New options for enteral nutrition in patients with severe acute pancreatitis

Severe acute pancreatitis (SAP) requires an adequate nutritional support. Enteral nutrition (EN) should be preferred to total parenteral nutrition in patients with SAP, as it is associated with reduced mortality and complications. However, in clinical practice EN is employed far less frequently than it should. The main obstacle to EN diffusion is that it is considered complicated, as to ensure full pancreatic rest, nutrition tubes should be placed in the jejunum, requiring often troublesome procedures. In the past few years, it has been proposed that EN through nasogastric (NG) tubes may be a simple, safe and equally valid alternative to nasojejunal tubes.

A research article published on August 7, 2010 in the World Journal of Gastroenterology addresses this question. The authors speculated that a pragmatic possibility in real-world clinical practice would be to employ NG feeding whenever tube migration to the jejunum of bedside inserted feeding tubes does not occur spontaneously. They therefore aimed at assessing the rate of spontaneous distal migration of EN tubes in patients with predicted SAP, to identify possible factors associated with it, and to compare the safety and tolerability of EN with an elemental formula in patients who started nutrition with a "proximal", NG or a "distal", naso-intestinal tube, depending on the success of spontaneous tube migration.

This is the first study of its kind observing the outcome of EN in SAP patients in a "real world" clinical setting, with the study protocol driven by the need to have more solid grounds in making clinical decisions about everyday medical care circumstances. Both the proximal and the distal enteral approaches resulted to be feasible, safe and effective in most patients. This issue has a relevant impact on everyday clinical practice as the main limit to EN usage in AP is the technical difficulty in obtaining small bowel access.

Reference: Piciucchi M, Merola E, Marignani M, Signoretti M, Valente R, Cocomello L, Baccini F, Panzuto F, Capurso G, Delle Fave G. Nasogastric or nasointestinal feeding in severe acute pancreatitis. World J Gastroenterol 2010; 16(29): 3692-3696

http://www.wjgnet.com/1007-9327/full/v16/i29/3692.htm

Correspondence to: Gianfranco Delle Fave, Professor, Digestive and Liver Disease Unit, Medical School, University "Sapienza", S. Andrea Hospital, Via Di Grottarossa 1035, 00189 Rome, Italy. gianfranco.dellefave@uniroma1.it

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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2009 IF: 2.092. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.