Nutritional Support for Acute Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PLA Institute of Hepatobiliary Surgery, Southwest Hospital;;
Southwest Hepatobiliary Surgery Hospital,Third Military Medical University, Chongqing 400038, China;

Corresponding author：

Keywords：

Acute pancreatitis; Enteral nutrition; Parenteral nutrition

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ObjectiveTo investigate the clinical advantages of enteral nutrition (EN) for acute pancreatitis（AP）comparing with parenteral nutrition (PN) and its prospect. MethodsLiteratures using MESH Browser in Medline were collected and reviewed. ResultsBeing of much higher cost and complications, total parenteral nutrition (TPN) ever regarded as most importantly for AP nutritional support, is now challenged by EN. Clinical evidence suggests enteral (jejunal) nutrition may diminish intestinal permeability to endotoxin and diminish bacterial translocation, thus reducing the cytokine drive to the generalized inflammatory response and preventing organ dysfunction, as well as achieving “pancreatic rest” equivalent to the TPN. Conclusion Early enteral nutrition should be used preferentially for patients with severe acute pancreatitis without paralytic ileus.

Citation： LIU Quanda,HE Zhenping. Nutritional Support for Acute Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(3): 306-308. doi: Copy

1.	Pupelis G, Austrums E, Jansone A, et al. Randomised trial of safety and efficacy of postoperative enteral feeding in patients with severe pancreatitis: preliminary report [J]. Eur J Surg, 2000; 166(5)∶383.
2.	AbouAssi S, O’Keefe SJ. Nutrition in acute pancreatitis [J]. J Clin Gastroenterol, 2001; 32(3)∶203.
3.	AbouAssi S, O’Keefe SJ. Nutrition support during acute pancreatitis [J]. Nutrition, 2002; 18(11-12)∶938.
4.	Scolapio JS, MalhiChowla N, Ukleja A. Nutrition supplementation in patients with acute and chronic pancreatitis [J]. Gastroenterod Clin North Am, 1999; 28(3)∶695.
5.	Boivin M, Lanspa S, Zinsmeister A, et al. Are diets associated with different rates of human interdigestive and postprandial pancreatic enzyme secretion? [J]. Gastroenterology, 1990; 99(6)∶1763.
6.	Vu MK, van der Veek PP, Frolich M, et al. Does jejunal feeding activate exocrine pancreatic secretion? [J]. Eur J Clin Invest, 1999; 29(12)∶1053.
7.	Bodoky G, Harsanyi L, Pap A, et al. Effect of enteral nutrition on exocrine pancreatic function [J]. Am J Surg, 1991; 161(1)∶144.
8.	O’Keefe SJ, Lemmer ER, Ogden JM, et al. The influence of intravenous infusions of glucose and amino acids of pancreatic enzyme and mucosal protein synthesis in human subjects [J]. JPEN J Parenter Enteral Nutr, 1998; 22 (5)∶253.
9.	Lashner BA, Kirsner JB, Hanauer SB. Acute pancreatitis associated with highconcentration lipid emulsion during total parenteral nutrition therapy for Crohn’s disease [J]. Gastroenterology, 1986; 90(4)∶1039.
10.	Kotani J, Usami M, Nomura H, et al. Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis [J]. Arch Surg, 1999; 134(3)∶287.
11.	HernandezAranda JC, GalloChico B, RamirezBarba EJ. Nutrition support in severe acute pancreatitis. Controlled clinical trial [J]. Nutr Hosp, 1996; 11(3)∶160.
12.	Olah A, Pardavi G, Belagyi T. Early jejunal feeding in acute pancreatitis: prevention of septic complications and multiorgan failure [J]. Magy Seb, 2000; 53(1)∶7.
13.	Sahin M, Ozer S, Vatansev C, et al. The impact of oral feeding on the severity of acute pancreatitis [J]. Am J Surg,1999; 178(5)∶394.
14.	Nakad A, Piessevaux H, Marot JC, et al. Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube [J]. Pancreas, 1998; 17(2)∶187.
15.	Winter TA, Marks T, Callanan M, et al. Impaired pancreatic secretion in severely malnourished patients is a consequence of primary pancreatic dysfunction [J]. Nutrition, 2001; 17(3)∶230.
16.	Lightner AM, Kirkwood KS. Pathophysiology of gallstone pancreatitis [J]. Front Biosci, 2001; 6∶ E66.
17.	Eatock FC, Brombacher GD, Steven A, et al. Nasogastric feeding in severe acute pancreatitis may be practical and safe [J]. Int J Pancreatol, 2000; 28(1)∶23.
18.	吴承堂, 黎沾良. 急性坏死性胰腺炎犬肠道菌群的变化 [J]. 中国普外基础与临床杂志, 1999; 6(3)∶131.
19.	Fong YM, Marano MA, Barber A, et al. Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans [J]. Ann Surg, 1989; 210(4)∶449.
20.	McClave SA, Greene LM, Snider HL, et al. Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis [J]. JPEN J Parenter Enteral Nutr， 1997; 21(1)∶14.
21.	Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis [J]. Gut, 1998; 42(3)∶431.
22.	Kalfarentzos F, Kehagias J, Mead N, et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial [J]. Br J Surg, 1997; 84(12)∶1665.
23.	Powell JJ, Murchison JT, Fearon KC, et al. Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis [J]. Br J Surg, 2000; 87(10)∶1375.
24.	陈丽莉, 朱捷. 急性出血坏死性胰腺炎术后早期实施肠内营养的临床研讨 [J]. 中国普外基础与临床杂志, 1999; 6(6)∶355.
25.	陈强谱. 急性胰腺炎的肠内营养 [J]. 中华肝胆外科杂志, 2001; 7 (9)∶521.
26.	陈晓理, 冯凯祥. 肠道动力学改变在急性胰腺炎的病程及治疗中的意义 [J]. 中国普外基础与临床杂志, 1999; 6(6)∶325.
27.	Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis [J]. Br J Surg, 2000; 87(6)∶695.

