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PP313 THE VALUE OF LONG TERM ENTERAL NUTRITION IN THE TREATMENT OF PANCREATIC FISTULAS - A PROSPECTIVE, RANDOMIZED, CONTROLLED CLINICAL TRIAL
Nutrition and chronic diseases II 26.43% moderate and 20.68% severe malnutrition. Active ethanol ingestion was significantly correlated with the presence of malnutrition (p = 0.03). Conclusion: Malnutrition is frequently encountered in patients with chronic pancreatitis. Due to the negative impact of malnutrition on patient’s prognosis, especially for those who necessitate surgical intervention, nutritional therapy must occupy an important place in the therapeutic management of chronic pancreatitis patients. Disclosure of Interest: None declared
PP311 DISEASE-RELATED MALNUTRITION IN OUTPATIENTS WITH SYSTEMIC SCLEROSIS R. Caccialanza1 , C. Bonino2 , C. Klersy3 , R. Caporali2 , E. Cereda1 , B. Xoxi2 , A. Crippa1 , M.L. Rava1 , M. Orlandi1 , C. Bonardi1 , B. Cameletti1 , C. Montecucco2 . 1 Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, 2 Rheumatology Division, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 3 Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Rationale: To evaluate the prevalence of malnutrition in a cohort of outpatients affected by Systemic Sclerosis (SSc) and its association with disease-related clinical variables. Methods: Over a 18-month period, 160 (87.5% females) SSc patients were recruited. We evaluated the following clinical variables: organs involvement, disease duration, disease subset, disease activity and severity (European Scleroderma Study Group score and SSc Severity scale), autoantibody pattern, comorbidities, drug treatment, functional status (Health Assessment Questionnaire Disability Index: HAQ-DI) and gastrointestinal symptoms (anorexia, dysgeusia, dysphagia, nausea, vomiting, pyrosis, regurgitation, early satiation, diarrhoea and constipation). Nutritional assessment included: body mass index (BMI), weight loss history (WL), energy intake and serum prealbumin. Malnutrition was defined by BMI < 20 kg/m2 and/or 6-month previous WL 10%. Results: BMI < 20 and WL 10% were recorded in 17 (11%) and 11 (7%) patients, respectively (both criteria, n = 4). Accordingly, prevalence of malnutrition was 15% (95% CI, 10 21%). Gastro-intestinal involvement was recorded in 82 patients (51%; 95% CI, 43 59%). Simple statistical models revealed a significant association with malnutrition for disease activity (p < 0.001), anorexia (p = 0.043), early satiation (p = 0.032) and serum prealbumin (p < 0.001). No correlation was found with energy intake. Sex and age-adjusted multivariable analysis confirmed disease activity (OR = 3.5 [95% CI, 1.8 6.9], p < 0.001) and serum prealbumin (OR = 7.4 [95% CI, 2.1 25.9], p = 0.002) as independent correlates of malnutrition. Conclusion: In SSc outpatients, despite the high frequency of gastrointestinal involvement, malnutrition may appear an uncommon finding, mostly dependent on the disease activity. Serum prealbumin seems a useful parameter in the nutritional assessment of such patients. Disclosure of Interest: None declared
145 PP312 INTRAVENOUS PAMIDRONATE IS NOT ASSOCIATED WITH RENAL DYSFUNCTION IN CHRONIC HOME PARENTERAL NUTRITION PATIENTS J. Siepler1 , R. Nishikawa1 , T. Diamantidis1 , R. Okamoto1 . 1 Pharmacy, Nutrishare, INC, Elk Grove, United States Rationale: Intravenous pamidronate (IVP) is used for bone mineral disease in home parenteral nutrition patients (HPN). but, IVP has been associated with the renal dysfunction (RD). We wanted to determine if RD was more frequent in a population of HPN patients receiving IVP compared to an age and gender matched control group Methods: The records of patients from a home care provider on HPN and IVP were reviewed. We collected BUN and creatinine (BUN/Cr) for each patient receiving IVP as well as an age and gender matched control group. Primary outcome was the number of patients in each group that had a sustained (3 consecutive) two fold increase of BUN/CR over baseline. In addition, IVP dose, and time to increase of BUN/CR were collected. These data were compared to the control group. Statistics