Premium
Meta‐Analysis of Efficacy of Rhubarb Combined With Early Enteral Nutrition for the Treatment of Severe Acute Pancreatitis
Author(s) -
Chen Xinrong,
Yang Kun,
Jing Guanda,
Yang Jie,
Li Ka
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1789
Subject(s) - medicine , acute pancreatitis , parenteral nutrition , cochrane library , randomized controlled trial , enteral administration , gastroenterology , pancreatitis , meta analysis , abdominal pain , medline , political science , law
Background Whether to provide rhubarb combined with early enteral nutrition (rhubarb/EEN) to patients with severe acute pancreatitis (SAP) remains controversial. This study aimed to systematically explore the efficacy and safety of rhubarb/EEN in SAP patients. Methods We performed searches in EMBASE, PubMed, Medline, Cochrane Library, Chinese Biomedicine Literature Database (SinoMed), Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI), and Wanfang database to identify relevant literature comparing rhubarb/EEN with EEN for SAP. Results Eleven randomized controlled trials (724 patients) were included. Meta‐analysis showed significantly shorter length of hospital stay (days) (mean difference [MD], −4.49; 95% CI, −6.09 to −2.90; P < .00001), shorter length of intensive care unit stay (days) (MD, −2.82; 95% CI, −4.00 to −1.64; P < .00001), shorter length of severe abdominal pain (days) (MD, −2.20; 95% CI, −2.50 to −1.90; P < .00001), shorter length of abdominal distention (days) (MD, −2.31; 95% CI, −2.84 to −1.78; P < .00001), shorter length of abnormal bowel sounds (days) (MD, −0.98; 95% CI, −1.12 to −0.88; P < .00001), less hospitalization expenditure ($1422.75/¥ 10,000) (MD, −1.40; 95% CI, −1.23 to −0.73; P < .00001), and smaller Acute Physiology and Chronic Health Evaluation II scores (points) (MD, −2.18; 95% CI, −2.81 to −1.56; P < .00001) in the rhubarb/EEN group than in the EEN group. Compared with EEN, rhubarb/EEN group had lower levels of white blood cells (10 9 /L) (MD, −2.77; 95% CI, −3.80 to −1.74; P < .00001), C‐reactive protein (mg/L) (MD, −10.71; 95% CI, −13.40 to −8.02; P < .00001), and interleukin‐6 (ng/L) (MD, −8.02; 95% CI, −11.38 to −4.65; P < .00001). However, there were no significant differences ( P > .05) between the 2 groups in terms of mortality rate (%) ( P = .40), infection rate (%) ( P = .28), and incidence of multiple organ dysfunction syndrome (%) ( P = .09), but the overall effective rate was higher in the rhubarb/EEN group (MD, 2.57; 95% CI, 1.22 to ≈5.42; P = .01). Conclusions Combination of EEN and rhubarb may improve the gastrointestinal function, inhibit systemic inflammation and disease severity, and enhance the efficacy of enteral nutrition, leading to better therapeutic effectiveness in SAP patients.