The difference in enteral nutrition (EN) versus total parenteral nutrition (TPN) in acute pancreatitis by etiology and disease severity

Abstract

Background: Supplemental nutrition improves long-term outcomes/mortality in acute pancreatitis, with Enteral Nutrition (EN) superior to Total Parenteral Nutrition (TPN). Differences in EN/TPN based upon etiology or disease severity have never been established. Methods: We performed a randomized retrospective case control on subjects admitted to Cooper University Hospital from 06/2007 to 01/2010 with acute pancreatitis who received supplemental nutrition (n = 161). These subjects were examined for caloric and protein demands. Subjects were matched for demographics, weight, albumin, prealbumin eliminating confounders. Demands among disease etiology/severity subgroups and statistical significance were determined. The incidence of EN v.TPN was determined. Results: Significant differences were found in total caloric demands, namely gallstone (n = 50) and alcohol (n = 36) (p = 0.04). Differences in protein demand were not established between these two groups (p = 0.24). Differences in caloric demand were found in bed-side index for severity in acute pancreatitis (BISAP) of 1, 2 and 3 versus 5. Protein demands were different between BISAP of 0 versus all others. 24% of the sample received EN. Conclu: sion: There are significant differences in total caloric demands for subjects with acute pancreatitis by disease severity and in gallstone versus alcohol-induced pancreatitis. These differences are not variations in the sample populations. Finally, EN is under-utilized despite knowledge of its value.