title: Physiological effects of enteral and parenteral feeding on pancreaticobiliary secretion in humans.
abstract: In the nutritional management of digestive disorders, it is important to know the relative secretory and metabolic responses to enteral and parenteral feeding. Twenty-seven healthy volunteers were studied while receiving either oral drinks or duodenal infusions of a complex formula diet, duodenal or intravenous infusions of elemental (protein as free amino acids, low fat) formulae, or saline. Pancreaticobiliary secretory responses were measured by nasoduodenal polyethylene glycol perfusion and aspiration, while monitoring blood hormone and nutrient levels. Diets were matched for protein (1.5 g x kg(-1) x d(-1)) and energy (40 kcal x kg(-1) x d(-1)). Compared with placebo, all oroenteral diets stimulated amylase, lipase, trypsin, and bile acid secretion and increased plasma concentrations of gastrin and cholecystokinin, whereas intravenous feeding did not. The complex formula produced a similar response whether given as drinks or duodenal infusions. Changing the duodenal formula to elemental reduced enzyme secretion by 50%, independently of CCK. Higher increases in plasma insulin, glucose, and amino acids were noted with intravenous feeding. Delivering food directly to the intestine by a feeding tube does not reduce pancreaticobiliary secretion. Enteral "elemental" formulae diminish, but only intravenous feeding avoids pancreatic stimulation. Intravenous administration impairs metabolic clearance.
authors.affiliation: Medical College of Virginia and Virginia Commonwealth University and McGuire Veterans Administration Hospital, Richmond 23298, USA. sjokeefe@hsc.vcu.edu
authors.forename: Stephen J D
authors.initials: SJ
authors.lastname: O'Keefe
authors.forename: Ronzo B
authors.initials: RB
authors.lastname: Lee
authors.forename: Frank P
authors.initials: FP
authors.lastname: Anderson
authors.forename: Chris
authors.initials: C
authors.lastname: Gennings
authors.forename: Souheil
authors.initials: S
authors.lastname: Abou-Assi
authors.forename: John
authors.initials: J
authors.lastname: Clore
authors.forename: Douglas
authors.initials: D
authors.lastname: Heuman
authors.forename: William
authors.initials: W
authors.lastname: Chey
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000097:blood; D001652:Bile Ducts / Q000378:metabolism*; D001786:Blood Glucose; D002766:Cholecystokinin / Q000097:blood; D004750:Enteral Nutrition; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005526:Food, Formulated; D005755:Gastrins / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010179:Pancreas / Q000201:enzymology* / Q000378:metabolism*; D010288:Parenteral Nutrition
chemical_list: D000596:Amino Acids; D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D005755:Gastrins; D007328:Insulin; D002766:Cholecystokinin