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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.

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