Objective: To investigate the curative effect of early enteral nutrition (EN) supplemented with probiotics (bifidobacterium) in patients with severe acute pancreatitis (ASP).
Methods: Seventy SAP cases admitted from January 2005 to October 2012 were randomly assigned into parenteral nutrition (PN) group (n=22), EN group (n=25) and bifidobacterium added EN (P+EN) group (n=23). In P+EN group, patients were given their nutrition the same as that of EN, and also probiotics (bifidobacterium, 4 capsules every 12 hours, given through nasal gastric tube, each capsule weighing 210 mg). The routine treatment including anti-infection and anti-acid agents, and that of inhibition of pancreatic secretion were given, except for the different nutritional interventions in all groups. The blood samples were collected for e same measurements of interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) by enzyme linked immunosorbent assay (ELISA), and for the C-reactive protein (CRP), lactic acid dehydrogenase (LDH), white blood cell (WBC) count, amylase and lipase by biochemistry assay 1 day before intervention of nutrition, and 7 days and 14 days after intervention. Changes in organ function and outcome were also recorded at the same time points.
Results: The plasma levels of IL-8, TNF-α, CRP, LDH, WBC count, amylase and lipase were significantly reduced after nutritional intervention compared with their levels on day 1 before intervention in all three groups. The plasma IL-8, TNF-α, CRP, lipase, LDH at 14 days after intervention of nutrition in P+EN group were significantly lower than those in PN group and EN group (IL-8: 21.00 ± 7.07 μg/L vs. 48.00 ± 10.32 μg/L, 32.00 ± 9.30 μg/L; TNF-α: 44.3 ± 10.9 ng/L vs. 132.1 ± 34.1 ng/L, 67.8 ± 22.3 ng/L; CRP: 35.0 ± 12.4 mg/L vs. 103.2 ± 49.2 mg/L, 63.0 ± 29.2 mg/L; lipase: 269 ± 79 U/L vs. 670 ± 145 U/L, 310 ± 78 U/L; LDH: 21.8 ± 10.3 U/L vs. 78.1 ± 37.4 U/L, 37.9 ± 25.1 U/L, P<0.05 or P<0.01). The WBC count in P+EN group was significantly lower than that in PN group (5.9 ± 3.0 × 10⁹/L, 6.3 ± 3.2 × 10⁹/L vs. 9.6 ± 3.0 ×10⁹/L, both P<0.05), but there was no significant difference in amylase between P+EN group and PN group (211 ± 49 U/L, 236 ± 52 U/L vs. 298 ± 71 U/L, P>0.05). The gastrointestinal dysfunction score in P+EN, EN, PN groups 14 days after nutritional intervention was 0.28 ± 0.05, 0.43 ± 0.09, 0.71 ± 0.11, respectively, with statistically significant differences (all P<0.01). Compared with PN and EN groups, the incidence of upper gastrointestinal bleeding (1 vs. 9, 2), infection and abscess (2 vs. 12, 5) was lower (all P<0.01), and hospital day was significantly shortened in P+EN group (10.4 ± 3.9 days vs. 25.8 ± 6.4 days, 13.4 ± 5.2 days, both P<0.01). There was no significant statistical difference in mortality rate among three groups.
Conclusion: Our results indicated that early EN with addition of probiotics (bifidobacterium) resulted in significant lowering of the level of pro-inflammatory cytokines, earlier restoration of gastrointestinal function, decrease of complications such as infection, and shortening of hospital day in patients with SAP.