Semi-elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study.

BACKGROUND Jejunal nutrition is recommended during acute pancreatitis. The use of semi-elemental formulas presents several theoretical advantages over polymeric formulas, but their clinical value has been poorly documented. Our aim was to evaluate in patients with acute pancreatitis the effect of enteral nutrition by a semi-elemental formula compared with a polymeric formula. METHODS A randomized prospective pilot study, stratified according to severity, was performed in 30 consecutive patients with acute pancreatitis requiring jejunal nutrition. The semi-elemental group received 35 kcal/kg/d of Peptamen (n = 15), and the polymeric group received the same quantity of Sondalis-Iso (n = 15). Tolerance was evaluated after 7 days of enteral nutrition (D7) on visual analog scale (VAS), stool frequency, and 24-hour steatorrhea/creatorrhea. Outcome was evaluated by weight loss, length of hospital stay, and infection rate. RESULTS Results were calculated as mean +/- SEM, t-test, or chi2. Patients of the 2 groups were comparable in terms of age, gender, and severity. Tolerance was good in both groups (semi-elemental vs polymeric: VAS, 7.4 +/- 0.6 vs 7.1 +/- 0.6, not significant (NS); number of stools per 24 hours, 1.7 +/- 0.4 vs 1.8 +/- 0.4, NS). Steatorrhea and creatorrhea were lower than normal in both groups. In semi-elemental group, the length of hospital stay was shorter (23 +/- 2 vs 27 +/- 1, p = .006) and weight loss was less marked (1 +/- 1 vs 2 +/- 0, p = .01). One patient in semi-elemental group and 3 patients in polymeric group developed an infection (NS). CONCLUSIONS Semi-elemental and polymeric nutrition are very well tolerated in patients with acute pancreatitis. Nutrition with a semi-elemental formula supports the hypothesis of a more favorable clinical course than nutrition with a polymeric formula, but this conclusion needs to be established in larger adequately powered clinical trials.

[1]  J. Bernier,et al.  Effect of continuous jejunal perfusion of elemental and complex nutritional solutions on pancreatic enzyme secretion in human subjects. , 1978, Gut.

[2]  A. Bullen,et al.  The diagnostic value of the oral pancreatic function test. , 1979, Scandinavian journal of gastroenterology.

[3]  A. Megibow,et al.  Acute pancreatitis: prognostic value of CT. , 1985, Radiology.

[4]  J. Cosnes,et al.  Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome , 1988, The British journal of surgery.

[5]  D L Robinson,et al.  Acute pancreatitis: value of CT in establishing prognosis. , 1990, Radiology.

[6]  F. Ziegler,et al.  Efficiency of enteral nitrogen support in surgical patients: small peptides v non-degraded proteins. , 1990, Gut.

[7]  R. Prielipp,et al.  Effect of enteral diets on whole body and gut growth in unstressed rats. , 1991, JPEN. Journal of parenteral and enteral nutrition.

[8]  P. Malfertheiner,et al.  Exocrine pancreatic function in the early phase of human acute pancreatitis. , 1995, Scandinavian journal of gastroenterology.

[9]  E. Cabré,et al.  How effective is enteral nutrition in inducing clinical remission in active Crohn's disease? A meta-analysis of the randomized clinical trials. , 1995, JPEN. Journal of parenteral and enteral nutrition.

[10]  J. Kehagias,et al.  Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: Results of a randomized prospective trial , 1997, The British journal of surgery.

[11]  S. McClave,et al.  Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. , 1997, JPEN. Journal of parenteral and enteral nutrition.

[12]  Chr.,et al.  Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicentre prospective study of 116 patients. , 1997, Gut.

[13]  Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis , 1998 .

[14]  T. Long.  Nutrition de l'agressé Conférence de consensus* , 1998 .

[15]  S. McClave,et al.  Artificial nutrition in pancreatic disease: what lessons have we learned from the literature? , 2000, Clinical nutrition.

[16]  M. Büchler,et al.  Frequency and time course of pancreatic and extrapancreatic bacterial infection in experimental acute pancreatitis in rats. , 2000, Surgery.

[17]  Société Nationale Française de Gastroentérologie.  [Consensus conference: acute pancreatitis]. , 2001, Annales de chirurgie.

[18]  H. Friess,et al.  ESPEN guidelines on nutrition in acute pancreatitis , 2002 .

[19]  J. Xiong,et al.  Clinical study on nutrition support in patients with severe acute pancreatitis. , 2003, World journal of gastroenterology.

[20]  P. Marik,et al.  Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis , 2004, BMJ : British Medical Journal.

[21]  C. McKay,et al.  A Randomized Study of Early Nasogastric versus Nasojejunal Feeding in Severe Acute Pancreatitis , 2005, The American Journal of Gastroenterology.