Nutrition in acute pancreatitis - influence on gut barrier and inflammatory response

Gunilla Eckerwall

Nutrition in acute pancreatitis - influence on gut barrier and inflammatory response

Gunilla Eckerwall

Surgery (Lund)

Research output: Thesis › Doctoral Thesis (compilation)

Abstract

Acute pancreatitis (AP) is associated with metabolic changes, acute inflammatory response and increased gut permeability. In AP, traditional treatment has been initial fasting on purpose to avoid activation of proteolytic enzymes and pancreatic enzyme secretion. However, enteral feeding has been suggested superior to fasting due to a proposed beneficial effect on the gut barrier function. The aim was to evaluate the present nutritional regime and the effects of enteral nutrition, oral nutrition or cellulose derivatives during AP.

In the first study, 99 cases of severe AP were analyzed retrospectively and fluid resuscitation and nutritional support were evaluated. In the second study 50 patients with predicted severe AP were randomized to total parental nutrition or enteral nutrition. In study III, sixty patients were randomized to fasting or immediate oral feeding. In the last study, oral pre-treatment with cellulose derivatives or antioxidants were evaluated in experimental pancreatitis. Interleukines, CRP and leucocytes measured acute inflammatory response. Gut barrier function was determined by excretion of polyethylene glycol, endogenous endotoxin-core antibodies, Ussing chamber experiments and bacterial counts. Complications, abdominal pain, hyperglycemia and length of hospital stay, evaluated clinical outcome.

The nutritional regime in severe AP included a moderate and hypocaloric initial fluid resuscitation, total parental nutrition as the preferred route for nutritional support, non-strict glucose control and associated mortality of 17%, indicating several modes of improving outcome. Nasogastric, early enteral nutrition was feasible and resulted in better blood glucose control. No beneficial effects on intestinal permeability or the inflammatory response were seen. In mild AP immediate oral feeding was feasible and may accelerate recovery without exacerbation of the disease process. In experimental acute pancreatits, pre-treatment with cellulose derivatives restored enteric microbial ecology, but did not influence on intestinal permeability.

Original language	English
Qualification	Doctor
Awarding Institution	Surgery (Lund)
Supervisors/Advisors	Andersson, Roland, Supervisor
Award date	2007 May 30
Publisher	The Department of Surgery, Lund University
ISBN (Print)	978-91-85550-73-2
Publication status	Published - 2007

Bibliographical note

Defence details

Date: 2007-05-30
Time: 09:00
Place: Föreläsningssal 1, Blocket, Universitetssjukhuset i Lund

External reviewer(s)

Name: Dervenis, Christos
Title: Professor
Affiliation: First Department of Surgery, Agia Olga Hospital, Athens, Greece

---

<div class="article_info">Gunilla Eckerwall, Hanna Olin, Bodil Andersson and Roland Andersson. 2006. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: What have we learned and what can we do better? Clin Nutr, vol 25 pp 497-504. Department of Surgery, Lund University</div>
<div class="article_info">Gunilla Eckerwall, Jakob Axelsson and Roland Andersson. 2006. Early nasogastric feeding in predicted severe acute pancreatitis - a clinical randomized study Ann Surg, vol 244 pp 959-965. Department of Surgery, Lund University</div>
<div class="article_info">Gunilla Eckerwall, Bobby Tingstedt, Per Bergenzaun and Roland Andersson. 2007. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery - a clinical randomized study Department of Surgery, Lund University (inpress)</div>
<div class="article_info">Jakob Axelsson, Gunilla Eckerwall, Gustav Norrman, Marwan Dib, Lazlo Nehez, Vasile Soltesz, Weström Björn and Roland Andersson. 2006. Intestinal bacteria and permeability during experimental acute pancreatitis in rats vol 19 pp 276-284. Department of Surgery, Lund University</div>

Subject classification (UKÄ)

Surgery

Free keywords

Surgery
orthopaedics
traumatology
Kirurgi
ortopedi
Medicin (människa och djur)
intestinal permeability
nasogastric
acute inflammation
dietary fiber
Medicine (human and vertebrates)
immediate oral feeding
fluid resuscitation
Acute pancreatitis
enteral nutrition
traumatologi

