Use of exclusive enteral nutrition in adults with Crohn’s disease: A review

Exclusive enteral nutrition(EEN)is well-established as a first line therapy instead of corticosteroid(CS)therapy to treat active Crohn’s disease(CD)in children.It also has been shown to have benefits over and above induction of disease remission in paediatric populations.However,other than in Japanese populations,this intervention is not routinely utilised in adults.To investigate potential reasons for variation in response between adult studies of EEN and CS therapy.The Ovid database was searched over a 6-mo period.Articles directly comparing EEN and CS therapy in adults were included.Eleven articles were identified.EEN therapy remission rates varied considerably.Poor compliance with EEN therapy due to unpalatable formula was an issue in half of the studies.Remission rates of studies that only included patients with previously untreated/new CD were higher than studies including patients with both existing and new disease.There was limited evidence to determine if disease location,duration of disease or age of diagnosis affected EEN therapy outcomes.There is some evidence to support the use of EEN as a treatment option for a select group of adults,namely those motivated to adhere to an EEN regimen and possibly those newly diagnosed with CD.In addition,the use of more palatable formulas could improve treatment compliance.     

The effectiveness of enteral nutrition for patients with primary liver cancer: A randomized controlled study protocol

Objective:The objective of this study is to explore the influence of the enteral nutrition on primary liver cancer patients after receiving hepatectomy.Method:This is a prospective randomized controlled research, which will be conducted between April 2021 and April 2022. Approval is obtained from the Research Ethics Committee of Chun’ an County First People''s Hospital (A20201108). Patients who meet the following conditions will be included in this experiment:

• (1)the patients aged 18 to 70 years;
• (2)in line with clinical diagnostic criteria for primary liver cancer;
• (3)planned liver resection for primary liver cancer;
• (4)liver function status of Child-Pugh A.

Patients with the following characteristics are excluded:

• (1)a history of other malignancy;
• (2)mental disorder;
• (3)severe diabetes or poor glycemic control;
• (4)serious complications: bleeding and bile leakage;
• (5)poor medical condition: renal failure, respiratory or heart failure.

Our investigation includes sixty patients who meet our inclusion criteria. The primary endpoints are length of postoperative hospital stay and liver function index. The secondary results involve the first flatus time and the first defecation time.Results:Table 1 indicates the postoperative outcomes between treatment group and control group.Conclusion:Enteral nutrition can improve recovery in the primary liver cancer patients after receiving hepatectomy.Trial registration:The protocol has been registered in Research Registry (researchregistry6275)     

The effect of minimum luminal nutrition on mucosal cellularity and immunity of the gut

Many catabolic patients can only consume small volumes of enteral nutrients. The aim of this study was to evaluate markers of cellularity and immunity in the small intestine of rats randomized to receive 6 days of parenteral nutrition, 25% enteral and 75% parenteral nutrition (i.e. minimum luminal nutrition) or enteral nutrition. The same glutamine-enriched solution was used for both parenteral and enteral nutrition. Enteral nutrition was associated with the least amount of jejunal atrophy ( P < 0.01), with the results from the minimum luminal nutrition group approximating those of the parenteral nutrition group. Parenteral nutrition was associated with the greatest number of CD2+ cells ( P < 0.05) and the lowest CD4/CD8 cell ratio ( P < 0.01) in the jejunal mucosa. In essence, we failed to demonstrate that there are any appreciable benefits associated with the enteral consumption of 25% of a nutrient load.     

早期肠内营养在重症急性胰腺炎治疗中的作用

目的探讨重症急性胰腺炎早期肠内营养的可行性、安全性及有效性。方法将我院40例重症急性胰腺炎病人，随机分成肠内营养组（EN）（20例）和对照组（20例），EN组在入院72h后在胃镜辅助下置空肠营养管，由肠外营养逐渐过渡到肠内营养，其余治疗与对照组相同。分别比较两组治疗后7天时的血浆白蛋白和血红蛋白水平，以及治疗前后血尿淀粉酶水平。结果所有病人对早期肠内营养都能耐。无胰腺炎复发，肠内营养对血尿淀粉酶无明显影响，EN组血浆白蛋白和血红蛋白水平较治疗前及对照组有显著提高，EN组有1例出现肺感染，2例并发胰腺假性囊肿。对照组有3例出现肺感染，2例并发胰腺假性囊肿。结论对重症急性胰腺炎进行早期肠内营养支持是可行、安全及有效的，能降低胰周及全身感染率，改善重症急性胰腺炎病人的营养状况。     

