Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study

被引:75
作者
De Lédinghen V. [1 ,2 ]
Beau P. [1 ]
Mannant P.-R. [1 ]
Borderie C. [1 ]
Ripault M.-P. [1 ]
Silvain C. [1 ]
Beauchant M. [1 ]
机构
[1] Serv. d'Hépato-Gastroenterol., Centre Hospitalier Universitaire, Poitiers
[2] Serv. d'Hépato-Gastroenterol., Hopital du Haut-Lévêque
关键词
cirrhosis; enteral nutrition; esophageal varices bleeding; portal hypertension;
D O I
10.1023/A:1018838808396
中图分类号
学科分类号
摘要
The aim of this randomized controlled study was to assess the nutritional and clinical effects of early enteral nutrition (EN) in cirrhotic patients with bleeding from esophageal varices. From August 1994 through August 1995, all patients admitted for acute variceal bleeding underwent emergency sclerotherapy or banding ligation and continuous infusion of octreotide and were randomized in two groups. In group A, patients received from day 1 discontinuous polymeric EN (1665 kcal/day, through nasogastric tube) and in group B, patients were nil by mouth. On day 4, all patients received oral diet. Nutritional status, liver function, and rebleeding were evaluated on days 4, 7, and 35. Twenty-two patients (17 men, 5 women, mean age 56 years) were included. On day 0, patients in group A (N = 12) and group B (N = 10) were comparable. On day 4, nitrogen balance was 0.7 ± 2.5 g/day in group A and -11.2 ± 6.7 g/day in group B (P = 0.01, Mann-Whitney test). On days 4, 7, and 35, no significant differences between the two groups were observed for nutritional status and liver function. Four (33%) group A patients rebled compared with one (10%) group B patient (NS). Hospital stay (14.5 ± 4.1 days vs 12.9 ± 5.3 days) and mortality (3 vs 2 patients), were comparable between the two groups. In conclusion, our study failed to demonstrate any favorable effect of short-term EN on nutritional status and liver function in cirrhotic patients hospitalized for variceal bleeding.
引用
收藏
页码:536 / 541
页数:5
相关论文
共 29 条
[1]  
Morgan M.Y., Alcohol and nutrition, Br Med Bull, 38, pp. 21-29, (1982)
[2]  
Muller M.J., Malnutrition in cirrhosis, J Hepatol, 23, 1 SUPPL., pp. 31-35, (1995)
[3]  
Kearns P.J., Young H., Garcia G., Blaschke T., O'Hanlon G., Rinki M., Sucher K., Gregory P., Accelerated improvement of alcoholic liver disease with enteral nutrition, Gastroenterology, 102, pp. 200-205, (1992)
[4]  
Hirsch S., Bunout D., De La Maza P., Iturriaga H., Petermann M., Icazar G., Gattas V., Ugarte G., Controlled trial on nutrition supplementation in outpatients with symptomatic alcoholic cirrhosis, JPEN, 17, pp. 119-124, (1993)
[5]  
Cabre E., Gonzalez-Huix F., Abad-lacruz A., Esteve M., Acero D., Fernandez-Banares F., Xiol X., Gassull M.A., Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics, Gastroenterology, 98, pp. 715-720, (1990)
[6]  
D'Amico G., Pagliaro L., Bosch J., The treatment of portal hypertension: A meta-analytic review, Hepatology, 22, pp. 332-354, (1995)
[7]  
Pagliaro L., D'Amico G., Luca A., Pasta L., Politi F., Aragona E., Malizia G., Portal hypertension: Diagnosis and treatment, J Hepatol, 23, 1 SUPPL., pp. 36-44, (1995)
[8]  
Thomsen B.L., Moller S., Sorensen T.I.A., Optimized analysis of recurrent bleeding and death in patients with cirrhosis and esophageal varices, J Hepatol, 21, pp. 367-375, (1994)
[9]  
Caly W.R., Strauss E., A prospective study of bacterial infections in patients with cirrhosis, J Hepatol, 18, pp. 353-358, (1993)
[10]  
Mendenhall C.L., Moritz T.E., Roselle G.A., Morgan T.R., Nemchausky B.A., Tamburro C.H., Schiff E.R., McClain C.J., Marsano L.S., Allen J.I., Samanta A., Weesner R.E., Henderson W., Gartside P., Chen T.S., French S.W., Chedid A., A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: Results of a department of veterans affairs cooperative study, Hepatology, 17, pp. 564-576, (1993)