were done using chi squared with p < 0.05 being considered significant. Results: Twenty-seven patients received IVP. Four (14.8%) in the IVP group and 0 in the control group had an increase in BUN/CR (p = 0.018). Mean time to increase in BUN/CR was 3±1 years. All patients’ BUN/CR returned to normal after 2 months while remaining on IVP. There was no difference in the IVP dose compared to those who had an increase in BUN/CR and those who did not. When the 4 patients with increased BUN/CR were reviewed, it appeared the RD was likely due to dehydration. Conclusion: We report IVP use in HPN patients was associated with increase in BUN/CR compared to an age/gender matched control group. It was likely that the patients increase in BUN/CR was due to dehydration. While the patients in the control group also were at risk for dehydration, none of them had a sustained increase in BUN/CR. All patients on IVP who develop RD should be evaluated for dehydration before deciding IVP is the cause. This should be investigated further. Disclosure of Interest: None declared
PP313 THE VALUE OF LONG TERM ENTERAL NUTRITION IN THE TREATMENT OF PANCREATIC FISTULAS A PROSPECTIVE, RANDOMIZED, CONTROLLED CLINICAL TRIAL S. Klek1 , P. Szybinski1 , K. Szczepanek1 , T. Gach1 , M. Sierzega1 . 1 Home Artificial Nutrition, Nutrimed Medical Corporation, Krakow, Poland Rationale: Postoperative pancreatic fistula is the most common and potentially life-threatening complication after pancreatic surgery. Although nutritional support is a key component of conservative therapy in such cases, there are no well-designed clinical trials substantiating the superiority of either total parenteral nutrition (TPN) or enteral nutrition (EN). This study was conducted to compare the efficacy and safety of both routes of
146 nutritional intervention. The trial was sponsored by Nutricia Ltd. as the 2006 Nutricia Fellowship. Methods: A randomized clinical trial was conducted in a tertiary surgical center of pancreatic and gastrointestinal surgery. Seventy-eight patients with postoperative pancreatic fistula were treated conservatively and randomly assigned to groups receiving for 30 days either enteral nutrition or total parenteral nutrition. The primary endpoint was the 30-day closure rate. Results: After 30 days, closure rates in patients receiving enteral and parenteral nutrition were 60% (24 of 40) and 37% (14 of 38), respectively (P = 0.043). The odds ratio for probability to be responder on EN compared to TPN was 2.571 (95% CI 1.031 to 6.411). Median time to closure was 27 days (95% CI 21 to 33) for EN and no median time was reached in TPN (P = 0.047). A logistic regression analysis identified only two factors significantly associated with fistula closure, i.e. enteral nutrition (odds ratio 6.136, 95% CI 1.204 to 41.623, P = 0.043) and initial fistula output of 200 ml/d or less (odds ratio 12.701, 95% CI 9.102 to 47.241, P < 0.001). Conclusion: Enteral nutrition is associated with significantly higher closure rates and shorter time to closure of postoperative pancreatic fistula. Disclosure of Interest: S. Klek Grant/Research Support from: Nutricia Fellowship 2006, P. Szybinski Grant/Research Support from: Nutricia Fellowship 2006, K. Szczepanek Grant/Research Support from: Nutricia Fellowship 2006, T. Gach Grant/Research Support from: Nutricia Fellowship 2006, M. Sierzega Grant/Research Support from: Nutricia Fellowship 2006
PP314 EFFECT OF THE SUPLEMENTATION OF DIFFERENT CONCENTRATIONS OF POLYDEXTROSE IN RATS SUBMITTED TO THE JEJUNOILEAL BYPASS E.F. Santos1 , M.R. Ara´ ujo2 , J.L. Cesarino2 , M.A. Falconi2 , C.K. Miyasaka3 , N.A. Andreollo1 . 