Nutritional support in patients with acute pancreatitis. Review of published studies
DOI:
https://doi.org/10.30978/GS-2024-1-70Keywords:
acute pancreatitis, nutritional support, enteral nutrition, complicationsAbstract
Acute pancreatitis is a common disease that occurs in 5—10% of patients with urgent pathology of the abdominal cavity. The most prevalent metabolic disorders affecting this group of patients are hypermetabolism and hypercatabolism syndromes, which are accompanied by excessive consumption of carbohydrates, fats, and amino acids, increased oxygen intake, and carbon dioxide production.
Objective — to analyse the current state of the problem of nutritional support for patients with acute pancreatitis.
The degree of nutritional disorders in patients with acute pancreatitis varies depending on the etiological factors and severity of the disease, necessitating a differential approach to their correction. Patients with acute pancreatitis experience disruption of the intestinal microflora due to the antibiotic therapy, nutrient and fiber deficiency, and lack of microbial antagonism. This disruption leads to excessive growth of bacteria, particularly gram‑negative microflora. The effectiveness and safety of enteral tube feeding are determined by a complex of factors: the timing of recovery of peristalsis and the absorption function of the intestinal wall, the type of mixture, and the method of its administration. Restoration of intestinal absorption in patients with severe acute pancreatitis occurs on average 48 hours after the start of complex conservative therapy. The use of antiflatulents as part of a mixture for enteral nutrition allows to improve the laboratory indicators of blood serum and reduce the frequency of intestinal complications on the 7th day by 21.5% (χ2=4.88, 95% CI 2.3—39.5, p=0.03). Nasogastric nutritional support in patients with severe acute pancreatitis is safe and leads to a 25.8% reduction in the incidence of local infectious complications (χ2=4.59, 95% CI 2.43—45.53, p=0.03), length of hospital stay by 16 days (p=0.04), and deaths by 21.4% (χ2=4.13, 95% CI 0.81—39.68, p=0.04) in comparison with parenteral nutrition. Nutritional support should be started with nasogastric administration of a food mixture, and in case of complications (intolerance, aspiration, etc.), nasojejunal administration. Parenteral nutrition should be used if enteral nutrition is impossible or not tolerated.
References
Abu-El-Haija M, Kumar S, Quiros JA, Balakrishnan K, Barth B, Bitton S, Eisses JF, Foglio EJ, Fox V, Francis D, Freeman AJ, Gonska T, Grover AS, Husain SZ, Kumar R, Lapsia S, Lin T, Liu QY, Maqbool A, Sellers ZM, Szabo F, Uc A, Werlin SL, Morinville VD. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):159-76. http://doi.org/10.1097/MPG.0000000000001715.
Arvanitakis M, Ockenga J, Bezmarevic M, Gianotti L, Krznarić Ž, Lobo DN, Löser C, Madl C, Meier R, Phillips M, Rasmussen HH, Van Hooft JE, Bischoff SC. ESPEN Guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2020 Mar;39(3):612-631. http://doi.org/10.1016/j.clnu.2020.01.004.
Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN Guideline on home enteral nutrition. Clin Nutr. 2020 Jan;39(1):5-22. http://doi.org/10.1016/j.clnu.2019.04.022.
Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN Practical Guideline: Home enteral nutrition. Clin Nutr. 2022 Feb;41(2):468-88. http://doi.org/10.1016/j.clnu.2021.10.018. Epub 2021 Nov 24. PMID: 35007816.
Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014 Jul 14;20(26):8505-24. http://doi.org/10.3748/wjg.v20.i26.8505.
Calder N, Walsh K, Olupot-Olupot P, et al. Modifying gut integrity and microbiome in children with severe acute malnutrition using legume-based feeds (MIMBLE): A pilot trial. Cell Rep Med. 2021 May 18;2(5):100280. http://doi.org/10.1016/j.xcrm.2021.100280.
Cañamares-Orbís P, García-Rayado G, Alfaro-Almajano E. Nutritional Support in Pancreatic Diseases. Nutrients. 2022 Oct 31;14(21):4570. http://doi.org/10.3390/nu14214570.
Chandankhede SR, Kulkarni AP. Acute intestinal failure. Indian J Crit Care Med. 2020 Sep;24(Suppl 4):S168-S174. http://doi.org/10.5005/jp-journals-10071-23618.
