The role of enteral feeding in attenuating the acute phase response and improving disease severity in acute pancreatitis

Objective To determine whether enteral nutrition(EN) can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis.Methods APACHEⅡ score,computed tomography (CT),C reactive protein(CRP),and endotoxin were determined on 62 patients with acute pancreatitis.Patients were stratified according to disease severity and randomised to receive either parenteral nutrition (PN) or EN for seven days and then re-evaluated.Results Systemic inflammatory response syndrome (SIRS),sepsis,organ failure, and ITU stay were globally improved in the enterally fed patients.The acute phase response and disease severity scores were significantly improved following enteral nutrition without change in the CT scan scores.CRP:158± 30.21 to 84±26.33,P0.05,APACHEⅡ scores:(8.2±1.36)to(6.3±1.18),P0.05.In parenterally fed patients these parameters did not change but there was an increase in endotoxin levels.Enterally fed patients showed no change in endotoxin levels.Conclusions EN moderates the acute phase response,and improves disease severity and clinical outcome in acute pancreatitis. Enteral feeding modulates the inflammatory and sepsis respone in acute pancreatitis and is clmically beneficial.