胰腺癌术后肠内营养与肠外营养的Meta分析

[目的]系统评价胰腺癌切除术后肠内营养(enteral nutrition,EN)与肠外营养(parenteral nutrition,PN)支持治疗的疗效.[方法]计算机检索国外Pubmed、西文生物医学期刊文献数据库,国内检索CNKI、维普和万方数据库,收集相关随机对照试验(randomized control trials,RCTs),并利用RevMan 5.1软件进行Meta分析.[结果]共纳入6项研究,包括411例研究对象.EN组比PN组术后住院时间短(WMD=1.44; 95％ CI:-2.04、-0.83),术后并发症的发生率低(OR=0.66;95％CI:0.42、1.05).然而,术后营养指标白蛋白PN组高于EN组(WMD=4.41;95％CI:-7.55、-0.73),而2组间血红蛋白比较差异无统计学意义(WMD=0.58;95％CI:-5.62、6.78).[结论]EN支持胰腺癌术后患者能有效缩短患者住院时间,降低并发症的发生.胰腺癌术后EN是一种有效的营养支持方式.     

Effect of probiotics on the nutritional status of severe stroke patients with nasal feeding that receive enteral nutrition: A protocol for systematic review and meta-analysis of randomized controlled trials

Background:Malnutrition is commonly observed after stroke and is closely associated with poor clinical outcomes. So, early nutrition support is particularly crucial for severe stroke patients. However, a significant number of critically ill patients are intolerant to enteral nutrition (EN). Probiotics have been widely used in malnutrition by various diseases and have a low incidence of enteral intolerance. So, we aim to elucidate the efficacy of probiotics in EN in improving the nutritional status and clinical prognosis of severe stroke patients with nasal feeding.Method:Embase, PubMed, Sinomed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang database, and Vip Journal Integration Platform were searched from inception to March 31, 2021. Randomized controlled trials that applied probiotics in patients with severe stroke were included. The data were extracted and the risk of bias was assessed independently by 2 evaluators.Results:Twenty-four studies comprising 2003 participants of randomized controlled trials were included. The result of pooled analyses showed that probiotics in EN were associated with better outcomes than EN alone on Glasgow Coma Scale score (mean difference [MD] = 1.03, 95% confidence intervals [CI]: 0.78–1.27; P < .00001), infection events (odds ratio [OR] = 0.25, 95% CI: 0.15–0.43; P < .00001), rate of intestinal flora dysbiosis (OR = 0.24, 95% CI: 0.12–0.48; P < .0001), gastrointestinal complications (OR = 0.25, 95% CI: 0.16–0.37, P < .00001), time to reach target nutrition (MD = −1.80, 95% CI: −2.42 to 1.18, P < .00001), prealbumin content (MD = 25.83, 95% CI: 13.68–37.99, P < .0001).Conclusion:Our results demonstrated that probiotics supplementation might be an effective intervention for improving the clinical prognosis in severe stroke patients with nasal feeding, but no significant effect on increasing muscle circumference.     

Pilot study investigating the effect of enteral and parenteral nutrition on the gastrointestinal microbiome post-allogeneic transplantation

Nutrition support is frequently required post-allogeneic haematopoietic progenitor cell transplantation (HPCT); however, the impact of mode of feeding on the gastrointestinal microbiome has not been explored. This study aimed to determine if there is a difference in the microbiome between patients receiving enteral nutrition (EN) and parenteral nutrition (PN) post-allogeneic HPCT. Twenty-three patients received either early EN or PN when required. Stool samples were collected at 30 days post-transplant and analysed with shotgun metagenomic sequencing. There was no difference in microbial diversity between patients who received predominantly EN (n = 13) vs. PN (n = 10) however patients who received predominantly EN had greater abundance of Faecalibacterium (P < 0·001) and ruminococcus E bromii (P = 0·026). Patients who had minimal oral intake for a longer duration during provision of nutrition support had a different overall microbial profile (P = 0·044), lower microbial diversity (P = 0·004) and lower abundance of faecalibacterium prausnitzii_C (P = 0·030) and Blautia (P = 0·007) compared to patients with greater oral intake. Lower microbial diversity was found in patients who received additional beta lactam antibiotics (P = 0·042) or had a longer length of hospital stay (P = 0·019). Post-HPCT oral intake should be encouraged to maintain microbiota diversity and, if nutrition support is required, EN may promote a more optimal microbiota profile.     

