Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 1998 Mar;42(3):431-5.
doi: 10.1136/gut.42.3.431.

Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis

A C Windsor  1 , S Kanwar, A G Li, E Barnes, J A Guthrie, J I Spark, F Welsh, P J Guillou, J V Reynolds
Affiliations
Clinical Trial

Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis

A C Windsor et al. Gut. 1998 Mar.

Abstract

Background: In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of systemic inflammatory response syndrome (SIRS) and sepsis.

Aims: To determine whether TEN can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis.

Methods: Glasgow score, Apache II, computed tomography (CT) scan score, C reactive protein (CRP), serum IgM antiendotoxin antibodies (EndoCAb), and total antioxidant capacity (TAC) were determined on admission in 34 patients with acute pancreatitis. Patients were stratified according to disease severity and randomised to receive either TPN or TEN for seven days and then re-evaluated.

Results: SIRS, sepsis, organ failure, and ITU stay, were globally improved in the enterally fed patients. The acute phase response and disease severity scores were significantly improved following enteral nutrition (CRP: 156 (117-222) to 84 (50-141), p < 0.005; APACHE II scores 8 (6-10) to 6 (4-8), p < 0.0001) without change in the CT scan scores. In parenterally fed patients these parameters did not change but there was an increase in EndoCAb antibody levels and a fall in TAC. Enterally fed patients showed no change in the level of EndoCAb antibodies and an increase in TAC.

Conclusion: TEN moderates the acute phase response, and improves disease severity and clinical outcome despite unchanged pancreatic injury on CT scan. Reduced systemic exposure to endotoxin and reduced oxidant stress also occurred in the TEN group. Enteral feeding modulates the inflammatory and sepsis response in acute pancreatitis and is clinically beneficial.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The study protocol, divided into four study periods.
Figure 2
Figure 2
APACHE II and CRP changes before and after nutritional support in parenterally fed (PF) and enterally fed (EF) patients (Wilcoxon matched pairs analysis).
See this image and copyright information in PMC

Comment in

  • Feeding the inflamed pancreas.
    Pennington CR. Pennington CR. Gut. 1998 Mar;42(3):315-6. doi: 10.1136/gut.42.3.315. Gut. 1998. PMID: 9577331 Free PMC article. No abstract available.
  • JPEN Journal Club 36. Quasirandomization.
    Koretz RL. Koretz RL. JPEN J Parenter Enteral Nutr. 2018 Aug;42(6):1099-1101. doi: 10.1002/jpen.1413. Epub 2018 Jun 30. JPEN J Parenter Enteral Nutr. 2018. PMID: 29959850 No abstract available.

References

    1. Ann Surg. 1980;192(4):505-17 - PubMed
    1. JPEN J Parenter Enteral Nutr. 1997 Jan-Feb;21(1):14-20 - PubMed
    1. Crit Care Med. 1985 Oct;13(10):818-29 - PubMed
    1. J Trauma. 1986 Oct;26(10):874-81 - PubMed
    1. Surgery. 1988 Aug;104(2):199-207 - PubMed