Semi-elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study.
BACKGROUND
Jejunal nutrition is recommended during acute pancreatitis. The use of semi-elemental formulas presents several theoretical advantages over polymeric formulas, but their clinical value has been poorly documented. Our aim was to evaluate in patients with acute pancreatitis the effect of enteral nutrition by a semi-elemental formula compared with a polymeric formula.


METHODS
A randomized prospective pilot study, stratified according to severity, was performed in 30 consecutive patients with acute pancreatitis requiring jejunal nutrition. The semi-elemental group received 35 kcal/kg/d of Peptamen (n = 15), and the polymeric group received the same quantity of Sondalis-Iso (n = 15). Tolerance was evaluated after 7 days of enteral nutrition (D7) on visual analog scale (VAS), stool frequency, and 24-hour steatorrhea/creatorrhea. Outcome was evaluated by weight loss, length of hospital stay, and infection rate.


RESULTS
Results were calculated as mean +/- SEM, t-test, or chi2. Patients of the 2 groups were comparable in terms of age, gender, and severity. Tolerance was good in both groups (semi-elemental vs polymeric: VAS, 7.4 +/- 0.6 vs 7.1 +/- 0.6, not significant (NS); number of stools per 24 hours, 1.7 +/- 0.4 vs 1.8 +/- 0.4, NS). Steatorrhea and creatorrhea were lower than normal in both groups. In semi-elemental group, the length of hospital stay was shorter (23 +/- 2 vs 27 +/- 1, p = .006) and weight loss was less marked (1 +/- 1 vs 2 +/- 0, p = .01). One patient in semi-elemental group and 3 patients in polymeric group developed an infection (NS).


CONCLUSIONS
Semi-elemental and polymeric nutrition are very well tolerated in patients with acute pancreatitis. Nutrition with a semi-elemental formula supports the hypothesis of a more favorable clinical course than nutrition with a polymeric formula, but this conclusion needs to be established in larger adequately powered clinical trials.
Tiengou
Laurent-Eric
LE
Gastroenterology and Nutrition Department, Teaching Hospital, Caen, France. tiengou-le@chu-caen.fr
Gloro
Romain
R
Pouzoulet
Julien
J
Bouhier
Karine
K
Read
Marie-Hélène
MH
Arnaud-Battandier
Franck
F
Plaze
Jean-Marie
JM
Blaizot
Xavier
X
Dao
Thông
T
Piquet
Marie-Astrid
MA
D000328:Adult; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D005526:Food, Formulated / Q000032:analysis*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss