title: Intensive Enteral Nutrition Is Ineffective for Patients With Severe Alcoholic Hepatitis Treated With Corticosteroids.
abstract: OBJECTIVE
  Severe alcoholic hepatitis (AH) is a life-threatening disease for which adequate oral nutritional support is recommended. We performed a randomized controlled trial to determine whether the combination of corticosteroid and intensive enteral nutrition therapy is more effective than corticosteroid therapy alone in patients with severe AH.
  
  
  METHODS
  We enrolled 136 heavy consumers of alcohol (age, 18-75 y) with recent onset of jaundice and biopsy-proven severe AH in our study, performed at 18 hospitals in Belgium and 2 in France, from February 2010 through February 2013. Subjects were assigned randomly (1:1) to groups that received either intensive enteral nutrition plus methylprednisolone or conventional nutrition plus methylprednisolone (controls). In the intensive enteral nutrition group, enteral nutrition was given via feeding tube for 14 days. The primary end point was patient survival for 6 months.
  
  
  RESULTS
  In an intention-to-treat analysis, we found no significant difference between groups in 6-month cumulative mortality: 44.4% of patients died in the intensive enteral nutrition group (95% confidence interval [CI], 32.2%-55.9%) and 52.1% of controls died (95% CI, 39.4%-63.4%) (P = .406). The enteral feeding tube was withdrawn prematurely from 48.5% of patients, and serious adverse events considered to be related to enteral nutrition occurred in 5 patients. Regardless of group, a greater proportion of patients with a daily calorie intake less than 21.5 kcal/kg/day died (65.8%; 95% CI, 48.8-78.4) than patients with a higher intake of calories (33.1%; 95% CI, 23.1%-43.4%) (P < .001).
  
  
  CONCLUSIONS
  In a randomized trial of patients with severe AH treated with corticosteroids, we found that intensive enteral nutrition was difficult to implement and did not increase survival. However, low daily energy intake was associated with greater mortality, so adequate nutritional intake should be a main goal for treatment. ClinicalTrials.gov number: NCT01801332.
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: Christophe.Moreno@erasme.ulb.ac.be.
authors.forename: Christophe
authors.initials: C
authors.lastname: Moreno
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Service d'Hépato-Gastroentérologie, Hôpital de Jolimont, Haine-Saint-Paul, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Deltenre
authors.affiliation: Research Center of Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Christelle
authors.initials: C
authors.lastname: Senterre
authors.affiliation: Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Lille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustot
authors.affiliation: Department of Gastroenterology, Hôpital Saint-Joseph, Liège, Belgium.
authors.forename: Boris
authors.initials: B
authors.lastname: Bastens
authors.affiliation: Department of Gastroenterology, Hôpital Ambroise Paré, Mons, Belgium.
authors.forename: Axel
authors.initials: A
authors.lastname: Hittelet
authors.affiliation: Service d'Hépatogastroentérologie, Centre Hositalier Unive de Caen, Caen, France.
authors.forename: Marie-Astrid
authors.initials: MA
authors.lastname: Piquet
authors.affiliation: Department of Liver and Biliopancreatic Disorders, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.affiliation: Department of Gastroenterology and Hepatology, Academisch Ziekenhuis Sint Jan, Brugge, Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: Orlent
authors.affiliation: Department of Hepatogastroenterology, Centre Hositalier Unive Brugmann, Brussels, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Lasser
authors.affiliation: Department of Hepatogastroenterology, Centre Hositalier Unive Saint-Pierre, Brussels, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sersté
authors.affiliation: Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Starkel
authors.affiliation: Department of Gastroenterology, Hôpital Saint-Pierre, Ottignies, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: De Koninck
authors.affiliation: Department of Gastroenterology, Hôpital Saint-Joseph, Warquignies, Belgium.
authors.forename: Sergio
authors.initials: S
authors.lastname: Negrin Dastis
authors.affiliation: Department of Hepatogastroenterology, Centre Hositalier Unive Sart Tilman, University of Liège, Liège, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Delwaide
authors.affiliation: Department of Hepatogastroenterology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Colle
authors.affiliation: Department of Gastroenterology, Hôpitaux Iris Sud, Brussels, Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: de Galocsy
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Antwerp, Edegem, Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Francque
authors.affiliation: Department of Gastroenterology, Centre Hospitalier Interrégional Edith Cavell, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Langlet
authors.affiliation: Department of Gastroenterology, CHR La Citadelle, Liège, Belgium.
authors.forename: Virginie
authors.initials: V
authors.lastname: Putzeys
authors.affiliation: Department of Hepatogastroenterology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Reynaert
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Delphine
authors.initials: D
authors.lastname: Degré
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Trépo
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001530:Belgium; D001706:Biopsy; D003131:Combined Modality Therapy; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005602:France; D006519:Hepatitis, Alcoholic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone
keywords: Cirrhosis; Ethanol; Liver Disease; Nutrients