in the two groups were lower than before the treatment, and significantly lower in the Observation group (P<0.05). There was no significant difference in the incidence of adverse reactions between the groups (P>0.05).

Conclusions

A combined regimen of probiotics, Ulinastatin and Somatostatin is safe and can more effectively relieve clinical symptoms in patients with severe acute pancreatitis, reduce levels of inflammatory factors, lower intestinal mucosal damage and improve the overall treatment effect compared to Ulinastatin and Somatostatin regimen alone.

Exploring the value of early laboratory indicators combined with pancreatitis activity scoring system in assessing the severity and prognosis of acute pancreatitis

Objective

To investigate the value of early laboratory indicators combined with the pancreatitis activity scoring system in assessing the severity and prognosis of acute pancreatitis (AP).

Methods

This is a retrospective study. A total of 160 patients with AP admitted to the Affiliated Hospital of Hebei University from February 2021 to February 2023 were enrolled and classified into three categories: mild acute pancreatitis (MAP), moderate severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP), with 80 cases with MAP and MSAP as the control group and 80 cases with SAP as the experimental group. The differences of inflammatory markers, blood routine, biochemical markers, coagulation markers and PASS score within 24 hours after admission were compared between the two groups, and independent risk factors for predicting AP severity were analyzed. Moreover, the diagnostic efficacy and prognostic value of independent risk factors were evaluated.

Results

The PASS score as well as CRP, PCT, IL-6, WBC, N, AST, DD and PT were higher in the experimental group than in the control group. Logistic regression analysis suggested that PASS, IL-6, PCT and WBC were independent risk factors for predicting severity of AP. In addition, PASS had the highest diagnostic efficacy.

Conclusion

Early elevation of PASS, IL-6, PCT and WBC in patients suffering from AP is of great significance in predicting SAP. PASS score combined with IL-6, PCT and WBC has important value in evaluating the severity and prognosis of AP.

Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards

Severe acute pancreatitis (SAP) leads to numerous inflammatory and nutritional disturbances. All SAP patients are at a high nutritional risk. It has been proven that proper nutrition significantly reduces mortality rate and the incidence of the infectious complications in SAP patients. According to the literature, early (started within 24-48 h) enteral nutrition (EN) is optimal in most patients. EN protects gut barrier function because it decreases gastrointestinal dysmotility secondary to pancreatic inflammation. Currently, the role of parenteral nutrition (PN) in SAP patients is limited to patients in whom EN is not possible or contraindicated. Early versus delayed EN, nasogastric versus nasojejunal tube for EN, EN versus PN in SAP patients and the role of immunonutrition (IN) in SAP patients are discussed in this review.

Feline comorbidities: What do we really know about feline triaditis?

PRACTICAL RELEVANCE

Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia.

DIAGNOSTIC CHALLENGES

Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases.

EVIDENCE BASE

The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.

Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis

Objective

This study was performed to systematically compare the safety and efficacy of total enteral nutrition (TEN) and total parenteral nutrition (TPN) for patients with severe acute pancreatitis (SAP).

Methods

The PubMed database was searched up to January 2017, and nine studies were retrieved. These studies were selected according to specific eligibility criteria. The methodological quality of each trial was assessed, and the study design, interventions, participant characteristics, and final results were then analyzed by Review Manager 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark).

Results

Nine relevant randomized controlled trials involving 500 patients (244 patients in the TEN group and 256 patients in the TPN group) were included in the meta-analysis. Pooled analysis showed a significantly lower mortality rate in the TEN than TPN group [odds ratio (OR), 0.31; 95% confidence interval (CI), 0.18–0.54]. The duration of hospitalization was significantly shorter in the TEN than TPN group (mean difference, −0.59; 95% CI, −2.56–1.38). Compared with TPN, TEN had a lower risk of pancreatic infection and related complications (OR, 0.41; 95% CI, 0.22–0.77), organ failure (OR, 0.17; 95% CI, 0.06–0.52), and surgical intervention (OR, 0.17; 95% CI, 0.05–0.62).

Conclusions

This meta-analysis indicates that TEN is safer and more effective than TPN for patients with SAP. When both TEN and TPN have a role in the management of SAP, TEN is the preferred option.

Risk factors for intolerance to enteral nutrition in patients with severe acute pancreatitis

AIM

To identify the risk factors for intolerance to enteral nutrition in patients with severe acute pancreatitis (SAP) and provide clinical data for the early clinical application of enteral nutrition in these patients.

METHODS

The clinical data of 243 patients who underwent enteral nutrition treatment for SAP at Tongde Hospital of Zhejiang Province from January 2012 to January 2018 were retrospectively analyzed. According to the presence of intolerance to enteral nutrition or not, the patients were divided into a tolerance group and an intolerance group. The risk factors for intolerance to enteral nutrition were determined by univariate analysis and multivariate logistic regression analysis.

RESULTS

Eight-four (34.57%) of the 243 SAP patients had intolerance to enteral nutrition. Univariate analysis and multivariate logistic regression analysis showed that age > 60 years (OR = 5.212, 95%CI: 1.462-18.587, P = 0.011), fasting time > 72 h (OR = 3.683, 95%CI: 1.322-11.612, P = 0.012), intra-abdominal pressure (IAP) > 20 cmH₂O (OR = 6.034, 95%CI: 2.431-20.114, P = 0.001), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score > 20 (OR = 6.411, 95%CI: 2.512-22.239, P = 0.001), and serum albumin < 25 g/L (OR = 5.961, 95%CI: 2.318-20.001, P = 0.001) were risk factors for intolerance to enteral nutrition in SAP patients. Adding soluble fiber (OR = 0.221, P = 0.002, 95%CI: 0.067-0.693) was identified to be a protective factor for intolerance to enteral nutrition in SAP patients.

CONCLUSION

The main risk factors for intolerance to enteral nutrition in SAP patients are age > 60 years, fasting time > 72 h, IAP > 20 cmH₂O, APACHE Ⅱ score > 20, and serum albumin < 25 g/L. Soluble fiber diet is able to prevent the development of intolerance to enteral nutrition in SAP patients.