The Correlations Between Early Enteral Nutrition and Intra-abdominal Pressure in Severe Acute Pancreatitis

Nanjing University School of Medicine

Status and phase: Completed; Phase 4

Conditions: Intra-abdominal Hypertension; Acute Pancreatitis

Treatments: Drug: early enteral nutrition; Drug: Delayed enteral nutrition

Study type: Interventional

Funder types: Other

Identifiers

NCT01507766

110-85

Details and patient eligibility

About

As an important management of severe acute pancreatitis (SAP), enteral nutrition (EN), especially early enteral nutrition (EEN) increases the blood flow of gut mucosa and stimulates the intestinal motility. Moreover, EEN maintains the gut integrity, prevents bacterial and endotoxin translocation and thereby theoretically reduces the incidence of infections. Therefore, EEN has the ability to reduce the infectious complications, length of hospital stay and mortality of patients with SAP.

However, the role of EEN is considered to be influenced by intra-abdominal hypertension (IAH) in patients with SAP. The previous studies showed that gut was the most sensitive splanchnic organ to the increase of intra-abdominal pressure (IAP). When IAH occurs, it reduces the blood flow of gut, and then results in the development of intestinal ischemia and edema. The hypoxia and hypoperfusion of intestine leads to the increase of permeability of the intestinal mucosal barrier, and then leads to bacterial translocation. Therefore, IAH could result in the gastrointestinal dysfunction. Nevertheless, the different impacts of specific IAP values on the tolerance of EEN have not been reported.

Furthermore, the effects of early enteral feeding on the IAP in SAP also remain unknown. Due to the severe inflammatory response of SAP, could EEN increase the burden of bowel, cause expansion of intestinal cavity, thus increase IAP? However, there were rare literatures up to date reporting the association between EEN and IAH in patients with SAP. Therefore, the present study aimed to investigate the influence of specific IAP on the tolerance of early enteral feeding, as well as the effects of EEN on IAP in SAP patients. Moreover, the impacts of EEN on the disease severity and clinical outcome of SAP were also researched.

Enrollment: 60 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• The diagnosis of acute pancreatitis accords with the Atlanta criteria in 1992
• Within 3 days from the onset of the disease
• Hemodynamics stable

Exclusion criteria

• Decompressive measures and enteral nutrition was performed before admission
• Ileus of lower digestive tract
• Pregnant pancreatitis
• Chronic organs dysfunction
• Immunodeficiency

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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60 participants in 2 patient groups

Early enteral nutrition

Experimental group

Description:

The enteral nutrition was started within 48h after admission

Treatment:

Drug: early enteral nutrition

Delayed enteral nutrition

Active Comparator group

Description:

The enteral nutrition was started at the 8th day after admission

Treatment:

Drug: Delayed enteral nutrition