Cho J, Petrov MS. Pancreatitis, pancreatic cancer, and their metabolic sequelae: Projected Burden to 2050. Clin Transl Gastroenterol. 2020 Nov;11(11):e00251. http://doi.org/10.14309/ctg.0000000000000251.
Cole S, Wakeham M, Werlin S, Goday PS. Classification and nutrition management of acute pancreatitis in the pediatric intensive care unit. J Pediatr Gastroenterol Nutr. 2018 Dec;67(6):755-9. http://doi.org/10.1097/MPG.0000000000002147.
Colvin SD, Smith EN, Morgan DE, Porter KK. Acute pancreatitis: an update on the revised Atlanta classification. Abdom Radiol (NY). 2020 May;45(5):1222-31. http://doi.org/10.1007/s00261-019-02214-w.
Dumnicka P, Maduzia D, Ceranowicz P, Olszanecki R, Drożdż R, Kuśnierz-Cabala B. The interplay between inflammation, coagulation and endothelial injury in the early phase of acute pancreatitis: clinical implications. Int J Mol Sci. 2017 Feb 8;18(2):354. http://doi.org/10.3390/ijms18020354.
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. http://doi.org/10.1002/14651858.CD010582.pub2.
Freitas LA, Fagundes AL, do Prado PR, Pereira MCA, de Medeiros AP, de Freitas LM, Teixeira TCA, Koepp J, de Carvalho REFL, Gimenes FRE. Factors associated with length of stay and death in tube-fed patients: A cross-sectional multicentre study. Nurs Open. 2021 Sep;8(5):2509-2519. http://doi.org/10.1002/nop2.774. Epub 2021 Jan 27. PMID: 33503335; PMCID: PMC8363365.
González-Salazar LE, Guevara-Cruz M, Serralde-Zúñiga AE. Medical and nutritional treatment in adult patients with acute intestinal failure. Rev Clin Esp (Barc). 2019 Apr;219(3):151-60. English, Spanish. http://doi.org/10.1016/j.rce.2018.08.003.
Guo Y, Cheng J, Li Y. [Influence of enteral nutrition initiation timing on curative effect and prognosis of acute respiratory distress syndrome patients with mechanical ventilation]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jun;30(6):573-77. Chinese. https://pubmed.ncbi.nlm.nih.gov/30009734/.
Hałasa M, Maciejewska-Markiewicz D, Baśkiewicz-Hałasa M, Safranow K, Stachowska E. Post-delivery milking delay influence on the effect of oral supplementation with bovine colostrum as measured with intestinal permeability test. Medicina (Kaunas). 2020 Sep 24;56(10):495. http://doi.org/10.3390/medicina56100495.
Huang LP, Jin SF, Jiang RL. Nutritional management of severe acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2022 Dec;21(6):603-4. http://doi.org/10.1016/j.hbpd.2022.06.015.
Jabłońska B, Mrowiec S. Nutritional support in patients with severe acute pancreatitis-current standards. Nutrients. 2021 Apr 28;13(5):1498. http://doi.org/10.3390/nu13051498.
Jin Y, Bai Y, Li Q, et al. Reduced pancreatic exocrine function and organellar disarray in a canine model of acute pancreatitis. PLoS One. 2016 Feb 19;11(2):e0148458. http://doi.org/10.1371/journal.pone.0148458.
Jin Z, Wang Z, Wang J. Early enteral nutrition prevent acute pancreatitis from deteriorating in obese patients. J Clin Gastroenterol. 2020 Feb;54(2):184-91. http://doi.org/10.1097/MCG.0000000000001117.
Kolosovych IV, Bezrodnyi BH, Hanol IV, Cherepenko IV. Stage approach in surgical treatment of acute pancreatitis. Med. perspekt. 2020Jul.1;25(2):124-9. https://doi.org/10.26641/2307-0404.2020.2.206384.
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. http://doi.org/10.26724/2079-8334-2021-4-78-75-79.
Krishnan K. Nutritional management of acute pancreatitis. Curr Opin Gastroenterol. 2017 Mar;33(2):102-6. http://doi.org/10.1097/MOG.0000000000000340.
Lakananurak N, Gramlich L. Nutrition management in acute pancreatitis: Clinical practice consideration. World J Clin Cases. 2020 May 6;8(9):1561-73. http://doi.org/10.12998/wjcc.v8.i9.1561.
Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, Ball CG, Parry N, Sartelli M, Wolbrink D, van Goor H, Baiocchi G, Ansaloni L, Biffl W, Coccolini F, Di Saverio S, Kluger Y, Moore E, Catena F. 2019 WSES Guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019 Jun 13;14-27. http://doi.org/10.1186/s13017-019-0247-0.
Li H, Yang Z, Tian F. Risk factors associated with intolerance to enteral nutrition in moderately severe acute pancreatitis: A retrospective study of 568 patients. Saudi J Gastroenterol. 2019 Nov-Dec;25(6):362-8. http://doi.org/10.4103/sjg.SJG_550_18.
Li XY, He C, Zhu Y, Lu NH. Role of gut microbiota on intestinal barrier function in acute pancreatitis. World J Gastroenterol. 2020 May 14;26(18):2187-2193. http://doi.org/10.3748/wjg.v26.i18.2187. PMID: 32476785; PMCID: PMC7235204.
Liang XY, Jia TX, Zhang M. Intestinal bacterial overgrowth in the early stage of severe acute pancreatitis is associated with acute respiratory distress syndrome. World J Gastroenterol. 2021 Apr 21;27(15):1643-54. http://doi.org/10.3748/wjg.v27.i15.1643.
Limketkai BN, Shah ND, Sheikh GN, Allen K. Classifying Enteral Nutrition: Tailored for Clinical Practice. Curr Gastroenterol Rep. 2019 Jul 31;21(9):47. http://doi.org/10.1007/s11894-019-0708-3.
Lin J, Lv C, Wu C, et al. Incidence and risk factors of nasogastric feeding intolerance in moderately-severe to severe acute pancreatitis. BMC Gastroenterol. 2022 Jul 2;22(1):327. http://doi.org/10.1186/s12876-022-02403-w.
Liu J, Huang L, Luo M, Xia X. Bacterial translocation in acute pancreatitis. Crit Rev Microbiol. 2019 Sep-Nov;45(5-6):539-47. http://doi.org/10.1080/1040841X.2019.1621795.
Lu XM, Jia DS, Wang R, Yang Q, Jin SS, Chen L. Development of a prediction model for enteral feeding intolerance in intensive care unit patients: A prospective cohort study. World J Gastrointest Surg. 2022 Dec 27;14(12):1363-74. http://doi.org/10.4240/wjgs.v14.i12.1363.
Ma N, Shen M, Wan Z, Pan S, Liu X, Yao Z. [Impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation: a prospective randomized controlled study]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Feb;30(2):176-180. Chinese. http://doi.org/10.3760/cma.j.issn.2095-4352.2018.02.016.
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA, Gervasio JM, Sacks GS, Roberts PR, Compher C; Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A. S.P. E.N.). JPEN J Parenter Enteral Nutr. 2016 Feb;40(2):159-211. http://doi.org/10.1177/0148607115621863.
Mehta NM, Skillman HE, Irving SY, Coss-Bu JA, Vermilyea S, Farrington EA, McKeever L, Hall AM, Goday PS, Braunschweig C. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017 Jul;41(5):706-42. http://doi.org/10.1177/0148607117711387.
O’keefe SJ, Lee RB, Li J, Zhou W, Stoll B, Dang Q. Trypsin and splanchnic protein turnover during feeding and fasting in human subjects. Am J Physiol Gastrointest Liver Physiol. 2006 Feb;290(2):G213-21. http://doi.org/10.1152/ajpgi.00170.2005.
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. http://doi.org/10.1038/ctg.2017.39. PMID: 28771242; PMCID: PMC5587840.
Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol. 2019 Mar;16(3):175-84. http://doi.org/10.1038/s41575-018-0087-5.
Qiu C, Chen C, Zhang W, Kou Q, Wu S, Zhou L, Liu J, Ma G, Chen J, Chen M, Luo H, Zhang X, Lai J, Yu Z, Yu X, Liao W, Guan X, Ouyang B. Fat-Modified Enteral Formula Improves Feeding Tolerance in Critically Ill Patients: A Multicenter, Single-Blind, Randomized Controlled Trial. JPEN J Parenter Enteral Nutr. 2017 Jul;41(5):785-95. http://doi.org/10.1177/0148607115601858.