A new strategy of enteral nutrition intervention for ICU patients targeting intestinal flora

Background:Enteral nutrition (EN) therapy is a routine supportive method for patients in the intensive care unit (ICU). However, the incidence of EN intolerance is prevalent, because most ICU patients suffer intestinal mucosal barrier damage and gastrointestinal motility disorder. There is no definite index to predict EN intolerance, and the current treatment methods are not effective in alleviating EN intolerance. Gut microbiota is an important component of the intestinal micro-ecological environment, and alterations in its structure and composition can reflect changes in intestinal function and microenvironment. The purpose of this study is to investigate the effect of EN on the gut microbiota of ICU patients by monitoring the dynamic alterations of gut microbiota and to screen out the microbial markers that can be used to predict the incidence of EN intolerance.Methods:One hundred ICU patients with trauma or in a period of acute stress after surgery will be enrolled, and their fecal samples will be collected at different timepoints for microbial sequencing and analysis. General clinical data (demographic information, surgical data, laboratory parameters, illness severity scores, and therapeutic drugs), nutritional status data (nutritional status assessment and nutrition therapy monitoring data), as well as clinical outcomes, will be recorded. The microbial and clinical data will be combined to analyze the baseline characteristics and dynamic alterations of gut microbiota along with the incidence of EN intolerance. Data related to the gut microbiota will be statistically analyzed by R software, and other data performed by SPSS23.0 software.Conclusions:The effect of EN on gut microbiota and microbial markers predicting the intolerance of EN will lead us to develop a new nutrition intervention strategy for ICU patients. Furthermore, the results of this study will provide a basis for the discovery of potential probiotics used for the prevention and treatment of EN intolerance.     

早期胃肠内营养支持对重型颅脑损伤患者预后的影响

目的探讨对重型颅脑损伤患者行早期胃肠内营养支持的临床价值。方法将同期收治的104例重型颅脑损伤患者随机分为观察组与对照组各52例,两组入院后均根据病情行常规治疗,在此基础上观察组于伤后24h内经十二指肠置管行早期胃肠内营养支持,24 h内予米汤或鸡蛋糊,48 h后予能全力;对照组入院至伤后1周行完全胃肠外营养,伤后约1周肠鸣音出现时鼻饲能全力。治疗后28 d观察两组急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及并发症发生情况,抽取空腹静脉血检测血生化指标包括血清总蛋白、白蛋白、Hb及总淋巴细胞计数、空腹血糖、氮平衡。结果观察组APACHEⅡ评分及并发症发生率均显著低于对照组,TP、Alb、Hb、氮平衡等血生化指标均优于对照组（P均〈0.05）。结论对重型颅脑损伤患者行早期胃肠内营养支持可通过改善全身营养及免疫状况等改善预后、降低并发症发生率,且具有操作简单、安全、方便、费用相对低廉等优点。     

The efficacy of enteral nutrition combined with accelerated rehabilitation in non-small cell lung cancer surgery: A randomized controlled trial protocol

Objective:To investigate the effect of enteral nutrition combined with accelerated rehabilitation in treating the non-small cell lung cancer (NSCLC).Methods:It is a randomized controlled experiment to be carried out from June 2021 to December 2021. It was permitted through the Ethics Committee of Cancer Hospital Affiliated to Shandong First Medical University (00923876). 100 patients are included in the study. The inclusion criteria contain: (1) patients with NSCLCs receiving surgery as the primary treatment; (2) over 18 years of age. The exclusion criteria are as follows: (1) age ≥65 years; (2) severe metabolic and systemic diseases, such as diabetes, hypertension, or severe liver and kidney dysfunction; (3) the body mass index <18.5 kg/m²; (4) patients who have received preoperational radiotherapy or chemotherapy. Patients in the control group are provided routine nutrition, including preoperative nutritional risk screening and assessment and preoperative nutrition education and dietary guidance, while patients in the nutrition group are provided additional enteral nutrition preparations combined with accelerated rehabilitation as in the control group. The primary outcomes include the perioperative change of serum albumin, serum prealbumin, hemoglobin, and total lymphocyte counts. The second outcomes include length of hospitalization, quality of life, and risk of postoperative complications.Results:Table ​Table11 shows the comparison of indicators after surgery between the 2 groups.Table 1Comparison of indicators after surgery between the 2 groups.

Toward enteral nutrition in the treatment of pediatric Crohn disease in Canada: A workshop to identify barriers and enablers

The treatment armamentarium in pediatric Crohn disease (CD) is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet]), which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn’s and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario), inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies). Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.     

Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta‐analysis

Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta‐analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta‐analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed‐ and random‐effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22–0.62, P = 0.00, test for heterogeneity: I² = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22–0.96, P = 0.04, test for heterogeneity: I² = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47–3.21, P = 0.01, test for heterogeneity: I² = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63–22.29, P = 0.01, test for heterogeneity: I² = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79–2.13, P = 0.30, test for heterogeneity: I² = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support.     