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Cite this

@phdthesis{83c00893d1ec4b88bc58c3392677712d,

title = "Nutrition in acute pancreatitis - influence on gut barrier and inflammatory response",

abstract = "Acute pancreatitis (AP) is associated with metabolic changes, acute inflammatory response and increased gut permeability. In AP, traditional treatment has been initial fasting on purpose to avoid activation of proteolytic enzymes and pancreatic enzyme secretion. However, enteral feeding has been suggested superior to fasting due to a proposed beneficial effect on the gut barrier function. The aim was to evaluate the present nutritional regime and the effects of enteral nutrition, oral nutrition or cellulose derivatives during AP. In the first study, 99 cases of severe AP were analyzed retrospectively and fluid resuscitation and nutritional support were evaluated. In the second study 50 patients with predicted severe AP were randomized to total parental nutrition or enteral nutrition. In study III, sixty patients were randomized to fasting or immediate oral feeding. In the last study, oral pre-treatment with cellulose derivatives or antioxidants were evaluated in experimental pancreatitis. Interleukines, CRP and leucocytes measured acute inflammatory response. Gut barrier function was determined by excretion of polyethylene glycol, endogenous endotoxin-core antibodies, Ussing chamber experiments and bacterial counts. Complications, abdominal pain, hyperglycemia and length of hospital stay, evaluated clinical outcome. The nutritional regime in severe AP included a moderate and hypocaloric initial fluid resuscitation, total parental nutrition as the preferred route for nutritional support, non-strict glucose control and associated mortality of 17%, indicating several modes of improving outcome. Nasogastric, early enteral nutrition was feasible and resulted in better blood glucose control. No beneficial effects on intestinal permeability or the inflammatory response were seen. In mild AP immediate oral feeding was feasible and may accelerate recovery without exacerbation of the disease process. In experimental acute pancreatits, pre-treatment with cellulose derivatives restored enteric microbial ecology, but did not influence on intestinal permeability.",

keywords = "Surgery, orthopaedics, traumatology, Kirurgi, ortopedi, Medicin (m{\"a}nniska och djur), intestinal permeability, nasogastric, acute inflammation, dietary fiber, Medicine (human and vertebrates), immediate oral feeding, fluid resuscitation, Acute pancreatitis, enteral nutrition, traumatologi",

author = "Gunilla Eckerwall",

note = "Defence details Date: 2007-05-30 Time: 09:00 Place: F{\"o}rel{\"a}sningssal 1, Blocket, Universitetssjukhuset i Lund External reviewer(s) Name: Dervenis, Christos Title: Professor Affiliation: First Department of Surgery, Agia Olga Hospital, Athens, Greece --- <div class={"}article_info{"}>Gunilla Eckerwall, Hanna Olin, Bodil Andersson and Roland Andersson. 2006. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: What have we learned and what can we do better? Clin Nutr, vol 25 pp 497-504. Department of Surgery, Lund University</div> <div class={"}article_info{"}>Gunilla Eckerwall, Jakob Axelsson and Roland Andersson. 2006. Early nasogastric feeding in predicted severe acute pancreatitis - a clinical randomized study Ann Surg, vol 244 pp 959-965. Department of Surgery, Lund University</div> <div class={"}article_info{"}>Gunilla Eckerwall, Bobby Tingstedt, Per Bergenzaun and Roland Andersson. 2007. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery - a clinical randomized study Department of Surgery, Lund University (inpress)</div> <div class={"}article_info{"}>Jakob Axelsson, Gunilla Eckerwall, Gustav Norrman, Marwan Dib, Lazlo Nehez, Vasile Soltesz, Westr{\"o}m Bj{\"o}rn and Roland Andersson. 2006. Intestinal bacteria and permeability during experimental acute pancreatitis in rats vol 19 pp 276-284. Department of Surgery, Lund University</div>",

year = "2007",

language = "English",

isbn = "978-91-85550-73-2",

publisher = "The Department of Surgery, Lund University",

type = "Doctoral Thesis (compilation)",

school = "Surgery (Lund)",

}

TY - THES

T1 - Nutrition in acute pancreatitis - influence on gut barrier and inflammatory response

AU - Eckerwall, Gunilla

N1 - Defence details Date: 2007-05-30 Time: 09:00 Place: Föreläsningssal 1, Blocket, Universitetssjukhuset i Lund External reviewer(s) Name: Dervenis, Christos Title: Professor Affiliation: First Department of Surgery, Agia Olga Hospital, Athens, Greece --- <div class="article_info">Gunilla Eckerwall, Hanna Olin, Bodil Andersson and Roland Andersson. 2006. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: What have we learned and what can we do better? Clin Nutr, vol 25 pp 497-504. Department of Surgery, Lund University</div> <div class="article_info">Gunilla Eckerwall, Jakob Axelsson and Roland Andersson. 2006. Early nasogastric feeding in predicted severe acute pancreatitis - a clinical randomized study Ann Surg, vol 244 pp 959-965. Department of Surgery, Lund University</div> <div class="article_info">Gunilla Eckerwall, Bobby Tingstedt, Per Bergenzaun and Roland Andersson. 2007. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery - a clinical randomized study Department of Surgery, Lund University (inpress)</div> <div class="article_info">Jakob Axelsson, Gunilla Eckerwall, Gustav Norrman, Marwan Dib, Lazlo Nehez, Vasile Soltesz, Weström Björn and Roland Andersson. 2006. Intestinal bacteria and permeability during experimental acute pancreatitis in rats vol 19 pp 276-284. Department of Surgery, Lund University</div>