Rai A, Anandhi A, Sureshkumar S, Kate V. Hunger-Based Versus Conventional Oral Feeding in Moderate and Severe Acute Pancreatitis: A Randomized Controlled Trial. Dig Dis Sci. 2022 Jun;67(6):2535-2542. http://doi.org/10.1007/s10620-021-06992-6. Epub 2021 Apr 30. PMID: 33939143; PMCID: PMC8090517.
Reintam Blaser A, Preiser JC, Fruhwald S, Wilmer A, Wernerman J, Benstoem C, Casaer MP, Starkopf J, van Zanten A, Rooyackers O, Jakob SM, Loudet CI, Bear DE, Elke G, Kott M, Lautenschläger I, Schäper J, Gunst J, Stoppe C, Nobile L, Fuhrmann V, Berger MM, Oudemans-van Straaten HM, Arabi YM, Deane AM; Working Group on Gastrointestinal Function within the Section of Metabolism, Endocrinology and Nutrition (MEN Section) of ESICM. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. Crit Care. 2020 May 15;24(1):224. http://doi.org/10.1186/s13054-020-02889-4.
Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, Fruhwald S, Hiesmayr M, Ichai C, Jakob SM, Loudet CI, Malbrain ML, Montejo González JC, Paugam-Burtz C, Poeze M, Preiser JC, Singer P, van Zanten AR, De Waele J, Wendon J, Wernerman J, Whitehouse T, Wilmer A, Oudemans-van Straaten HM; ESICM Working Group on Gastrointestinal Function. Early enteral nutrition in critically ill patients: ESICM Clinical Practice Guidelines. Intensive Care Med. 2017 Mar;43(3):380-98. http://doi.org/10.1007/s00134-016-4665-0.
Rinninella E, Annetta MG, Serricchio ML, Dal Lago AA, Miggiano GA, Mele MC. Nutritional support in acute pancreatitis: from physiopathology to practice. An evidence-based approach. Eur Rev Med Pharmacol Sci. 2017 Jan;21(2):421-32. PMID: 28165542.
Roberts KM, Nahikian-Nelms M, Ukleja A, Lara LF. Nutritional aspects of acute pancreatitis. Gastroenterol Clin North Am. 2018 Mar;47(1):77-94. http://doi.org/10.1016/j.gtc.2017.10.002.
Ruperto M, Montero-Bravo A, Partearroyo T, Puga AM, Varela-Moreiras G, Samaniego-Vaesken ML. A Descriptive Analysis of Macronutrient, Fatty Acid Profile, and Some Immunomodulatory Nutrients in Standard and Disease-Specific Enteral Formulae in Europe. Front Nutr. 2022 May 10;9:877875. http://doi.org/10.3389/fnut.2022.877875. PMID: 35619966; PMCID: PMC9129913.
Saluja A, Dudeja V, Dawra R, Sah RP. Early intra-acinar events in pathogenesis of pancreatitis. Gastroenterology. 2019 May;156(7):1979-93. http://doi.org/10.1053/j.gastro.2019.01.268.
Seminerio J, O’Keefe SJ. Jejunal feeding in patients with pancreatitis. Nutr Clin Pract. 2014 Jun;29(3):283-6. http://doi.org/10.1177/0884533614529164.
Shi N, Li N, Duan X, Niu H. Interaction between the gut microbiome and mucosal immune system. Mil Med Res. 2017 Apr 27;4:14. http://doi.org/10.1186/s40779-017-0122-9.
Singh P, Garg PK. Pathophysiological mechanisms in acute pancreatitis: Current understanding. Indian J Gastroenterol. 2016 May;35(3):153-66. http://doi.org/10.1007/s12664-016-0647-y.
Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R. Acute Pancreatitis: Diagnosis and Treatment. Drugs. 2022 Aug;82(12):1251-1276. http://doi.org/10.1007/s40265-022-01766-4. Epub 2022 Sep 8. PMID: 36074322; PMCID: PMC9454414.
Tao Y, Tang C, Feng W, Bao Y, Yu H. Early nasogastric feeding versus parenteral nutrition in severe acute pancreatitis: A retrospective study. Pak J Med Sci. 2016 Nov-Dec;32(6):1517-21. http://doi.org/10.12669/pjms.326.11278.
Tempero MA. NCCN Guidelines Updates: Pancreatic Cancer. J Natl Compr Canc Netw. 2019 May 1;17(5.5):603-5. https://pubmed.ncbi.nlm.nih.gov/31117041/.