1 Department of Surgery, 2 State University of Campinas, Campinas, 3 Cruzeiro do Sul University, S˜ ao Paulo, Brazil Rationale: Prebiotics functional foods can increase the absorption of iron improving its biodisponibility. The purpose this study is to compare the effect of the supplementation of different concentrations of polydextrose (PDX) in the iron metabolism in rats submitted to the jejunoileal bypass. Methods: The rats were submitted the jejunoileal bypass, after 15 days in recovery had received formulated diet AIN-93M and were distributed in four groups: Co (n 6) = Sham + control diet without PDX; G1 (n 6) = operated + diet with PDX (50 g/kg diet); G2 (n 6) = operated + diet with PDX (75 g/kg diet); G3 (n 4) = operated + diet with PDX (100 g/kg diet) for 60 days. The hematocrit, hemoglobin, seric iron were performed. The consumption of ration as well as the verification of the weight profit were carried through to each two days per 60 days. The data were analyzed by twoway ANOVA/Duncan’s test (p < 0.05*). The experimental protocol was previously approved by the Committee of Ethics in Animal Experimentation (CEEA) of the State University of Campinas UNICAMP. Results: Hematocrit (%) (Co = 44.77±1.46; G*1 = 43.22 ±1.16; G2 = 45.00±1.52; G3* = 46.76±1.71). Hemoglobin
Poster presentations (g/dL) (Co = 15.08±0.52; G1* = 14.42±0.33; G2 = 14.90 ±0.54; G3 = 15.50±0.60). Seric iron (mg/dL) (Co = 197.17 ±8.30; G1 = 147.80±14.90; G2* = 187.30±15.80; G3* = 128.00±16.70). Consumption of ration (g) (Co = 22.92 ±1.41; G1* = 19.61±1.42; G2* = 19.91±1.19; G3* = 19.16 ±1.43). Weight profit (g) (Co = 429.83±14.93; G*1 = 289.71 ±5.93; G2* = 310.33±7.53; G3* = 290.20±9.45). Conclusion: The lesser profit of weight of the operated rats can be associated to the lesser consumption of diet. Amongst the studied concentrations 7.5% and 10% seem to be more favorable, suggesting that this prebiotics is an important preventive procedure in sight of the iron deficiency. Disclosure of Interest: None declared
PP315 COMPARISON OF REFERRAL PATHWAYS FOR PATIENTS ON HOME PARENTERAL NUTRITION (HPN) IN SCOTLAND, NEW ZEALAND AND DENMARK J. Baxter1 , L. Gillanders2 , H. Rasmussen3 , B. Wilson4 , B. Perry2 , M. Staun5 . 1 Centre for MCNs, Kings Cross Hospital, Dundee, United Kingdom; 2 Auckland City Hospital, Auckland, New Zealand; 3 Arhus University Hospital, Arhus, 4 Odense University Hospital, Odense, 5 Rigshospitalet, Copenhagen, Denmark Rationale: The provision of adult HPN in New Zealand and Scotland has been described. Denmark has similar population demographics with a developing registry. The aim of this study was to compare prevalence and referral pathways to identify if there is access to equitable care. Methods: The HPN registries for each country were examined for 2009 period prevalence. The referral pathways for treatment were explored to identify whether this may affect prevalence. Results: The 2009 period prevalence rates for adult HPN are presented in the table. 2009
Adult patients (n)
Population (M)
Period prevalence (/M)
Scotland NZ Denmark
119 21 277
5.1 4.2 5.5
23.3 5.6 50.3
Diagnostic categories for the populations studied were similar except that 6% of the Danish patients were provided HPN due to cancer. In Scotland, a Managed Clinical Network exists to support referral for adult HPN. Patients living a distance from a tertiary centre are managed nearer to home using nationally agreed procedures and protocols. New Zealand has no nationally organised service and inequality of service has previously been reported. HPN is managed regionally with the largest centre (Auckland) offering an advisory service and education protocols. The service in Denmark to support adult HPN patients is not organised at a national level. Regional centres approved by the Danish Board of Health manage patients, the largest being located in Copenhagen. Educational activities among centres support the equality of service and postgraduate education provide knowledge of the service available to departments referring patients. Conclusion: This study shows that rates of provision of HPN significantly differs and raises the question whether
