Effects of early enteral nutrition on serum endotoxin and inflammatory cytokines in patients with severe acute pancreatitis

Objective To study the effects of early enteral nutrition on serum endotoxin and inflammatory cytokines in patients with severe acute pancreatitis. Methods Thirty-seven patients with severe acute pancreatitis were divided randomizely to enteral nutrition group (n=19, Group EN) and parenteral nutrition group (n=18, Group PN) within 36 to 48 hours of admission. Serum concentrations of endotoxin and inflammatory cytokines were detectedin all patients before nutritional support and 3,7 days after nutritional support. APACHE-II score, intestinal function, systemic inflammatory response syndrome(SIRS), incidences of multiple organ dysfunction syndrome(MODS) and infection of pancreas and peripancreas were observed. Results All patients in group EN tolelated early enteral nutrition well. The serum concentrations of endotoxin and inflammatory cytokines before nutritional support were no significant differences between two groups (P 0.05 ). At 3,7days after nutrilinal support,serum concentrations of endotoxin of group EN were lower than those of group PN (P 0.05 ). There were no significant differences between two groups in serum concentrations of inflammatory cytokines at 3day after nutritional support(P0.05). However, concentrations of all inflammatory cytokines in group EN on 7days were lower than those of group PN (P0.05).Compared with group PN, APACHE-Ⅱ score deseased significantly on day 7 after nutritional support, intestinal function and SIRS improved more rapidly, incidences of MODS and infection of pancreas and peripancreas deseased significantly in group EN. Conclusion Early EN may promote the recovery of intestinal function, attenuate intestinal endotoxemia, moderate the acute inflammatory response,desease the incidences of MODS and the infection of pancreas and peripancreas in patients with severe acute pancreatitis.