Enteral feeding without pancreatic stimulation

Objective: All forms of commonly practiced enteral feeding techniques stimulate pancreatic secretion, and only intravenous feeding avoids it. In this study, we explored the possibility of more distal enteral infusions of tube feeds to see whether activation of the ileal brake mechanism can result in enteral feeding without pancreatic stimulation, with particular reference to trypsin, because the avoidance of trypsin stimulation may optimize enteral feeding in acute pancreatitis. Methods: The pancreatic secretory responses to feeding were studied in 36 healthy volunteers by standard double-lumen duodenal perfusion/aspiration techniques over 6 hours. Subjects were assigned to no feeding (n = 7), duodenal feeding with a polymeric diet ( n = 7) or low-fat elemental diet ( n = 6), mid-distal jejunal feeding ( n = 11), or intravenous feeding ( n = 5). All diets provided 40 kcal/kg ideal body weight/d and 1.5 g protein/kg ideal body weight/d. Plasma gut peptide responses were monitored in 15 subjects. Results: In comparison with basal fasting trypsin secretion rates ( mean = 134 [ standard error = 22] U/h), duodenal feeding with the polymeric and elemental formulae stimulated trypsin secretion ( mean = 408 [ standard error = 51] U/ h; P< 0.001), whereas intravenous feeding ( mean = 171 [ standard error = 34] U/ h) and mid-distal jejunal ( mean = 119 [ standard error = 16] U/ h) did not. Stimulation was associated with an increase in plasma cholecystokinin, whereas distal jejunal feeding resulted in an increase in plasma glucagon-like peptide-1 and peptide YY concentrations. Conclusions: Our results suggest that enteral feeding can be given without stimulating pancreatic trypsin secretion provided it is delivered into the mid-distal jejunum. The mechanism may involve activation of the ileal brake mechanism.