临床肠内营养支持对老年慢性阻塞性肺病患者心肺功能影响的干预研究

目的探讨肠内营养对老年慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)患者心肺功能的影响。方法选择老年COPD稳定期患者58例,常规治疗基础上随机分为2组,其中治疗组29例(肠内营养),对照组29例(自由饮食)。治疗前后检测各项营养指标(血清总蛋白、白蛋白、前白蛋白)、LVEF、肺功能[第一秒用力呼气容积(FEV1),用力肺活量(FVC)]。结果治疗组治疗后体质量指数、血清总蛋白、白蛋白、前白蛋白水平较治疗前明显升高,而对照组以上各项指标改善不明显。治疗组治疗后体质量指数、血清总蛋白、白蛋白、前白蛋白水平较对照组明显改善,差异有统计学意义(P<0.05)。治疗组治疗后LVEF[(48.98±6.38)%vs(42.38±5.98)%,(42.73±5.34)%]、FVC[(2.98±0.38)Lvs(2.75±0.31)L,(2.76±0.34)L]、FEV1[(2.06±0.87)Lvs(1.78±0.72)L,(1.92±0.90)L]、FEV1/FVC[(78.36±12.32)vs(70.65±12.28),(71.23±12.55)]较治疗前和对照组明显改善,差异有统计学意义(P<0.05)。结论老年COPD患者,在常规治疗的同时给予肠内营养治疗,可以改善患者营养状况,进一步改善患者心肺功能,缩短住院时间。     

胃肠激素在早期肠内营养预防应激性溃疡的表达研究

目的 探讨胃肠激素在早期肠内营养预防应激性溃疡的作用.方法 将38例危重患者随机分为3组:A组13例,给予抑酸药物加早期(发病24 h内)肠内营养;B组13例,给予抑酸药物加延迟(发病72 h后)肠内营养;C组12例,单纯应用抑酸药物.于发病后5 d、2周时分别行胃镜检查,观察溃疡的发生情况;同时测定各组前列腺素(PGE-2)和胃泌素(GAS)、生长抑素(SS)的含量.结果 A组溃疡发生率及溃疡指数均明显低于B、C组(P<0.01),溃疡抑制率高于其他两组(P<0.01);A、B组2周后溃疡愈合率高于C组(P<0.05).与B、C组比较,A组胃黏膜中的PGE-2、GAS水平明显增高,SS水平明显降低(P<0.05);B、C组间亦有统计学差异(P<0.05).结论 应用抑酸药物同时给予早期肠内营养治疗可能对应激性溃疡的发生有一定的预防作用.肠内营养可能通过调节胃肠激素含量起作用.     

食管癌术后早期肠内营养支持的疗效分析

目的分析食管癌患者术后早期进行肠内营养对患者免疫功能影响和应用效果。方法选取我院2017年1月至2019年6月收治的102例食管癌患者作为本次研究对象,将患者按随机数字法分为两组,每组患者均为51例。对其中一组食管癌患者使用早期肠内营养支持,设为研究组;另外一组患者进行标准的肠外营养支持,设定为对照组。对两组患者在术前1天(T0)、进行营养支持的第1天(T1)和1周时间(T2)的营养指标、细胞免疫指标以及体液免疫指标等情况做检测,记录检测数据并对比分析。结果两组患者T2时检测出的营养指标、细胞免疫指标以及体液免疫指标等水平都要高于T1。研究组患者T2时各项指标比对照组患者改善得更好,两组间对比有统计学差异(P<0.05)。结论早期肠内营养支持能够使食管癌患者营养指标、细胞免疫指标以及体液免疫等指标得到改善效果,值得临床大力推广。     

早期肠内营养对重症胰腺炎患者的影响

目的通过对44例重症胰腺炎不同方法的治疗，观察腑内营养（C-N）和静脉营养（PN）在住院时间、并发症及住院费用的区别。方法病人入院后给予禁饮食、胃肠减压，止痛抑制胃酸、胰液分泌及抗感染等治疗，第2天给予静脉营养。一组在病情稳定后（一般入院3-5天）开始给予肠内营养（EN）；另一组给静脉营养（PN）至进食，其中8例次半月后行肠内营养。结果EN组未出现腹痛腹泻及腹腔感染病，假性囊肿3例，平均住院时间18天，住院费用19996．70元。PN组腹痛腹泻病例12例次，腹腔感染2例次，多器官功能损害1例，静脉导管感染1例，假性囊肿6例，平均住院时间21．7天，住院费用36781．00元。两组住院时间无统计学意义（t检验P〉0．05），住院费用有统计学意义（t检验P〈0．05）。结论重症胰腺炎早期行肠内营养可减少住院费用、腹腔感染和腹痛腹泻等并发症。