Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis.
BACKGROUND
Recent evidence suggests that intestinal dysfunction has a role in sustaining the systemic inflammatory response in acute pancreatitis and may be ameliorated by the introduction of enteral nutrition. This study therefore assessed the effect of early enteral nutrition on the systemic inflammatory response in patients with prognostically severe acute pancreatitis.


METHODS
Patients with prognostically severe acute pancreatitis within 72 h of disease onset were randomized to receive either enteral nutrition or conventional therapy consisting of a nil-by-mouth regimen. Serum interleukin (IL) 6, soluble tumour necrosis factor receptor I (sTNFRI) and C-reactive protein (CRP) were used as markers of the inflammatory response. Intestinal function was assessed using a differential sugar permeability technique.


RESULTS
Of 27 patients, 13 received enteral nutrition. A median of 21 (range 0-100) per cent of calorific requirements was delivered over the first 4 days by enteral nutrition. There were no significant complications of enteral nutrition. The introduction of enteral nutrition did not affect the serum concentrations of IL-6 (P = 0.28), sTNFRI (P = 0.53) or CRP (P = 0.62) over the first 4 days of the study. Although there were no significant differences in intestinal permeability between the two patient groups at admission (chi2 = 2.33, d.f. = 1, P = 0.13), by day 4 abnormal intestinal permeability occurred more frequently in patients receiving enteral nutrition (chi2 = 4.94, d.f. = 1, P = 0.03)


CONCLUSIONS
Early enteral nutrition did not ameliorate the inflammatory response in patients with prognostically severe acute pancreatitis. Furthermore, it did not have a beneficial effect on intestinal permeability. Presented in part to the Pancreatic Society of Great Britain and Ireland in Leeds, UK, November 1998 and at Digestive Disease Week in Orlando, Florida, USA, May 1999
Powell
J J
JJ
University Department of Surgical and Clinical Sciences and Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK.
Murchison
J T
JT
Fearon
K C
KC
Ross
J A
JA
Siriwardena
A K
AK
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000378:metabolism*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism*; D007410:Intestinal Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000276:immunology / Q000378:metabolism / Q000628:therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000378:metabolism*
D015415:Biomarkers; D015850:Interleukin-6; D018124:Receptors, Tumor Necrosis Factor; D002097:C-Reactive Protein