Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis.
BACKGROUND
In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of systemic inflammatory response syndrome (SIRS) and sepsis.


OBJECTIVE
To determine whether TEN can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis.


METHODS
Glasgow score, Apache II, computed tomography (CT) scan score, C reactive protein (CRP), serum IgM antiendotoxin antibodies (EndoCAb), and total antioxidant capacity (TAC) were determined on admission in 34 patients with acute pancreatitis. Patients were stratified according to disease severity and randomised to receive either TPN or TEN for seven days and then re-evaluated.


RESULTS
SIRS, sepsis, organ failure, and ITU stay, were globally improved in the enterally fed patients. The acute phase response and disease severity scores were significantly improved following enteral nutrition (CRP: 156 (117-222) to 84 (50-141), p < 0.005; APACHE II scores 8 (6-10) to 6 (4-8), p < 0.0001) without change in the CT scan scores. In parenterally fed patients these parameters did not change but there was an increase in EndoCAb antibody levels and a fall in TAC. Enterally fed patients showed no change in the level of EndoCAb antibodies and an increase in TAC.


CONCLUSIONS
TEN moderates the acute phase response, and improves disease severity and clinical outcome despite unchanged pancreatic injury on CT scan. Reduced systemic exposure to endotoxin and reduced oxidant stress also occurred in the TEN group. Enteral feeding modulates the inflammatory and sepsis response in acute pancreatitis and is clinically beneficial.
Windsor
A C
AC
Department of Surgery, St James's University Hospital, Leeds, UK.
Kanwar
S
S
Li
A G
AG
Barnes
E
E
Guthrie
J A
JA
Spark
J I
JI
Welsh
F
F
Guillou
P J
PJ
Reynolds
J V
JV
D018806:APACHE; D000208:Acute Disease; D000210:Acute-Phase Reaction / Q000628:therapy*; D000368:Aged; D000906:Antibodies / Q000097:blood; D004731:Endotoxins / Q000276:immunology; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D010195:Pancreatitis / Q000276:immunology / Q000628:therapy*; D010289:Parenteral Nutrition, Total; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control
D000906:Antibodies; D004731:Endotoxins; D007075:Immunoglobulin M