1. Pupelis G, Austrums E, Jansone A, et al. Randomised trial of safety and efficacy of postoperative enteral feeding in patients with severe pancreatitis: preliminary report [J]. Eur J Surg, 2000; 166(5)∶383.
2. AbouAssi S, O’Keefe SJ. Nutrition in acute pancreatitis [J]. J Clin Gastroenterol, 2001; 32(3)∶203.
3. AbouAssi S, O’Keefe SJ. Nutrition support during acute pancreatitis [J]. Nutrition, 2002; 18(11-12)∶938.
4. Scolapio JS, MalhiChowla N, Ukleja A. Nutrition supplementation in patients with acute and chronic pancreatitis [J]. Gastroenterod Clin North Am, 1999; 28(3)∶695.
5. Boivin M, Lanspa S, Zinsmeister A, et al. Are diets associated with different rates of human interdigestive and postprandial pancreatic enzyme secretion? [J]. Gastroenterology, 1990; 99(6)∶1763.
6. Vu MK, van der Veek PP, Frolich M, et al. Does jejunal feeding activate exocrine pancreatic secretion? [J]. Eur J Clin Invest, 1999; 29(12)∶1053.
7. Bodoky G, Harsanyi L, Pap A, et al. Effect of enteral nutrition on exocrine pancreatic function [J]. Am J Surg, 1991; 161(1)∶144.
8. O’Keefe SJ, Lemmer ER, Ogden JM, et al. The influence of intravenous infusions of glucose and amino acids of pancreatic enzyme and mucosal protein synthesis in human subjects [J]. JPEN J Parenter Enteral Nutr, 1998; 22 (5)∶253.
9. Lashner BA, Kirsner JB, Hanauer SB. Acute pancreatitis associated with highconcentration lipid emulsion during total parenteral nutrition therapy for Crohn’s disease [J]. Gastroenterology, 1986; 90(4)∶1039.
10. Kotani J, Usami M, Nomura H, et al. Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis [J]. Arch Surg, 1999; 134(3)∶287.
11. HernandezAranda JC, GalloChico B, RamirezBarba EJ. Nutrition support in severe acute pancreatitis. Controlled clinical trial [J]. Nutr Hosp, 1996; 11(3)∶160.
12. Olah A, Pardavi G, Belagyi T. Early jejunal feeding in acute pancreatitis: prevention of septic complications and multiorgan failure [J]. Magy Seb, 2000; 53(1)∶7.
13. Sahin M, Ozer S, Vatansev C, et al. The impact of oral feeding on the severity of acute pancreatitis [J]. Am J Surg,1999; 178(5)∶394.
14. Nakad A, Piessevaux H, Marot JC, et al. Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube [J]. Pancreas, 1998; 17(2)∶187.
15. Winter TA, Marks T, Callanan M, et al. Impaired pancreatic secretion in severely malnourished patients is a consequence of primary pancreatic dysfunction [J]. Nutrition, 2001; 17(3)∶230.
16. Lightner AM, Kirkwood KS. Pathophysiology of gallstone pancreatitis [J]. Front Biosci, 2001; 6∶ E66.
17. Eatock FC, Brombacher GD, Steven A, et al. Nasogastric feeding in severe acute pancreatitis may be practical and safe [J]. Int J Pancreatol, 2000; 28(1)∶23.
18. 吴承堂, 黎沾良. 急性坏死性胰腺炎犬肠道菌群的变化 [J]. 中国普外基础与临床杂志, 1999; 6(3)∶131.
19. Fong YM, Marano MA, Barber A, et al. Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans [J]. Ann Surg, 1989; 210(4)∶449.
20. McClave SA, Greene LM, Snider HL, et al. Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis [J]. JPEN J Parenter Enteral Nutr， 1997; 21(1)∶14.
21. Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis [J]. Gut, 1998; 42(3)∶431.
22. Kalfarentzos F, Kehagias J, Mead N, et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial [J]. Br J Surg, 1997; 84(12)∶1665.
23. Powell JJ, Murchison JT, Fearon KC, et al. Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis [J]. Br J Surg, 2000; 87(10)∶1375.
24. 陈丽莉, 朱捷. 急性出血坏死性胰腺炎术后早期实施肠内营养的临床研讨 [J]. 中国普外基础与临床杂志, 1999; 6(6)∶355.
25. 陈强谱. 急性胰腺炎的肠内营养 [J]. 中华肝胆外科杂志, 2001; 7 (9)∶521.
26. 陈晓理, 冯凯祥. 肠道动力学改变在急性胰腺炎的病程及治疗中的意义 [J]. 中国普外基础与临床杂志, 1999; 6(6)∶325.
27. Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis [J]. Br J Surg, 2000; 87(6)∶695.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Nutritional Support for Acute Pancreatitis

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