Intensive Enteral Nutrition Is Ineffective for Patients With Severe Alcoholic Hepatitis Treated With Corticosteroids

被引：126

作者：

Moreno, Christophe ^{[1
,2
]}

Deltenre, Pierre ^{[1
,4
,5
]}

Senterre, Christelle ^{[3
]}

Louvet, Alexandre ^{[6
]}

Gustot, Thierry ^{[1
,2
]}

Bastens, Boris ^{[7
]}

Hittelet, Axel ^{[8
]}

Piquet, Marie-Astrid ^{[9
]}

Laleman, Wim ^{[10
]}

Orlent, Hans ^{[11
]}

Lasser, Luc ^{[12
]}

Serste, Thomas ^{[13
]}

Starkel, Peter ^{[14
]}

De Koninck, Xavier ^{[15
]}

Dastis, Sergio Negrin ^{[16
]}

Delwaide, Jean ^{[17
]}

Colle, Isabelle ^{[18
]}

de Galocsy, Chantal ^{[19
]}

Francque, Sven ^{[20
]}

Langlet, Philippe ^{[21
]}

Putzeys, Virginie ^{[22
]}

Reynaert, Hendrik ^{[23
]}

Degre, Delphine ^{[1
,2
]}

Trepo, Eric ^{[1
,2
]}

机构：

[1] Clin Univ Bruxelles, Hop Erasme, Dept Gastroenterol Hepatopancreatol & Digest Onco, Brussels, Belgium

[2] Univ Libre Bruxelles, Sch Publ Hlth, Lab Expt Gastroenterol, Brussels, Belgium

[3] Univ Libre Bruxelles, Sch Publ Hlth, Res Ctr Epidemiol Biostat & Clin Res, Brussels, Belgium

[4] CHU Vaudois, Div Gastroenterol & Hepatol, CH-1011 Lausanne, Switzerland

[5] Hop Jolimont, Serv Hepatogastroenterol, Haine St Paul, Belgium

[6] Ctr Hosp Reg & Univ Lille, Hop Huriez, Serv Malad Appareil Digestif, Pl Verdun, F-59037 Lille, France

[7] Hop St Joseph, Dept Gastroenterol, Liege, Belgium

[8] Hop Ambroise Pare, Dept Gastroenterol, Mons, Belgium

[9] Ctr Hositalier Univ Caen, Serv Hepatogastroenterol, Caen, France

[10] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Liver & Biliopancreat Disorders, Leuven, Belgium

[11] Acad Ziekenhuis St Jan, Dept Gastroenterol & Hepatol, Brugge, Belgium

[12] Ctr Hositalier Univ Brugmann, Dept Hepatogastroenterol, Brussels, Belgium

[13] Ctr Hositalier Univ St Pierre, Dept Hepatogastroenterol, Brussels, Belgium

[14] Catholic Univ Louvain, Clin Univ St Luc, Dept Gastroenterol, B-1200 Brussels, Belgium

[15] Hop St Pierre, Dept Gastroenterol, Ottignies, Belgium

[16] Hop St Joseph, Dept Gastroenterol, Warquignies, Belgium

[17] Univ Liege, Ctr Hositalier Univ Sart Tilman, Dept Hepatogastroenterol, Liege, Belgium

[18] Ghent Univ Hosp, Dept Hepatogastroenterol, Ghent, Belgium

[19] Hop Iris Sud, Dept Gastroenterol, Brussels, Belgium

[20] Univ Antwerp Hosp, Dept Gastroenterol & Hepatol, Edegem, Belgium

[21] Ctr Hosp Interreg Edith Cavell, Dept Gastroenterol, Brussels, Belgium

[22] CHR La Citadelle, Dept Gastroenterol, Liege, Belgium

[23] Univ Ziekenhuis Brussel, Dept Hepatogastroenterol, Brussels, Belgium

来源：

GASTROENTEROLOGY | 2016年 / 150卷 / 04期

关键词：

Nutrients; Ethanol; Liver Disease; Cirrhosis; RANDOMIZED CLINICAL-TRIAL; LIVER-DISEASE; COMPETING RISK; CIRRHOSIS; PENTOXIFYLLINE; MALNUTRITION; SURVIVAL; THERAPY; MODEL; PREDNISOLONE;

D O I：

10.1053/j.gastro.2015.12.038

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Severe alcoholic hepatitis (AH) is a life-threatening disease for which adequate oral nutritional support is recommended. We performed a randomized controlled trial to determine whether the combination of corticosteroid and intensive enteral nutrition therapy is more effective than corticosteroid therapy alone in patients with severe AH. METHODS: We enrolled 136 heavy consumers of alcohol (age, 18-75 y) with recent onset of jaundice and biopsy-proven severe AH in our study, performed at 18 hospitals in Belgium and 2 in France, from February 2010 through February 2013. Subjects were assigned randomly (1: 1) to groups that received either intensive enteral nutrition plus methylprednisolone or conventional nutrition plus methylprednisolone (controls). In the intensive enteral nutrition group, enteral nutrition was given via feeding tube for 14 days. The primary end point was patient survival for 6 months. RESULTS: In an intention-to-treat analysis, we found no significant difference between groups in 6-month cumulative mortality: 44.4% of patients died in the intensive enteral nutrition group (95% confidence interval [CI], 32.2%-55.9%) and 52.1% of controls died (95% CI, 39.4%-63.4%) (P = .406). The enteral feeding tube was withdrawn prematurely from 48.5% of patients, and serious adverse events considered to be related to enteral nutrition occurred in 5 patients. Regardless of group, a greater proportion of patients with a daily calorie intake less than 21.5 kcal/kg/day died (65.8%; 95% CI, 48.8-78.4) than patients with a higher intake of calories (33.1%; 95% CI, 23.1%-43.4%) (P < .001). CONCLUSIONS: In a randomized trial of patients with severe AH treated with corticosteroids, we found that intensive enteral nutrition was difficult to implement and did not increase survival. However, low daily energy intake was associated with greater mortality, so adequate nutritional intake should be a main goal for treatment. ClinicalTrials.gov number: NCT01801332.

引用

页码：903 / +

页数：16

共 30 条

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