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Systematic review: nutritional support in acute pancreatitis
Article first published online: 4 JUL 2008
DOI: 10.1111/j.1365-2036.2008.03786.x
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
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How to Cite
PETROV, M. S., PYLYPCHUK, R. D. and EMELYANOV, N. V. (2008), Systematic review: nutritional support in acute pancreatitis. Alimentary Pharmacology & Therapeutics, 28: 704–712. doi: 10.1111/j.1365-2036.2008.03786.x
Publication History
- Issue published online: 20 AUG 2008
- Article first published online: 4 JUL 2008
- Publication data Submitted 25 April 2008 First decision 13 May 2008 Resubmitted 8 June 2008, 26 June 2008 Accepted 26 June 2008 Epub Accepted Article 4 July 2008
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Summary
Background There has been controversy concerning the merits of enteral and parenteral nutrition compared with no supplementary nutrition in the management of patients with acute pancreatitis.
Aim To perform a systematic review of the data from randomized controlled trials (RCTs) in acute pancreatitis that compares enteral nutrition with no supplementary nutrition, parenteral nutrition with no supplementary nutrition and enteral nutrition with parenteral nutrition.
Methods A search was undertaken in the MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials.
Results Fifteen RCTs were included. Enteral nutrition, when compared with no supplementary nutrition, was associated with no significant change in infectious complications: ratio of relative risks (RR) 0.56, 95% confidence interval (CI) 0.07–4.32, P = 0.58, but a significant reduction in mortality: ratio of RR 0.22, 95% CI 0.07–0.70, P = 0.01. Parenteral nutrition, when compared with no supplementary nutrition, was associated with no significant change in infectious complications: RR 1.36, 95% CI 0.18–10.40; P = 0.77, but a significant reduction in mortality: RR 0.36, 95% CI 0.13–0.97, P = 0.04. Enteral nutrition, when compared with parenteral nutrition, was associated with a significant reduction in infectious complications: RR 0.41, 95% CI 0.30–0.57, P < 0.001, but no significant change in mortality: RR 0.60, 95% CI 0.32–1.14, P = 0.12.
Conclusions The use of either enteral or parenteral nutrition, in comparison with no supplementary nutrition, is associated with a lower risk of death in acute pancreatitis. Enteral nutrition is associated with a lower risk of infectious complications compared with parenteral nutrition.