title: Randomised clinical trial: enteral nutrition does not improve the long-term outcome of alcoholic cirrhotic patients with jaundice.
abstract: BACKGROUND
  Malnutrition and jaundice are independent prognostic factors in cirrhosis.
  
  
  OBJECTIVE
  To assess the impact of enteral nutrition on the survival of alcoholic cirrhotic patients with jaundice but without acute alcoholic hepatitis.
  
  
  METHODS
  The study was a multicentre prospective randomised controlled trial comparing effects of enteral nutrition vs. a symptomatic support in patients with alcoholic cirrhosis and jaundice (bilirubin ≥51 µmol/L) but without severe acute alcoholic hepatitis. A total of 99 patients were randomised to receive either the conventional symptomatic treatment (55 patients) or the symptomatic support associated with 35 kcal/Kg/day of enteral nutrition during 4 weeks followed by an oral nutritional support during 2 months (44 patients). Randomisation was stratified on nutritional status. One-year survival curves were compared using the Kaplan-Meier method and Logrank test.
  
  
  RESULTS
  Populations in both arms were similar. One-year survival was similar in the overall population (27/44 patients (61.4%) in the enteral nutrition arm vs. 36/55 (65.5%) in the control arm; Logrank P = 0.60) and in the subgroup suffering from malnutrition [18/29 patients (62.1%) in the enteral nutrition arm vs. 20/32 (62.5%) in the control arm; Logrank P = 0.99]. There was no statistical difference for bilirubin, prothrombin rate, Child-Pugh score, albumin or nutritional assessment. Complications during treatment (bleeding, encephalopathy, infection) occurred in 23% of patients in the enteral nutrition group (10/44) vs. 16% (9/55) of the control patients (P = 0.59).
  
  
  CONCLUSIONS
  Enteral nutrition does not improve the survival and hepatic or nutritional parameters of cirrhotic patients with jaundice.
authors.affiliation: Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, France. dupont-be@chu-caen.fr
authors.forename: B
authors.initials: B
authors.lastname: Dupont
authors.forename: T
authors.initials: T
authors.lastname: Dao
authors.forename: C
authors.initials: C
authors.lastname: Joubert
authors.forename: C
authors.initials: C
authors.lastname: Dupont-Lucas
authors.forename: R
authors.initials: R
authors.lastname: Gloro
authors.forename: E
authors.initials: E
authors.lastname: Nguyen-Khac
authors.forename: E
authors.initials: E
authors.lastname: Beaujard
authors.forename: P
authors.initials: P
authors.lastname: Mathurin
authors.forename: E
authors.initials: E
authors.lastname: Vastel
authors.forename: M
authors.initials: M
authors.lastname: Musikas
authors.forename: I
authors.initials: I
authors.lastname: Ollivier
authors.forename: M-A
authors.initials: MA
authors.lastname: Piquet
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007565:Jaundice / Q000150:complications / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome