Nutrition management in acute pancreatitis: Clinical practice consideration

Acute pancreatitis(AP)is a common gastrointestinal disease and the leading cause of hospital admission and healthcare burden among gastrointestinal disorders in many countries.Patients can present with varying degrees of inflammation and disease severity,ranging from self-limiting mild AP to devastating and fatal severe AP.Many factors contribute to malnutrition in AP,especially abnormal metabolism and catabolism related to inflammation.The concept of“pancreatic rest”is not evidence-based.There is however,emerging evidence that supports the use of oral or enteral nutrition to improve nutrition status and to reduce local and systemic inflammation,complications,and death.In mild disease,patients are generally able to initiate solid oral diet and do not require specialized nutrition care such as enteral or parenteral nutrition.In contrast,nutrition interventions are imperative in moderately severe and severe AP.The current article aims to review the latest evidence and suggest practical nutrition interventions in patients with AP,including nutrition requirements,routes of nutrition treatment,types of formula,and the role of nutritional supplements,such as glutamine,probiotics,omega-3 fatty acids,and antioxidants.

Forward-viewing radial-array echoendoscope for staging of colon cancer beyond the rectum

AIM:To evaluate feasibility of the novel forward-viewing radial-array echoendoscope for staging of colon cancer beyond rectum as the first series.METHODS:A retrospective study with prospectively entered database.From March 2012 to February 2013,a total of 21 patients(11 men)(mean age 64.2 years)with colon cancer beyond the rectum were recruited.The novel forward-viewing radial-array echoendoscope was used for ultrasonographic staging of colon cancer beyond rectum.Ultrasonographic T and N staging were recorded when surgical pathology was used as a gold standard.RESULTS:The mean time to reach the lesion and the mean time to complete the procedure were 3.5 and 7.1min,respectively.The echoendoscope passed through the lesions in 13 patients(61.9%)and reached the cecum in 10 of 13 patients(76.9%).No adverse events were found.The lesions were located in the cecum(n=2),ascending colon(n=1),transverse colon(n=2),descending colon(n=2),and sigmoid colon(n=14).The accuracy rate for T1(n=3),T2(n=4),T3(n=13)and T4(n=1)were 100%,60.0%,84.6%and 100%,respectively.The overall accuracy rates for the T and N staging of colon cancer were 81.0%and52.4%,respectively.The accuracy rates among traversable lesions(n=13)and obstructive lesions(n=8)were 61.5%and 100%,respectively.endoscopic ultrasound and computed tomography had overall accuracy rates of 81.0%and 68.4%,respectively.CONCLUSION:The echoendoscope is a feasible staging tool for colon cancer beyond rectum.However,accuracy of the echoendoscope needs to be verified by larger systematic studies.

Optimal hang time of enteral formula at standard room temperature and high temperature

BACKGROUND Despite high risk of bacterial contamination,yet there are no studies that have evaluated the optimal hang time of blenderized and reconstituted powdered formulas at standard room temperature and high temperature.AIM To investigate the optimal hang time of both types of formulas at standard room temperature and high temperature.METHODS Ten specimens of blenderized formula and 10 specimens of reconstituted powdered formula were prepared using aseptic techniques.Five specimens of each formula were administered at 25℃and 32℃.Simulated administration was done in an incubator.The samples were collected at 0,2,4,6 h and aerobic culture was performed.Food and drug administration criteria were used to determine the unacceptable levels of bacterial contamination.RESULTS Unacceptable contamination for blenderized formula began at 4 h at 25℃and at 2 h at 32℃.As for the reconstituted powdered formula,there was no bacterial growth in all specimens up to 6 h at both temperatures.CONCLUSION The optimal hang time to avoid significant bacterial contamination of the blenderized formula should be limited to 2 h at standard room temperature and be administered by bolus method at high temperature,while a reconstituted powdered formula may hang up to 6 h at both temperatures.