PP311 DISEASE-RELATED MALNUTRITION IN OUTPATIENTS WITH SYSTEMIC SCLEROSIS R. Caccialanza1 , C. Bonino2 , C. Klersy3 , R. Caporali2 , E. Cereda1 , B. Xoxi2 , A. Crippa1 , M.L. Rava1 , M. Orlandi1 , C. Bonardi1 , B. Cameletti1 , C. Montecucco2 . 1 Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, 2 Rheumatology Division, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 3 Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Rationale: To evaluate the prevalence of malnutrition in a cohort of outpatients affected by Systemic Sclerosis (SSc) and its association with disease-related clinical variables. Methods: Over a 18-month period, 160 (87.5% females) SSc patients were recruited. We evaluated the following clinical variables: organs involvement, disease duration, disease subset, disease activity and severity (European Scleroderma Study Group score and SSc Severity scale), autoantibody pattern, comorbidities, drug treatment, functional status (Health Assessment Questionnaire Disability Index: HAQ-DI) and gastrointestinal symptoms (anorexia, dysgeusia, dysphagia, nausea, vomiting, pyrosis, regurgitation, early satiation, diarrhoea and constipation). Nutritional assessment included: body mass index (BMI), weight loss history (WL), energy intake and serum prealbumin. Malnutrition was defined by BMI < 20 kg/m2 and/or 6-month previous WL 10%. Results: BMI < 20 and WL 10% were recorded in 17 (11%) and 11 (7%) patients, respectively (both criteria, n = 4). Accordingly, prevalence of malnutrition was 15% (95% CI, 10 21%). Gastro-intestinal involvement was recorded in 82 patients (51%; 95% CI, 43 59%). Simple statistical models revealed a significant association with malnutrition for disease activity (p < 0.001), anorexia (p = 0.043), early satiation (p = 0.032) and serum prealbumin (p < 0.001). No correlation was found with energy intake. Sex and age-adjusted multivariable analysis confirmed disease activity (OR = 3.5 [95% CI, 1.8 6.9], p < 0.001) and serum prealbumin (OR = 7.4 [95% CI, 2.1 25.9], p = 0.002) as independent correlates of malnutrition. Conclusion: In SSc outpatients, despite the high frequency of gastrointestinal involvement, malnutrition may appear an uncommon finding, mostly dependent on the disease activity. Serum prealbumin seems a useful parameter in the nutritional assessment of such patients. Disclosure of Interest: None declared
145 PP312 INTRAVENOUS PAMIDRONATE IS NOT ASSOCIATED WITH RENAL DYSFUNCTION IN CHRONIC HOME PARENTERAL NUTRITION PATIENTS J. Siepler1 , R. Nishikawa1 , T. Diamantidis1 , R. Okamoto1 . 1 Pharmacy, Nutrishare, INC, Elk Grove, United States Rationale: Intravenous pamidronate (IVP) is used for bone mineral disease in home parenteral nutrition patients (HPN). but, IVP has been associated with the renal dysfunction (RD). We wanted to determine if RD was more frequent in a population of HPN patients receiving IVP compared to an age and gender matched control group Methods: The records of patients from a home care provider on HPN and IVP were reviewed. We collected BUN and creatinine (BUN/Cr) for each patient receiving IVP as well as an age and gender matched control group. Primary outcome was the number of patients in each group that had a sustained (3 consecutive) two fold increase of BUN/CR over baseline. In addition, IVP dose, and time to increase of BUN/CR were collected. These data were compared to the control group. Statistics were done using chi squared with p < 0.05 being considered significant. Results: Twenty-seven patients received IVP. Four (14.8%) in the IVP group and 0 in the control group had an increase in BUN/CR (p = 0.018). Mean time to increase in BUN/CR was 3±1 years. All patients’ BUN/CR returned to normal after 2 months while remaining on IVP. There was no difference in the IVP dose compared to those who had an increase in BUN/CR and those who did not. When the 4 patients with increased BUN/CR were reviewed, it appeared the RD was likely due to dehydration. Conclusion: We report IVP use in HPN patients was associated with increase in BUN/CR compared to an age/gender matched control group. It was likely that the patients increase in BUN/CR was due to dehydration. While the patients in the control group also were at risk for dehydration, none of them had a sustained increase in BUN/CR. All patients on IVP who develop RD should be evaluated for dehydration before deciding IVP is the cause. This should be investigated further. Disclosure of Interest: None declared
