Influence of early enteral nutrition on the function of intestinal mucosa barrier in patient with severe acute pancreatitis

Objective:To study the effects of early enteral nutrition (EN) on serum endotoxin, inflammatory cytokines and function of intestinal mucosa barrier in patients with severe acute pancreatitis (SAP). Methods:Forty-three patients with severe acute pancreatitis were divided randomly into enteral nutrition group (n=22,Group EN) and parenteral nutrition group (n=21,Group PN) within 24 to 48 hours of admission. Serum concentrations of endotoxin, inflammatory cytokines, amylolytic enzyme, CRP and serum albumin were detected in all patients before nutritional support and on 3, 14 days after nutritional support. The ratio of lactulose to mannitol in urin(eL/M)before and on 14 days after nutritional support were detected by HPLC. APACHE-II score. Incidences of multiple organ dysfunction syndrome (MODS) and infection of pancreas and peripancreas were observed. Results:All patients in group EN tolerated early enteral nutrition well. The serum concentrations of endotoxin, inflammatory cytokines, the urinary L/M ratio and APACHE-Ⅱscore before nutritional support were no significant differences between two groups (P0.05). On 3,14 days after nutritional support, serum concentrations of endotoxin of group EN were lower than those of group PN (P0.05). There were no significant differences between two groups in serum concentrations of inflammatory cytokines on 3 days after nutritional support (P0.05).However, concentrations of all inflammatory cytokines in group EN on 14 days were lower than those of group PN (P0.05). Compared with group PN, the urinary L/M ratio deceased significantly on 14 day after nutritional support in group EN. Compared with group PN, APACHE-Ⅱscore decreased significantly on 14 day after nutritional support. Incidences of MODS and infection of pancreas and peripancreas decreased significantly in group EN(P 0.05). Conclusion:Early EN may promote the recovery of function of barrier of intestinal mucosa, attenuate intestinal endotoxemia, moderate the acute inflammatory response, decrease the incidences of MODS and the infection of pancreas and peripancreas in patients with severe acute pancreatitis.