Relevance. Early onset of enteral nutrition (up to 48 hours after hospitalization) in patients with severe acute pancreatitis is associated with a 24% reduction in infectious complications and a 32% reduction in mortality. Data on the possibility of nasogastric tube feeding remain contradictory.
Objective: comparison of the effectiveness and safety of nasogastric administration of food mixtures in patients with severe acute pancreatitis.
Methods. The study included 103 patients with severe acute pancreatitis, which were divided depending on the characteristics of the chosen treatment tactics into three groups: based group (nasogastric nutrition was performed) - 34 patients, comparison group #1 (standard enteral nutrition) - 33 patients and comparison group #2 (parenteral nutrition) - 36 patients. To analyze the effectiveness of nutritional support in the study groups after 7 and 14 days from the beginning of treatment, the level of laboratory parameters was assessed, the incidence of local complications, mortality, duration of multiorgan failure and hospital stay were analyzed.
Results. After 7 and 14 days of nutritional support, a significant difference was found between total protein, albumin, creatinine, urea, cholesterol, glucose and serum Na + (p<0.05) between patients in the main group and comparison group #2, with the level of cholesterol, K + and Na + corresponded to the norm in both groups. There was also a significant difference in the incidence of infected local complications of severe acute pancreatitis in the main group and comparison group #2 - 35.3% and 61.1%, respectively (χ2=4.59, 95% CI 2.43-45.53, p=0.03), duration of multiorgan failure - 12.2±1.7 [8-16] days and 15.3±1.1 [13-18] days, respectively (p<0.001), duration of hospital stay - 55.5±30.5 [27-124] days and 71.5±35.9 [35-148] days, respectively (p=0.04) and fatalities - 14.7% and 36.1%, respectively (χ2=4.13, 95 % CI 0.81-39.68, p=0.04). When comparing these indicators between the main group and the comparison group #1 no significant difference was obtained (p>0.05).
Conclusions. Nasogastric nutrition is an effective and safe method of administration of mixtures in patients with severe acute pancreatitis and can be considered as an alternative to enteral nutrition.
Kolosovych IV, Hanol IV, Cherepenko IV, Lebedieva KO, Korolova KO. Intrabdominal pressure and its correction in acute surgical pathology. Wiad Lek. 2022;75(2):372-376. DOI: 10.36740/WLek202202108.
Jabłońska B, Mrowiec S. Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards. Nutrients. 2021 Apr 28;13(5):1498. DOI: 10.3390/nu13051498.
Publisher Site: https://www.mdpi.com/2072-6643/13/5/1498
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145288/
Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol. 2019 Mar;16(3):175-184. DOI: 10.1038/s41575-018-0087-5.
Publisher Site: https://www.nature.com/articles/s41575-018-0087-5
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597260/
O'Keefe SJD, Rakitt T, Ou J, El Hajj II, Blaney E, Vipperla K, Holst JJ, Rehlfeld J. Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity. Clin Transl Gastroenterol. 2017 Aug 3;8(8):e112. DOI: 10.1038/ctg.2017.39.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587840/
Jin Y, Bai Y, Li Q, Bhugul PA, Huang X, Liu L, Pan L, Ni H, Chen B, Sun H, Zhang Q, Hehir M, Zhou M. Reduced Pancreatic Exocrine Function and Organellar Disarray in a Canine Model of Acute Pancreatitis. PLoS One. 2016 Feb 19;11(2):e0148458. DOI: 10.1371/journal.pone.0148458.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760769/
O'Keefe SJ, Lee RB, Li J, Stevens S, Abou-Assi S, Zhou W. Trypsin secretion and turnover in patients with acute pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2005 Aug; 289(2):G181-7. DOI: 10.1152/ajpgi.00297.2004.
Kolosovych IV, Hanol IV, Cherepenko IV. Enteral tube feeding in acute pancreatitis and its complications. World of Medicine and Biology. 2021; 4(78):75-9. DOI: 10.26724/2079-8334-2021-4-78-75-79
Publisher Site: https://womab.com.ua/en/smb-2021-04/9161
Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN; American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology. 2018 Mar; 154(4):1096-1101. DOI: 10.1053/j.gastro.2018.01.032. PMID: 29409760.
Lakananurak N, Gramlich L. Nutrition management in acute pancreatitis: Clinical practice consideration. World J Clin Cases. 2020 May 6; 8(9):1561-1573. DOI: 10.12998/wjcc.v8.i9.1561.
Publisher Site: https://www.wjgnet.com/2307-8960/full/v8/i9/1561.htm
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211526/
Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014 Jul 14; 20(26):8505-24. DOI: 10.3748/wjg.v20.i26.8505.
Publisher Site: https://www.wjgnet.com/1007-9327/full/v20/i26/8505.htm
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093701/
Chang YS, Fu HQ, Xiao YM, Liu JC. Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis: a meta-analysis. Crit Care. 2013 Jun 20; 17(3):R118. DOI: 10.1186/cc12790.
Publisher Site: https://ccforum.biomedcentral.com/articles/10.1186/cc12790
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057382/
Dutta AK, Goel A, Kirubakaran R, Chacko A, Tharyan P. Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis. Cochrane Database Syst Rev. 2020 Mar 26; 3(3):CD010582. DOI: 10.1002/14651858.CD010582.pub2.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098540/
This work is licensed under a Creative Commons Attribution 4.0 International License.