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Semi-Elemental Formula or Polymeric Formula: Is There a Better Choice for Enteral Nutrition in Acute Pancreatitis? Randomized Comparative Study
Laurent-Eric Tiengou, MD*,
Romain Gloro, MD*,
Julien Pouzoulet, MD*,
Karine Bouhier, MD*,
Marie-Hélène Read, PhD ,
Franck Arnaud-Battandier, MD ,
Jean-Marie Plaze, MSc ,
Xavier Blaizot, PhD ,
Thông Dao, MD* and
Marie-Astrid Piquet, MD, PhD*
From the * Gastroenterology and Nutrition
Department, Teaching Hospital, Caen, France;
Department of Biochemistry, Teaching Hospital,
Caen, France; Nestlé Clinical
Nutrition, Noisiel, France; and Department of
Statistics, Teaching Hospital, Caen, France
Correspondence: Laurent-Eric Tiengou, MD, Service de Gastroentérologie
et Nutrition, Centre Hospitalier Universitaire de Caen, Avenue de la
Côte de Nacre, 14033 Caen Cedex, France. Electronic mail may be sent to
tiengou-le{at}chu-caen.fr.
Background: Jejunal nutrition is recommended during acute
pancreatitis. The use of semi-elemental formulas presents several theoretical
advantages over polymeric formulas, but their clinical value has been poorly
documented. Our aim was to evaluate in patients with acute pancreatitis the
effect of enteral nutrition by a semi-elemental formula compared with a
polymeric formula. Methods: A randomized prospective pilot study,
stratified according to severity, was performed in 30 consecutive patients
with acute pancreatitis requiring jejunal nutrition. The semi-elemental group
received 35 kcal/kg/d of Peptamen (n = 15), and the polymeric group received
the same quantity of Sondalis-Iso (n = 15). Tolerance was evaluated after 7
days of enteral nutrition (D7) on visual analog scale (VAS), stool frequency,
and 24-hour steatorrhea/creatorrhea. Outcome was evaluated by weight loss,
length of hospital stay, and infection rate. Results: Results were
calculated as mean ± SEM, t-test, or 2.
Patients of the 2 groups were comparable in terms of age, gender, and
severity. Tolerance was good in both groups (semi-elemental vs
polymeric: VAS, 7.4 ± 0.6 vs 7.1 ± 0.6, not significant
(NS); number of stools per 24 hours, 1.7 ± 0.4 vs 1.8 ±
0.4, NS). Steatorrhea and creatorrhea were lower than normal in both groups.
In semi-elemental group, the length of hospital stay was shorter (23 ±
2 vs 27 ± 1, p = .006) and weight loss was less
marked (1 ± 1 vs 2 ± 0, p = .01). One patient
in semi-elemental group and 3 patients in polymeric group developed an
infection (NS). Conclusions: Semi-elemental and polymeric nutrition
are very well tolerated in patients with acute pancreatitis. Nutrition with a
semi-elemental formula supports the hypothesis of a more favorable clinical
course than nutrition with a polymeric formula, but this conclusion needs to
be established in larger adequately powered clinical trials.
Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 1,
1-5 (2006)
DOI: 10.1177/014860710603000101

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