Effect of total parenteral nutrition (TPN) with and without glutamine dipeptide supplementation on outcome in severe acute pancreatitis (SAP)

Objective: To investigate the effect of total parenteral nutrition (TPN) and glutamine-supplemented TPN in patients with serious acute pancreatitis (SAP). Methods: Sixty-four patients with SAP were randomly divided into three therapeutic groups. Twenty-three cases (group I) were treated by traditional therapeutic program combined with traditional therapy, the 21 cases in group II and 20 cases in group III were treated by TPN and glutamine-supplemented TPN, respectively. The concentration of serum albumin was determined, recovery time of blood amylase, the incidence of complications, mortality, length of hospital stay (LOS) and body mass of the patients in each group were monitored. Results: The concentrations of serum albumin were low in all three groups at admission. After 2 weeks of treatment, the serum albumin concentration increased in groups II and III, while it remained almost the same in group I. Mortalities for groups I, II, and III were 43.5% (10/23), 14.3% (3/21, vs. group I P < 0.05) and 0% (vs. group I P < 0.01), respectively. The incidence of complications in group I (21/23) was much higher than those in group II (11/21, P < 0.01) and group III (4/20, P < 0.01), and in group III they were less frequent than in group II (P < 0.05). In fact no pancreatic infection occurred in group III with glutamine dipeptide supplementation. The loss of body mass in group I was more profound than in groups II and III, P < 0.05. The length of stay (LOS) in group I (39.1 +/- 10.60d) was longer than those of group II (28.6 +/- 6.90d, P < 0.05) and III (25.3 +/- 7.60d, P < 0.01). Conclusions: Combined with conventional therapy, TPN and glutamine dipeptide-supplemented TPN therapy can reduce mortality and the incidence of infectious complications, shorten the LOS, and improve the nutritional status of patients with SAP. Glutamine-supplemented TPN therapy can apparently prevent the occurrence of pancreatic infection. (c) 2004 Elsevier Ltd. All rights reserved.