November 12, 2014
Notes: Cote, Gregory A
Sagi, Sashidhar V
Schmidt, Suzette E
Lehman, Glen A
Pancreas. 2013 Jul;42(5):850-4. doi: 10.1097/MPA.0b013e318287c9d4.
Author Address: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. firstname.lastname@example.org
Reference Type: Journal Article
Record Number: 5248Author: Cui, L. H., Wang, X. H., Peng, L. H., Yu, L. and Yang, Y. S.
Title: [The effects of early enteral nutrition with addition of probiotics on the prognosis of patients suffering from severe acute pancreatitis]
Journal: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Short Title: [The effects of early enteral nutrition with addition of probiotics on the prognosis of patients suffering from severe acute pancreatitis]
Alternate Journal: Zhonghua wei zhong bing ji jiu yi xue
ISSN: 2095-4352 (Print)
Accession Number: 23660099
Pancreatitis, Acute Necrotizing/diagnosis/*therapy
Abstract: OBJECTIVE: To investigate the curative effect of early enteral nutrition (EN) supplemented with probiotics (bifidobacterium) in patients with severe acute pancreatitis (ASP). METHODS: Seventy SAP cases admitted from January 2005 to October 2012 were randomly assigned into parenteral nutrition (PN) group (n=22), EN group (n=25) and bifidobacterium added EN (P+EN) group (n=23). In P+EN group, patients were given their nutrition the same as that of EN, and also probiotics (bifidobacterium, 4 capsules every 12 hours, given through nasal gastric tube, each capsule weighing 210 mg). The routine treatment including anti-infection and anti-acid agents, and that of inhibition of pancreatic secretion were given, except for the different nutritional interventions in all groups. The blood samples were collected for e same measurements of interleukin-8 (IL-8) and tumor necrosis factor (TNF-alpha) by enzyme linked immunosorbent assay (ELISA), and for the C-reactive protein (CRP), lactic acid dehydrogenase (LDH), white blood cell (WBC) count, amylase and lipase by biochemistry assay 1 day before intervention of nutrition, and 7 days and 14 days after intervention. Changes in organ function and outcome were also recorded at the same time points. RESULTS: The plasma levels of IL-8, TNF-alpha, CRP, LDH, WBC count, amylase and lipase were significantly reduced after nutritional intervention compared with their levels on day 1 before intervention in all three groups. The plasma IL-8, TNF-alpha, CRP, lipase, LDH at 14 days after intervention of nutrition in P+EN group were significantly lower than those in PN group and EN group (IL-8: 21.00 +/- 7.07 mug/L vs. 48.00 +/- 10.32 mug/L, 32.00 +/- 9.30 mug/L; TNF-alpha: 44.3 +/- 10.9 ng/L vs. 132.1 +/- 34.1 ng/L, 67.8 +/- 22.3 ng/L; CRP: 35.0 +/- 12.4 mg/L vs. 103.2 +/- 49.2 mg/L, 63.0 +/- 29.2 mg/L; lipase: 269 +/- 79 U/L vs. 670 +/- 145 U/L, 310 +/- 78 U/L; LDH: 21.8 +/- 10.3 U/L vs. 78.1 +/- 37.4 U/L, 37.9 +/- 25.1 U/L, P<0.05 or P<0.01). The WBC count in P+EN group was significantly lower than that in PN group (5.9 +/- 3.0 x 10(9)/L, 6.3 +/- 3.2 x 10(9)/L vs. 9.6 +/- 3.0 x10(9)/L, both P<0.05), but there was no significant difference in amylase between P+EN group and PN group (211 +/- 49 U/L, 236 +/- 52 U/L vs. 298 +/- 71 U/L, P>0.05). The gastrointestinal dysfunction score in P+EN, EN, PN groups 14 days after nutritional intervention was 0.28 +/- 0.05, 0.43 +/- 0.09, 0.71 +/- 0.11, respectively, with statistically significant differences (all P<0.01). Compared with PN and EN groups, the incidence of upper gastrointestinal bleeding (1 vs. 9, 2), infection and abscess (2 vs. 12, 5) was lower (all P<0.01), and hospital day was significantly shortened in P+EN group (10.4 +/- 3.9 days vs. 25.8 +/- 6.4 days, 13.4 +/- 5.2 days, both P<0.01). There was no significant statistical difference in mortality rate among three groups. CONCLUSION: Our results indicated that early EN with addition of probiotics (bifidobacterium) resulted in significant lowering of the level of pro-inflammatory cytokines, earlier restoration of gastrointestinal function, decrease of complications such as infection, and shortening of hospital day in patients with SAP.