Nutritional status efficacy of early nutritional support in gastrointestinal care: A systematic review and meta-analysis

BACKGROUND Gastrointestinal surgery is a complicated process used to treat many gastrointestinal diseases,and it is associated with a large trauma:Most patients often have different degrees of malnutrition and immune dysfunction before surgery and are prone to various infectious complications during postoperative recovery,thus affecting the efficacy of surgical treatment.Therefore,early postoperative nutritional support can provide essential nutritional supply,restore the intestinal barrier and reduce complication occurrence.However,different studies have shown different conclusions.AIM To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis.METHODS Articles comparing the effect of early nutritional support and delayed nutritional support were retrieved from PubMed,EMBASE,Springer Link,Ovid,China National Knowledge Infrastructure,China Biology Medicine databases.Notably,only randomized controlled trial articles were retrieved from the databases(from establishment date to October 2022).The risk of bias of the included articles was determined using Cochrane Risk of Bias V2.0.The outcome indicators,such as albumin,prealbumin,and total protein,after statistical intervention were combined.RESULTS Fourteen literatures with 2145 adult patients undergoing gastrointestinal surgery(1138 patients(53.1%)receiving early postoperative nutritional support and 1007 patients(46.9%)receiving traditional nutritional support or delayed nutritional support)were included in this study.Seven of the 14 studies assessed early enteral nutrition while the other seven studies assessed early oral feeding.Furthermore,six literatures had"some risk of bias,"and eight literatures had"low risk".The overall quality of the included studies was good.Meta-analysis showed that patients receiving early nutritional support had slightly higher serum albumin levels,than patients receiving delayed nutritional support[MD(mean difference)=3.51,95%CI:-0.05 to 7.07,Z=1.93,P=0.05].Also,patients receiving early nutritional support had shorter hospital stay(MD=-2.29,95%CI:-2.89 to-1.69),Z=-7.46,P<0.0001)shorter first defecation time(MD=-1.00,95%CI:-1.37 to-0.64),Z=-5.42,P<0.0001),and fewer complications(Odd ratio=0.61,95%CI:0.50 to 0.76,Z=-4.52,P<0.0001)than patients receiving delayed nutritional support.CONCLUSION Early enteral nutritional support can slightly shorten the defecation time and overall hospital stay,reduce complication incidence,and accelerate the rehabilitation process of patients undergoing gastrointestinal surgery.

Critically ill patients and gut motility: Are we addressing it?

Gastrointestinal(GI) dysmotility is a common problemin the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI dysmotility can be divided for clinical purposes on upper GI dysmotility and lower GI dysmotility. Upper GI dysmotility manifests by nausea, feeding intolerance and vomiting; its implications include aspiration into the airway of abdominal contents and underfeeding. Several strategies to prevent and treat this condition can be tried and they include prokinetics and post-pyloric feeds. It is important to note that upper GI dysmotility should be treated only when there are clinical signs of intolerance(nausea, vomiting) and not based on measurement of gastric residual volumes. Lower GI dysmotility manifests throughout the spectrum of ileus and diarrhea. Ileus can present in the small bowel and the large bowel as well. In both scenarios the initial treatment is correction of electrolyte abnormalities, avoiding drugs that can decrease motility and patient mobilization. When this fails, in the case of small bowel ileus, lactulose and polyethylene glycol solutions can be useful. In the case of colonic pseudo obstruction, neostigmine, endoscopic decompression and cecostomy can be tried when the situation reaches the risk of rupture. Diarrhea is also a common manifestation of GI dysmotility and the most important step is to differentiate between infectious sources and non-infectious sources.

COMPARISON OF RANITIDINE AND PANTOPRAZOLE FOR STRESS ULCER BLEEDING PROPHYLAXIS IN CRITICALLY ILL PATIENTS REQUIRING MECHANICAL VENTILATION

Objective To compare the efficacy of Ranitidine and Pantoprazole for the prevention of haemorrhage from stress ulcer among critical care patients. Methods A total of 121 critically ill patients were included in this retrospective study. The choice of pharmacologic stress ulcer prophylaxis were either Ranitidine or Pantoprazole. The primary outcome was the incidence of stress-related significant upper gastrointestinal bleeding, and the secondary outcome was the incidence of hospital acquired pneumonia (HAP). Results A total of 63 patients were given Ranitidine, and 58 patients were given Pantoprazole for stress ulcer bleeding prophylaxis. Nine patients (7.44%, 9/121) developed clinically-important upper gastrointestinal bleeding, including 5 (7.94%, 5/63) in the Ranitidine group, and 4 (6.90%,4/58) in the Pantoprazole group. The rate of HAP was 3.17% (2/63) in the Ranitidine group, and 15.52% (9/58) in the Pantoprazole group. Conclusion Ranitidine was associated with lower rates of HAP as compared with Pantoprazole, with no statistically significant difference in clinically-important gastrointestinal hemorrhage. Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted.