Mishall Prasannan, (2020) A Study on Early Enteral Feeding in Acute Pancreatitis - Nasogastric Vs Nasojejunal Feeding. Masters thesis, Madras Medical College, Chennai.
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Abstract
AIM OF THE STUDY: 1. To assess any difference between NG and NJ routes, in tolerance, acute phase response, and pain. 2. To study the clinical course of patients managed conservatively. METHODS: Study Centre: Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. Duration of Study: Dec 2017 to Jan 2019. Study Design: Randomised control study. Sample Size: Approximately 6 0 Inclusion Criteria : 1.All patients with both clinical and biochemical presentation of Acute pancreatitis (abdominal pain + serum amylase at least 3 times the upper limit of the reference range), 2.An Acute Physiology and Chronic Health Evaluation (APACHE) II score of 6 or more. Exclusion criteria : Patients under 18 yr of age and pregnant females. Methodology : Patients were divided by simple randomisation into those who receive either nasogastric tube or a nasojejunal tube. Patients who had nasogastric route of early enteral nutrition were labelled as Group A and the patients who revieved nasojejunal mode of feeding were labelled Group B. All Patients who fit the inclusion criteria will be observed and Monitored for the inflammatory response by daily measurement of APACHE II score, CRP levels, visual analogue score (VAS) for pain,Feeds were commenced at full strength and a rate of 30 ml/h increasing to 100 ml/h over 24–48 h. The caloric target was 2,000 kcal per day. This was chosen over an individually calculated target in an attempt to simplify administration. Each of these parameters was then observed on the day of commencement of feed and the following 4 days. Patients in both groups were followed throughout the period of hospitalization to detect any evidence of increase in the severity of pancreatitis as a result of the introduction of feeding. RESULTS: The patients who were subjected to nasogastric mode of feeding showed a decreasing trend in the mean values of the Apache 2 scores drastically. The patients who underwent enteral feeding through the naso gastric route showed a marked decrease in the visual analogue scoring. The visual analogue scores showed an overall value that remained unchanged throughout the course of nasojejunal feeding in acute pancreatitis. CRP levels showed not much of a difference among both the nasogastric and nasojejunal routes. Overall, both the subgroups of patients improved after being subjected to early enteral nutrition. The comparison between the nasogastric and nasojejunal routes of feeding show that, there is marked improvement in the pain levels among the subset treated with nasogastric route of feeding. The decline in Apache 2 scores among the nasogastric feeders show that, in a critically ill patient, this mode of nutrition can actively reduce the sepsis scores when compared to all other modes of nutrition. The levels of CRP , on the contrary, show no such change among both the groups of patients. This concludes that the nutritive support given to the patient suffering from acute pancreatitis does not really have an impact on the severity of inflammation of the pancreas. CONCLUSION: It has been clearly established that there is a role for early enteral feeding in patients of acute pancreatitis. In a critically ill patient who cannot be shifted out of the intensive care cubicle, there is a higher risk of increased disease progression when the patient is subjected to fluoroscopy or endoscopic intervention for adequate placement of a nasojejunal tube. And it is in such a scenario, the simple yet effective nasogastric tube comes to the rescue, bringing down the markers of sepsis and giving relief from agony for the patient. To conclude, we can advocate early enteral feeding by the use of a nasogastric tube without further deterioration of the disease condition of the patient.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711010 |
| Uncontrolled Keywords: | Early Enteral Feeding, Acute Pancreatitis, Nasogastric, Nasojejunal Feeding. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 00:23 |
| Last Modified: | 09 Feb 2021 00:23 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13930 |
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