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early oral nutrition acute pancreatitis

Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh
Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis...
February 21, 2016: World Journal of Gastroenterology: WJG
Paul E Marik
PURPOSE OF REVIEW: Anorexia is a preserved evolutionally response that may be beneficial during acute illness. Yet current clinical practice guidelines recommend early and targeted enteral nutritional support. However, the optimal timing of the initiation of enteral nutrition and the caloric and protein requirements of critically ill patients is controversial. RECENT FINDINGS: Starvation promotes autophagy and this may play a key role in promoting host defenses and the immune response to intracellular pathogens...
March 2016: Current Opinion in Clinical Nutrition and Metabolic Care
Lijun Cao, Yun Sun, Zhonghua Lu, Pinjie Zhang, Lu Yin, Hui Li, Tianfeng Hua, Yao Zheng
Acute pancreatitis (AP) is a frequent and potentially life-threatening disease with high morbidity and mortality. The overall mortality of AP is approximately 5%. Alcohol consumption and gallstones are the main etiology of AP. Hypertriglyceridemia, idiosyncratic reactions to drugs, anatomic alterations and ascaris lumbricoides can also give rise to AP. Although spinal cord injury (SCI) can cause AP, however, the case of induced by cervical spine surgery has not been reported. A 61-year-old man with quadriplegic and respiratory distress received cervical spine surgery for spinal cervical spondylosis and multi-stage longitudinal ligament...
2015: Neuro Endocrinology Letters
Younghoon Kwon, Ryan J Koene, Caroline Cross, Jennifer McEntee, Jaime S Green
BACKGROUND: Factitious fever is extremely challenging to diagnose in patients with complicated chronic medical problems, and represents as much as 10% of fevers of unknown origin. Factitious fever caused by self-injecting oral medications through indwelling central catheters is a diagnostic challenge. CASE PRESENTATION: We present a 32-year-old Caucasian female with history of short gut syndrome, malnutrition requiring total parental nutrition, and pancreatic auto-islet transplant with fever of unknown origin...
2015: BMC Research Notes
Rupjyoti Talukdar, Santhi S Vege
PURPOSE OF REVIEW: To summarize recent data on classification systems, cause, risk factors, severity prediction, nutrition, and drug treatment of acute pancreatitis. RECENT FINDINGS: Comparison of the Revised Atlanta Classification and Determinant Based Classification has shown heterogeneous results. Simvastatin has a protective effect against acute pancreatitis. Young black male, alcohol, smoldering symptoms, and subsequent diagnosis of chronic pancreatitis are risk factors associated with readmissions after acute pancreatitis...
September 2015: Current Opinion in Gastroenterology
Attila Oláh, Laszlo Romics
The use of enteral feeding as part of the management of acute pancreatitis dates back almost two decades. This review describes the indications for and limitations of enteral feeding for the treatment of acute pancreatitis using up-to-date evidence-based data. A systematic review was carried out to analyse current data on the use of enteral nutrition in the management of acute pancreatitis. Relevant literature was analysed from the viewpoints of enteral vs parenteral feeding, early vs delayed enteral nutrition, nasogastric vs nasojejunal feeding, and early oral diet and immunonutrition, particularly glutamine and probiotic supplementation...
November 21, 2014: World Journal of Gastroenterology: WJG
Xian L Zhao, Shi F Zhu, Gui J Xue, Juan Li, Yi L Liu, Mei H Wan, Wei Huang, Qing Xia, Wen F Tang
OBJECTIVE: Early enteral nutrition is beneficial for acute pancreatitis (AP), but the optimal timing and criteria remain unclear. The aim of this study was to explore the feasibility and safety of early oral refeeding (EORF) based on hunger in patients with moderate or severe AP. METHODS: In a prospective, single-center, controlled, randomized clinical trial (ChiCTR-TRC-12002994), eligible patients with moderate or severe AP were randomized to either EORF or conventional oral refeeding (CORF)...
January 2015: Nutrition
G Pupelis, H Plaudis, K Zeiza, N Drozdova, M Mukans, V Boka
BACKGROUND: Restoration of gastrointestinal function is a crucial determinant of favorable outcome in severe acute pancreatitis (SAP). The purpose of this study was to retrospectively review our experience with early oral feeding in patients with the necrotizing form of SAP. Over the last 10 years, we have routinely gradually increased oral feeds in order to restore gastrointestinal function. METHODS: Early low volume oral (ELVO) feeds containing 248-330 kcal/daily were routinely provided for all patients to help stimulate gastrointestinal function...