Thantry AN, Urooj A, Halumathigatta Nagappa D. Screening of malnutrition using Patient-Generated Subjective Global Assessment tool and hand muscle strength in subjects with pancreatitis. Chronic Dis Transl Med. 2022 Oct 13;8(4):314-21. http://doi.org/10.1002/cdt3.48.
Wanden-Berghe C, Patino-Alonso MC, Galindo-Villardón P, Sanz-Valero J. Complications Associated with Enteral Nutrition: CAFANE Study. Nutrients. 2019 Sep 1;11(9):2041. http://doi.org/10.3390/nu11092041.
Wang C, Li Q, Ren J. Microbiota-immune interaction in the pathogenesis of gut-derived infection. Front Immunol. 2019 Aug 7;10:1873. http://doi.org/10.3389/fimmu.2019.01873.
Yang AL. Nutrition and Acute Pancreatitis. J Clin Med. 2021 Feb 18;10(4):836. http://doi.org/10.3390/jcm10040836. PMID: 33670647; PMCID: PMC7922255.
Yasuda H, Kondo N, Yamamoto R, Asami S, Abe T, Tsujimoto H, Tsujimoto Y, Kataoka Y. Monitoring of gastric residual volume during enteral nutrition. Cochrane Database Syst Rev. 2021 Sep 27;9(9):CD013335. http://doi.org/10.1002/14651858.CD013335.pub2. PMID: 34596901; PMCID: PMC8498989.
Ye S, Si C, Deng J, Chen X, Kong L, Zhou X, Wang W. Understanding the Effects of Metabolites on the Gut Microbiome and Severe Acute Pancreatitis. Biomed Res Int. 2021 Oct 19;2021:1516855. http://doi.org/10.1155/2021/1516855. PMID: 34712726; PMCID: PMC8548099.
Yu S, Xiong Y, Xu J, Liang X, Fu Y, Liu D, Yu X, Wu D. Identification of Dysfunctional Gut Microbiota Through Rectal Swab in Patients with Different Severity of Acute Pancreatitis. Dig Dis Sci. 2020 Nov;65(11):3223-3237. http://doi.org/10.1007/s10620-020-06061-4. Epub 2020 Feb 19. PMID: 32076933.
Zhang H, Li L, Wu J, Xu W, Wu J. Enteral nutrition preparations for blood glucose variability and prognosis for severe acute pancreatitis with stress hyperglycemia. Altern Ther Health Med. 2023 Jan;29(1):163-9. PMID: 36074968.
Zhao H, Han Y, Peng KR, Luo YY, Yu JD, Fang YH, Chen J, Lou JG. Nasogastric or nasojejunal feeding in pediatric acute pancreatitis: a randomized controlled trial. World J Pediatr. 2021 Oct;17(5):536-543. http://doi.org/10.1007/s12519-021-00441-0. Epub 2021 Jul 12. PMID: 34254272.
Zhong Y, Yu Z, Wang L, Yang X. Combined detection of procalcitonin, heparin-binding protein, and interleukin-6 is a promising assay to diagnose and predict acute pancreatitis. J Clin Lab Anal. 2021 Aug;35(8):e23869. http://doi.org/10.1002/jcla.23869.
Zhou W, Ruksakulpiwat S, Fan Y, Ji L. Nutritional Interventions on Physical Functioning for Critically Ill Patients: An Integrative Review. J Multidiscip Healthc. 2021 Jun 18;14:1489-507. http://doi.org/10.2147/JMDH.S314132.
Zhu Y, He C, Li X, Cai Y, Hu J, Liao Y, Zhao J, Xia L, He W, Liu L, Luo C, Shu X, Cai Q, Chen Y, Lu N. Gut microbiota dysbiosis worsens the severity of acute pancreatitis in patients and mice. J Gastroenterol. 2019 Apr;54(4):347-358. http://doi.org/10.1007/s00535-018-1529-0. Epub 2018 Dec 5. PMID: 30519748.
Zou M, Yang Z, Fan Y, Gong L, Han Z, Ji L, Hu X, Wu D. Gut microbiota on admission as predictive biomarker for acute necrotizing pancreatitis. Front Immunol. 2022 Aug 29;13:988326. http://doi.org/10.3389/fimmu.2022.988326. PMID: 36105818; PMCID: PMC9466706.
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