Summary table of included studies

PopulationInterventionComparison
ECKERWALL 2007150Patients with clinical signs of mild acute pancreatitis, pancreas amylase ≥ 3 times above normal, onset of abdominal pain within 48h, acute physiological and chronic health evaluation score (APACHE) II <8 and C-reactive protein (CRP) <150mg/L.
N=60 (one drop out)
Alcohol related: oral feeding group 3/30; fasting group 5/30; total 13%
Fasting (+ iv fluids)
- oral fluids and diet reintroduced in a traditional step- wise manner as tolerated.

N=30
Immediate oral feeding
(+ iv fluids when needed)

N=30
(1 dropped out n=29 completed)
SAX 1987158Patients with acute abdominal pain, clinical findings of abdominal tenderness in the left upper quadrant, nausea, or vomiting; a history of alcohol abuse or gallbladder disease; and laboratory findings of an increased amylase level +/− radiographic confirmation of pancreatic calcifications consistent with chronic pancreatitis.
N=54
Alcohol related: early TPN 86%; no nutrition 76%
TPN + conventional therapy (see comparison) started within 24 hrs of admission.

n=29
Conventional therapy (iv fluids, analgesics, antacids, nasogastric insertion)

n=26
XIAN-LI 2004160Patients with severe acute pancreatitis (SAP) diagnosed by clinical evaluations, clinical biochemistry and CT scanning of the pancreas, according to the universal standard for SAP diagnosis in China.
N=64
Alcohol related: 7/64 (11%)
Group I: traditional conservative therapy (iv fluids, electrolyte replacement, starvation treatment, NG decompression, analgesics, pancreatic exocrine secretion suppression, prophylactic antibiotics and necessary infusion of albumin or fresh plasma)
n=23
Group II: traditional conservative therapy + TPN (iso-caloric + iso-nitrogenous)
n=21

Group III: traditional conservative therapy + TPN + additional glutamine dipeptide- supplementation
n=20
PETROV 2008161n=9 studies included patients with severe acute pancreatitis.
n=6 studies included patients with mild and severe acute pancreatitis.
N=15 studies in total
N= 617 patients
Alcohol related: not reported
  1. enteral nutrition (n=11 studies)
  2. parenteral nutrition (n=3 studies)
  3. enteral nutrition (n=1 study)
  1. no supplementary nutrition
  2. no supplementary nutrition
ECKERWALL 2006163Patients with a clinical diagnosis of acute pancreatitis (abdominal pain, amylase 3 or more time the upper limit of normal, onset of abdominal pain within 48 hrs, APACHE II 8 or more and/or CRP of 150 mg/L or more and/or pancreatic liquid shown on CT)
N=50
Alcohol related: 14%
Parental

N=26
Enteral

N=24
ABOU-ASSI 2002159Patients with acute pancreatitis who were in need of nutritional support, with acute abdominal pain, 3-fold elevation of serum pancreatic enzymes, amylase, lipase.
N=53
Alcohol related: 62%
Total parenteral nutrition (TPN)
n=27
Total enteral nutrition (TEN) – via NJ tube
n=26
McCLAVE 1997157Patients with acute pancreatitis or an acute flare of chronic pancreatitis
N=32
Alcohol related: TEN group: 75% (±11.2); TPN group: 62.5 % (±12.5)
Total parenteral nutrition (TPN)
n=16
Total enteral nutrition (TEN)
n=16
PETROV 2006151Patients with severe acute pancreatitis within 72 hrs of onset. Diagnosis was based on clinical and biochemical presentation
N=69
Alcohol related: enteral: 11/35; parenteral: 15/34; total 38%
Parental

N=34
Enteral

N=35
GUPTA 2006155Patients with acute pancreatitis (defined as abdominal pain and serum amylase concentration of 1000 U/I or more). The diagnosis of predicted severe acute pancreatitis was established by the presence of APACHE II of 6 or more
N=17
Alcohol related: enteral 1/8; parenteral 5/9; total 35%
Parental

N=9
Enteral

N=8

Feeding through NJ tube
KALFARENTZOS 1997156Patients with acute severe pancreatitis (3 or more criteria according to the Imrie classification or APACHE II score of 8 or more, C- reactive protein > 120 mg/l within 48 hrs of admission, and grade D or E by CT according to Balthazar criteria)
N=38
Alcohol related: enteral 3/18; parenteral 2/20; total 13%
Parental

N=20
Enteral

N=18

Through nasoenteric feeding tube
OLAAH 2002149Patients with acute pancreatitis admitted to the surgical ward (clinical symptoms and laboratory signs of pancreatitis (amylase > 200 U/L)
N=89
Alcohol related: enteral 33/41; parenteral 39/48; total 81%
Parental

N=48
Enteral

N=41

NJ tube
WINDSOR 1998148Patients with acute pancreatitis with a serum amylase of > 1000 IU
N=34
Alcohol related: enteral 2/16; parenteral 2/18; total 12%
Parental nutrition

N=18
Enteral nutrition

N=16
PETROV 2008161RCTs of nasogastric versus nasojejunal feeding in patients with severe acute pancreatitis.
N=2 studies in meta-analysis
N=79 patients
Alcohol related: total in NG group 10/43 (23%)
Enteral nutrition via nasogastric feeding

N=43
Enteral nutrition via nasojejunal feeding

N=36
KUMAR 2006153Patients with severe acute pancreatitis. The severity was defined according to Atlanta criteria- presence of organ failure and acute physiology and chronic health evaluation score of ≥ 8 or CT severity score ≥ 7.
N=31
Alcohol related: NJ group 4/14; NG group 4/16; total 27%
Nasojejunal (NJ) feeding

N=14

-all patients achieved the goal of 1800kcal within 7 days from start of feeding (4 patients were supplemented by parenteral nutrition during feeding)
Nasogastric (NG) feeding

N=16

-all patients achieved the goal of 1800kcal within 7 days from start of feeding (6 patients were supplemented by parenteral nutrition during feeding)
EATOCK 2005154Patients with both a clinical and biochemical presentation of acute pancreatitis (abdominal pain + serum amylase at least 3 times the upper limit of the reference range), and objective evidence of disease severity (Glasgow prognostic score 3 or more, or a APACHE II score 6 or more or a CRP level >150 mg/L)
N=49
Alcohol related: total 24.5%
Nasogastric feeding

N=27

77.8% of target calories were delivered beyond 60 hrs
Nasojejunal feeding

N=22

76.1% of target calories were delivered beyond 60 hrs.

From: 4, Alcohol-related Pancreatitis

Cover of Alcohol Use Disorders
Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet].
NICE Clinical Guidelines, No. 100.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guidelines Centre.

Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.