Feeding and Pancreatic Rest in Acute Pancreatitis

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

Investigators

Linked publications & trials

Abstract

[unreadable] Severe acute pancreatitis (SAP) is a disease of high (20-30%) mortality associated with prolonged[unreadable] hospitalization and excessive costs. Despite the major advances in our understanding of the[unreadable] pathophysiology of the disease, treatment remains supportive. The backbone of management is nutritional[unreadable] support as metabolic expenditure is excessively high and patients cannot eat for extended lengths of time .[unreadable] Because of concern that stimulation of the injured pancreas would exacerbate the disease process which is[unreadable] characterized by the premature activation of trypsinogen within the pancreas, the cornerstone of[unreadable] management has been pancreatic rest with intravenous feeding (TPN) which avoids pancreatic stimulation.[unreadable] However, the infective and metabolic complications of TPN have been shown to outweigh its benefits, and[unreadable] several prospective randomized comparative trials have demonstrated that patient outcome is better even[unreadable] with post-pyloric enteral feeding, which is stimulatory. Furthermore, 2 recent studies have collaborated[unreadable] studies in other populations of critically ill patients, showing that nasogastric (NG) feeding with a semielemental[unreadable] diet is as effective as post-pyloric feeding with the same dietary formula and does not increase the[unreadable] risk of aspiration despite the known impairmrnt of gastric emptying. This led to the recommendation that NG[unreadable] feeding should be used preferentially as it does not require expertize to start and to do. The concern remains[unreadable] that the mortality rate was not improved, raising the question whether NG feeding was better than no[unreadable] feeding. However, no feeding is not an option in SAP as unopposed protein catabolism would result in lifethreatening[unreadable] protein deficiency within 2 weeks. Exploratory studies of ours have suggested that feeding could[unreadable] be optimized by the placement of specialized double-lumen feeding tubes in the mid-jejunum (40cm past the[unreadable] ligament of Treitz) by transnasal endsocopic techniques to bypass the compressed upper Gl tract, to avoid[unreadable] pancreatic stimulation, and to stimulate the ileal brake - which experimentally has been shown to suppress[unreadable] acute pancreatitis. In the proposed study, we therefore plan to test the hypothesis that in comparison to[unreadable] simple NG feeding, skilled placement of DJ feeding tube systems hastens the resolution of disease because[unreadable] it is more effective in providing nutrition and does not exacerbate the disease process, thus leading to[unreadable] reduced morbidity, mortality and hospital costs. To recruit sufficient patients (n=114) to satisfy our statistical[unreadable] power calculations in a reasonable time period (5 years), we have formed a consortium with 8 leading[unreadable] national centers to conduct a multicenter clinical trial to achieve our goal.[unreadable]