Jj. Powell et al., Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis, BR J SURG, 87(10), 2000, pp. 1375-1381
Background: Recent evidence suggests that intestinal dysfunction has a role
in sustaining the systemic inflammatory response in acute pancreatitis and
may be ameliorated by the introduction of enteral nutrition. This study th
erefore assessed the effect of early enteral nutrition on the systemic infl
ammatory response in patients with prognostically severe acute pancreatitis
.
Methods: Patients with prognostically severe acute pancreatitis within 72 h
of disease onset were randomized to receive either enteral nutrition or co
nventional therapy consisting of a nil-by-mouth regimen. Serum interleukin
(IL) 6, soluble tumour necrosis factor receptor I (sTNFRI) and C-reactive p
rotein (CRP) were used as markers of the inflammatory response. Intestinal
function was assessed using a differential sugar permeability technique.
Results: Of 27 patients, 13 received enteral nutrition. A median of 21 (ran
ge 0-100) per cent of calorific requirements was delivered over the first 4
days by enteral nutrition. There were no significant complications of ente
ral nutrition. The introduction of enteral nutrition did not affect the ser
um concentrations of IL-6 (P = 0.28), sTNFRT (P= 0.53) or CRP (P= 0.62) ove
r the first 4 days of the study. Although there were no significant differe
nces in intestinal permeability between the two patient groups at admission
(chi(2)=2.33, d.f.=1, P=0.13), by day 4 abnormal intestinal permeability o
ccurred more frequently in patients receiving enteral nutrition (chi(2) =4.
94, d.f.=1, P=0.03).
Conclusion: Early enteral nutrition did not ameliorate the inflammatory res
ponse in patients with prognostically severe acute pancreatitis. Furthermor
e, it did not have a beneficial effect on intestinal permeability.