PY - 2007

Y1 - 2007

N2 - Acute pancreatitis (AP) is associated with metabolic changes, acute inflammatory response and increased gut permeability. In AP, traditional treatment has been initial fasting on purpose to avoid activation of proteolytic enzymes and pancreatic enzyme secretion. However, enteral feeding has been suggested superior to fasting due to a proposed beneficial effect on the gut barrier function. The aim was to evaluate the present nutritional regime and the effects of enteral nutrition, oral nutrition or cellulose derivatives during AP. In the first study, 99 cases of severe AP were analyzed retrospectively and fluid resuscitation and nutritional support were evaluated. In the second study 50 patients with predicted severe AP were randomized to total parental nutrition or enteral nutrition. In study III, sixty patients were randomized to fasting or immediate oral feeding. In the last study, oral pre-treatment with cellulose derivatives or antioxidants were evaluated in experimental pancreatitis. Interleukines, CRP and leucocytes measured acute inflammatory response. Gut barrier function was determined by excretion of polyethylene glycol, endogenous endotoxin-core antibodies, Ussing chamber experiments and bacterial counts. Complications, abdominal pain, hyperglycemia and length of hospital stay, evaluated clinical outcome. The nutritional regime in severe AP included a moderate and hypocaloric initial fluid resuscitation, total parental nutrition as the preferred route for nutritional support, non-strict glucose control and associated mortality of 17%, indicating several modes of improving outcome. Nasogastric, early enteral nutrition was feasible and resulted in better blood glucose control. No beneficial effects on intestinal permeability or the inflammatory response were seen. In mild AP immediate oral feeding was feasible and may accelerate recovery without exacerbation of the disease process. In experimental acute pancreatits, pre-treatment with cellulose derivatives restored enteric microbial ecology, but did not influence on intestinal permeability.

AB - Acute pancreatitis (AP) is associated with metabolic changes, acute inflammatory response and increased gut permeability. In AP, traditional treatment has been initial fasting on purpose to avoid activation of proteolytic enzymes and pancreatic enzyme secretion. However, enteral feeding has been suggested superior to fasting due to a proposed beneficial effect on the gut barrier function. The aim was to evaluate the present nutritional regime and the effects of enteral nutrition, oral nutrition or cellulose derivatives during AP. In the first study, 99 cases of severe AP were analyzed retrospectively and fluid resuscitation and nutritional support were evaluated. In the second study 50 patients with predicted severe AP were randomized to total parental nutrition or enteral nutrition. In study III, sixty patients were randomized to fasting or immediate oral feeding. In the last study, oral pre-treatment with cellulose derivatives or antioxidants were evaluated in experimental pancreatitis. Interleukines, CRP and leucocytes measured acute inflammatory response. Gut barrier function was determined by excretion of polyethylene glycol, endogenous endotoxin-core antibodies, Ussing chamber experiments and bacterial counts. Complications, abdominal pain, hyperglycemia and length of hospital stay, evaluated clinical outcome. The nutritional regime in severe AP included a moderate and hypocaloric initial fluid resuscitation, total parental nutrition as the preferred route for nutritional support, non-strict glucose control and associated mortality of 17%, indicating several modes of improving outcome. Nasogastric, early enteral nutrition was feasible and resulted in better blood glucose control. No beneficial effects on intestinal permeability or the inflammatory response were seen. In mild AP immediate oral feeding was feasible and may accelerate recovery without exacerbation of the disease process. In experimental acute pancreatits, pre-treatment with cellulose derivatives restored enteric microbial ecology, but did not influence on intestinal permeability.

KW - Surgery

KW - orthopaedics

KW - traumatology

KW - Kirurgi

KW - ortopedi

KW - Medicin (människa och djur)

KW - intestinal permeability

KW - nasogastric

KW - acute inflammation

KW - dietary fiber

KW - Medicine (human and vertebrates)

KW - immediate oral feeding

KW - fluid resuscitation

KW - Acute pancreatitis

KW - enteral nutrition

KW - traumatologi

M3 - Doctoral Thesis (compilation)

SN - 978-91-85550-73-2

PB - The Department of Surgery, Lund University

ER -

Nutrition in acute pancreatitis - influence on gut barrier and inflammatory response

Abstract

Bibliographical note

Subject classification (UKÄ)

Free keywords

UN SDGs

Fingerprint

Cite this