January 2014: Acta Chirurgica Belgica
Scott Tenner, John Baillie, John DeWitt, Santhi Swaroop Vege
This guideline presents recommendations for the management of patients with acute pancreatitis (AP). During the past decade, there have been new understandings and developments in the diagnosis, etiology, and early and late management of the disease. As the diagnosis of AP is most often established by clinical symptoms and laboratory testing, contrast-enhanced computed tomography (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically...
September 2013: American Journal of Gastroenterology
Maxim S Petrov, Kerry McIlroy, Lorraine Grayson, Anthony R J Phillips, John A Windsor
BACKGROUND & AIMS: Nasojejunal tube feeding is a standard of care in patients with predicted severe acute pancreatitis (AP) and several recent trials suggested that nasogastric tube feeding (NGT) is as safe and efficient as nasojejunal tube feeding in these patients. The aim was to investigate whether NGT presents any benefit to patients with mild to moderate AP. METHODS: The study design was a randomized controlled trial. The patients in the intervention group received NGT within 24 h of hospital admission...
October 2013: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Slavica Naumovski-Mihalić
BACKGROUND: Acute pancreatitis is an autodigestive disease in which the pancreatic tissue is damaged by the digestive enzimes produces by the acinar cells and is associated with severe upper abdominal pain. The severity of acute pancreatitis ranges from edema to necrosis of the gland. The edematous form of the disease occurs in about 80-85% of patients and is self-limited, with recovery in few days. In the 15-20% of patients with the most severe form of pancreatitis, hospitalization is prolonged and commonly associated with infection and other complications including multiple organ failure...
2009: Lijec̆nic̆ki Vjesnik
Xin Zhao, Da-Zhi Chen, Ren Lang, Zhong-Kui Jin, Hua Fan, Tian-Ming Wu, Xian-Liang Li, Qiang He
PURPOSE: The aim of this study was to establish enhanced recovery protocols for the management of mild gallstone pancreatitis. METHODS: Sixty consecutive patients were divided into enhanced recovery and traditional recovery (TR) groups in a randomized observational study. The basic enhanced recovery elements included early laparoscopic cholecystectomy, restrictive endoscopic intervention, and early oral nutrition. The incidence of complications, readmission, length of stay, and total medical cost were analyzed during the hospital course...
June 2013: Surgery Today
Enrique de-Madaria
Cardiovascular diseases could be a risk factor for acute pancreatitis (AP), specifically hypertension and ischemic heart disease. Smoking is associated with AP (OR 2.34), with the association being less marked than with chronic pancreatitis. Moreover, smoking may worsen the prognosis of AP. The bedside index for severity in AP (BISAP) prognostic system has a similar ability to predict mortality to the Acute Physiology and Chronic Health Evaluation II (APACHE II) index and is much simpler to calculate. Magnetic resonance imaging is a safe technique (it does not radiate the patient) and is useful in the diagnosis of complications, severity prediction and clinical decision making...
September 2012: Gastroenterología y Hepatología
Juan Li, Gui-Jun Xue, Yi-Ling Liu, Muhammad A Javed, Xian-Lin Zhao, Mei-Hua Wan, Guang-Yuan Chen, Kiran Altaf, Wei Huang, Wen-Fu Tang
OBJECTIVES: To evaluate the safety and efficacy of early oral refeeding (EORF) in patients with mild acute pancreatitis (AP) and to investigate the optimal duration to commence EORF. METHODS: A prospective, randomized, controlled trial was conducted in patients with mild AP. Patients with EORF (started oral feeding once they subjectively felt hungry) were compared with patients receiving routine oral refeeding (RORF) for time interval between disease onset and initiation of oral refeeding, total length of hospitalization (LOH), postrefeeding LOH, and adverse gastrointestinal events...
