Hot Literature: Early enteral feeding in dogs with acute pancreatitis

The nutritional management in cases of severe acute pancreatitis can be problematic, and, traditionally, fasting to "rest" the pancreas has been used in many cases. This assumption has been challenged recently in the human medical literature because it has been shown that exocrine pancreatic secretion is decreased during pancreatitis in people, especially in the face of severe inflammation.

Furthermore, the gut itself is negatively affected by fasting and can contribute to systemic inflammation in cases of acute pancreatitis. Gut regeneration is most effectively addressed via intraluminal feeding. Clinical trials in people with acute pancreatitis have shown that early enteral nutrition was beneficial as compared with parenteral nutrition, resulting in fewer infectious complications, shorter hospital stays, and an improved outcome.

New research in dogs has been conducted to see if early feeding in cases of severe acute pancreatitis is well-tolerated and whether there are similar benefits to this practice. As a pilot study involving only 10 dogs, it was designed as a platform for future research into this area.

Study design

Dogs over 22 lb (10 kg) with severe acute pancreatitis and no other recognizable diseases that could cause secondary pancreatitis were included in this study. They ranged in age from 2 to 11 years and included various breeds. The diagnosis was based on clinical signs, serum canine pancreatic lipase concentrations (> 200 μg/L), and appropriate pancreatic changes noted on ultrasonographic examination. All of the dogs were given intravenous fluid therapy and fresh frozen plasma as well as an infusion of electrolyte solution given through a nasoesophageal tube. An antiemetic, analgesics, and antibiotics were also given as indicated.

The dogs were assigned to one of two treatment groups. Within the first 12 to 24 hours, they received either parenteral nutrition or enteral nutrition via esophageal tube feeding, which continued for three days. The dogs were monitored daily and findings recorded for clinical severity, any complications, and vomiting or regurgitation; a pain score was also determined. Serum samples were repeatedly tested for canine trypsin-like immunoreactivity, canine pancreatic specific lipase, C-reactive protein, gastrin, and serum pancreatic elastase-1.

Study results

A significantly greater number of vomiting or regurgitation episodes occurred in the parenteral nutrition group, and the dogs receiving enteral nutrition did not display any postprandial pain. Not surprisingly, there were more catheter-related complications in dogs receiving parenteral nutrition. All of the other parameters were similar for each group. During the relatively short duration of this study, the outcome was not significantly different between the two groups, and all but one dog survived through the follow-up period of two to four years. The dog that died had been in the parenteral nutrition group and developed an extrahepatic bile duct obstruction and pleural effusion.

As emphasized by the authors, this pilot study is just a starting point for further research into the best methods for nutritional management of these challenging cases. However, they concluded that early enteral nutrition in dogs with severe acute pancreatitis appears to be well-tolerated and reduces the number of catheter-related complications-an encouraging start in the clarification of nutritional management of acute pancreatitis in dogs.

Mansfield CS, James FE, Steiner JM, et al. A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis. J Vet Intern Med 2011;25(3):419-425.

Link to the abstract of the article: http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2011.0703.x/full