title: [Intravenous glutamine and early nasojejunal nutrition in severe acute pancreatitis -- a prospective randomized clinical study].
abstract: BACKGROUND
  Severe acute pancreatitis (SAP) is still one of the great challenges in gastro-intestinal surgery. According to recent studies, intravenously administered glutamine with total parenteral nutrition may be beneficial in the prevention of infectious complications and may reduce mortality rate. However, it has not been investigated yet, whether i.v. glutamine is able to achieve the same effect with early enteral nutrition as well.
  
  
  OBJECTIVE
  The objective of our prospective randomized double-blind study was to explore the effects of intravenously administered glutamine with early nasojejunal nutrition in severe acute pancreatitis.
  
  
  METHODS
  Forty-five patients with severe acute pancreatitis (with a Glasgow score at least 3 and/or a CRP level above 150 mg/ml on admission) were randomized into two groups. Group Glutamine (n = 24) was given 0.5 g/kg/die glutamine intravenously, while the control group (n = 21) received normal amino acid solution in the same quantity for 7 days. Nasojejunal nutrition was introduced 48 hours after admission in case of all patients, and their management was the same in every other aspect, too. The primary end-points of the study were the rate of pancreas-specific infectious complications and organ failure, and the secondary end-points were the necessity for radiological and surgical interventions, length of hospital stay and mortality rate.
  
  
  RESULTS
  In group Glutamine, infected acute peripancreatic fluid collections (APFC) were detected in 4 patients, 2 patients had post-necrotic pancreatic/peripancreatic fluid collections (PNPFC), 2 patients had infected pseudocysts and 2 patients had walled-off pancreatic necrosis (WOPN). Ten patients were cured by ultrasound assisted puncture or drainage successfully. No surgical intervention was necessary. In the control group, 4 patients had infected APFC, 2 patients had infected PNPFC, infected pseudocysts and infected WOPN were diagnosed in 3 cases. Radiological intervention was effective in 9 cases, but 3 patients needed surgery. Three patients died of multi-organ failure, thus the mortality rate of the control group was 14%, while the mortality rate of the Glutamine group was zero. The mean hospital stay of the Glutamine group was 10.6 days, which is significantly shorter than the mean hospital stay of the control group, which was 15.9 days (p = 0.00104).
  
  
  CONCLUSIONS
  The results of the Glutamine group are better in every end-points, however, statistically significant difference was detected in one parameter only, the length of hospital stay.
authors.affiliation: Petz Aladár Megyei Oktatókórház Sebészeti Osztály 9023 Győr Vasvári. kajda@freemail.hu
authors.forename: Nóra
authors.initials: N
authors.lastname: Hajdú
authors.forename: Tibor
authors.initials: T
authors.lastname: Belágyi
authors.forename: Akos
authors.initials: A
authors.lastname: Issekutz
authors.forename: Péter
authors.initials: P
authors.lastname: Bartek
authors.forename: Béla
authors.initials: B
authors.lastname: Gartner
authors.forename: Attila
authors.initials: A
authors.lastname: Oláh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D004322:Drainage; D004750:Enteral Nutrition; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007441:Intubation, Gastrointestinal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D011677:Punctures; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D005973:Glutamine