January 2013: Pancreas
Marcellus Simadibrata
We reported a case of acute pancreatitis as the complication of dengue hemorrhagic fever (DHF). This complication can cause more severe fatal condition, and difficulties in treatment, although it is rare. Dengue hemorrhagic fever (DHF) is one of the endemic diseases and often come as an outbreak event in South East Asia including Indonesia. Dengue hemorrhagic fever (DHF) is a global public health problem, because until now there has been no medicine to eradicate the dengue virus, no dengue vaccine and difficult to eradicate the mosquitoes as the contagious vector...
January 2012: Acta Medica Indonesiana
Abdul Rehman Alvi, Ghulam Murtaza Sheikh, Syed Faraz Kazim
OBJECTIVE: To review the trends in management and analyze the factors influencing outcomes of acute necrotizing pancreatitis. METHODS: It was a retrospective analytical study. All adult patients with computed tomography with proven necrotizing pancreatitis managed at the department of surgery, Aga Khan University Hospital, Karachi were included in this study extending from January 1998 to January 2008. Outcome variables were hospital stay, complication rate and in-hospital mortality...
October 2011: JPMA. the Journal of the Pakistan Medical Association
Hirofumi Shirakawa, Taira Kinoshita, Naoto Gotohda, Shinichiro Takahashi, Toshio Nakagohri, Masaru Konishi
BACKGROUND/PURPOSE: This study was conducted to ascertain the feasibility and effectiveness of preoperative enteral immunonutrition using an immune-enhanced formula (Impact) in patients undergoing pancreaticoduodenectomy. METHODS: Twenty-five patients undergoing an elective pancreaticoduodenectomy were asked to ingest Impact for 5 days (750 mL/day) prior to surgery in addition to their normal diets. We retrospectively compared the early postoperative outcomes of the Impact group (n = 18), which consisted of patients who fully complied with the study protocol, and a control group (n = 13), which consisted of patients who had not ingested Impact prior to surgery...
May 2012: Journal of Hepato-biliary-pancreatic Sciences
Olaf J Bakker, Hjalmar C van Santvoort, Sandra van Brunschot, Usama Ahmed Ali, Marc G Besselink, Marja A Boermeester, Thomas L Bollen, Koop Bosscha, Menno A Brink, Cornelis H Dejong, Erwin J van Geenen, Harry van Goor, Joos Heisterkamp, Alexander P Houdijk, Jeroen M Jansen, Thom M Karsten, Eric R Manusama, Vincent B Nieuwenhuijs, Bert van Ramshorst, Alexander F Schaapherder, George P van der Schelling, Marcel Bm Spanier, Adriaan Tan, Juda Vecht, Bas L Weusten, Ben J Witteman, Louis M Akkermans, Hein G Gooszen
BACKGROUND: In predicted severe acute pancreatitis, infections have a negative effect on clinical outcome. A start of enteral nutrition (EN) within 24 hours of onset may reduce the number of infections as compared to the current practice of starting an oral diet and EN if necessary at 3-4 days after admission. METHODS/DESIGN: The PYTHON trial is a randomised controlled, parallel-group, superiority multicenter trial. Patients with predicted severe acute pancreatitis (Imrie-score ≥ 3 or APACHE-II score ≥ 8 or CRP > 150 mg/L) will be randomised to EN within 24 hours or an oral diet and EN if necessary, after 72 hours after hospital admission...
2011: Trials
N Teich, J Mössner
Nutritional concepts in acute pancreatitis have changed. Early enteral nutrition widely replaced parenteral nutrition alone in severe acute pancreatitis. First trials suggest early oral refeeding as nutritional treatment of choice in patients with mild acute pancreatitis. In this review, we summarise the current knowledge on nutrition in acute pancreatitis and discuss future developments.
October 2010: Deutsche Medizinische Wochenschrift
G Gutiérrez-Salmeán, M Peláez-Luna
BACKGROUND: Nutritional support is a cornerstone in acute pancreatitis (AP) treatment, which is a catabolic state that can result in patient's nutritional depletion. First step in the management of AP is to asses its severity. Despite mild AP cases usually do not require nutritional support severe cases benefit from its early initiation. Total enteral nutrition (TEN) decreases the frequency of complications and is the preferred nutrition modality in AP. Availability of nutrition specialists is often limited and usually the primary care physician decides when and how to start nutritional support in AP...
2010: Revista de Gastroenterología de México
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