Effect of Enteral Glutamine in the Outcome of Severe Acute Pancreatitis a Randomised Controlled Trial

Saheer Neduvanchery, MBBS, MS, Vikas Gupta, MBBS, MS, McH, Td Yadav, Rakesh Kocherr. PGIMER,CHANDIGARH

OBJECTIVE: To determine the effect of enteral glutamine in the outcome of SAP.

METHODS: 62 patients (35 males) with mean age 42.11±13.44 years with SAP were randomised into study group (32 patients) who received enteral glutamine for two weeks and control group (30 patients). The 2 groups were followed till discharge/death. Biochemical, hematological parameters and serum albumin, were measured on day 0, 7, 14 and 28 and CRP on day 0, 7, and 14. Clinical outcome was compared between 2 groups.

RESULTS: Gall stone was the commonest etiology(41.90%) followed by alcohol(30.60%).The mean duration of onset of disease to hospital admission was 4.79±4.05 days(range 1-23 days).All demographic parameters, severity indices ie BISAP score (2.28±1.023 vs 2.03±.928), APACHE II at admission (10.09±4.672 vs  9.81 ±4.718) and mCTSI  (7.44±2.169 vs 7.20±2.325),  and serum CRP were  comparable between two group. 28 day serum albumin and APACHE II score were better in study group vs control group(3.386 ±0. 505 vs 2.721 ± 0.734, p = 0.025 and 6.25±3.076 vs 10.00±3.559,p=0.07 respectively).Incidence of organ failure, local/infectious complications, need for interventions, duration of hospital and ICU stay and mortality were similar.

CONCLUSIONS: Enteral glutamine showed improvement in serum albumin and trend towards decreasing the severity of severe acute pancreatitis during the course of illness. However it did not translate into reduction in infectious complication, organ failure, need for invasive intervention, duration of hospital and ICU stay and mortality.

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