engleski

A systematic review of enteral nutrition formulations for acute pancreatitis

INTRODUCTION: Acute pancreatitis (AP) is a common disease with increasing incidence. Severe cases are characterized with high mortality and despite improvements in intensive care management, there is still no specific treatment that relevantly benefits clinical outcome. AIMS: To assess effects of different enteral nutrition (EN) formulations in patients with AP. METHODS: We conducted searches of Medline, Embase, Central, and SCI-E for RCTs assessing use of a specific EN formula compared to control (other EN formula, TPN, placebo, or no intervention). We assessed the following outcomes: mortality, organ failure, and local septic complications (LSC). RESULTS: Twenty-six RCTs with a total of 1979 patients were included. Immunonutrition significantly decreased mortality (P=0.005), but subgroup analysis comparing immunonutrition to another EN did not confirm this finding. Probiotics did not confirm any significant effect, however sensitivity analysis by exclusion of one trial with inconsistent results showed decrease in mortality (P=0.02) and LSC (P=0.002), but not organ failure. Semi-elemental EN reduced mortality (P=0.002), organ failure (P<0.00001), and LSC (P<0.00001). Few trials evaluated polymeric and fibre-enriched formulas, showing no significant effect. Any EN compared to TPN confirmed reduced mortality (P<0.0001), organ failure (P<0.00001) and LSC (P<0.00001), and any EN compared to no intervention was associated with lower mortality (P=0.01). CONCLUSION: Whether supplementation of EN with potential immunomodulatory agents leads to beneficial effects is still debatable. Studies assessing probiotics yielded inconsistent results, therefore we do not support the routine use of these formulations in clinical practice, but further research is required. EN is significantly more efficient than TPN and no nutritional support.

Systematic review ; enteral nutrition ; acute pancreatitis ; meta-analysis

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