PP313 THE VALUE OF LONG TERM ENTERAL NUTRITION IN THE TREATMENT OF PANCREATIC FISTULAS A PROSPECTIVE, RANDOMIZED, CONTROLLED CLINICAL TRIAL S. Klek1 , P. Szybinski1 , K. Szczepanek1 , T. Gach1 , M. Sierzega1 . 1 Home Artificial Nutrition, Nutrimed Medical Corporation, Krakow, Poland Rationale: Postoperative pancreatic fistula is the most common and potentially life-threatening complication after pancreatic surgery. Although nutritional support is a key component of conservative therapy in such cases, there are no well-designed clinical trials substantiating the superiority of either total parenteral nutrition (TPN) or enteral nutrition (EN). This study was conducted to compare the efficacy and safety of both routes of
146 nutritional intervention. The trial was sponsored by Nutricia Ltd. as the 2006 Nutricia Fellowship. Methods: A randomized clinical trial was conducted in a tertiary surgical center of pancreatic and gastrointestinal surgery. Seventy-eight patients with postoperative pancreatic fistula were treated conservatively and randomly assigned to groups receiving for 30 days either enteral nutrition or total parenteral nutrition. The primary endpoint was the 30-day closure rate. Results: After 30 days, closure rates in patients receiving enteral and parenteral nutrition were 60% (24 of 40) and 37% (14 of 38), respectively (P = 0.043). The odds ratio for probability to be responder on EN compared to TPN was 2.571 (95% CI 1.031 to 6.411). Median time to closure was 27 days (95% CI 21 to 33) for EN and no median time was reached in TPN (P = 0.047). A logistic regression analysis identified only two factors significantly associated with fistula closure, i.e. enteral nutrition (odds ratio 6.136, 95% CI 1.204 to 41.623, P = 0.043) and initial fistula output of 200 ml/d or less (odds ratio 12.701, 95% CI 9.102 to 47.241, P < 0.001). Conclusion: Enteral nutrition is associated with significantly higher closure rates and shorter time to closure of postoperative pancreatic fistula. Disclosure of Interest: S. Klek Grant/Research Support from: Nutricia Fellowship 2006, P. Szybinski Grant/Research Support from: Nutricia Fellowship 2006, K. Szczepanek Grant/Research Support from: Nutricia Fellowship 2006, T. Gach Grant/Research Support from: Nutricia Fellowship 2006, M. Sierzega Grant/Research Support from: Nutricia Fellowship 2006
PP314 EFFECT OF THE SUPLEMENTATION OF DIFFERENT CONCENTRATIONS OF POLYDEXTROSE IN RATS SUBMITTED TO THE JEJUNOILEAL BYPASS E.F. Santos1 , M.R. Ara´ ujo2 , J.L. Cesarino2 , M.A. Falconi2 , C.K. Miyasaka3 , N.A. Andreollo1 . 1 Department of Surgery, 2 State University of Campinas, Campinas, 3 Cruzeiro do Sul University, S˜ ao Paulo, Brazil Rationale: Prebiotics functional foods can increase the absorption of iron improving its biodisponibility. The purpose this study is to compare the effect of the supplementation of different concentrations of polydextrose (PDX) in the iron metabolism in rats submitted to the jejunoileal bypass. Methods: The rats were submitted the jejunoileal bypass, after 15 days in recovery had received formulated diet AIN-93M and were distributed in four groups: Co (n 6) = Sham + control diet without PDX; G1 (n 6) = operated + diet with PDX (50 g/kg diet); G2 (n 6) = operated + diet with PDX (75 g/kg diet); G3 (n 4) = operated + diet with PDX (100 g/kg diet) for 60 days. The hematocrit, hemoglobin, seric iron were performed. The consumption of ration as well as the verification of the weight profit were carried through to each two days per 60 days. The data were analyzed by twoway ANOVA/Duncan’s test (p < 0.05*). The experimental protocol was previously approved by the Committee of Ethics in Animal Experimentation (CEEA) of the State University of Campinas UNICAMP. Results: Hematocrit (%) (Co = 44.77±1.46; G*1 = 43.22 ±1.16; G2 = 45.00±1.52; G3* = 46.76±1.71). Hemoglobin
Poster presentations (g/dL) (Co = 15.08±0.52; G1* = 14.42±0.33; G2 = 14.90 ±0.54; G3 = 15.50±0.60). Seric iron (mg/dL) (Co = 197.17 ±8.30; G1 = 147.80±14.90; G2* = 187.30±15.80; G3* = 128.00±16.70). Consumption of ration (g) (Co = 22.92 ±1.41; G1* = 19.61±1.42; G2* = 19.91±1.19; G3* = 19.16 ±1.43). Weight profit (g) (Co = 429.83±14.93; G*1 = 289.71 ±5.93; G2* = 310.33±7.53; G3* = 290.20±9.45). Conclusion: The lesser profit of weight of the operated rats can be associated to the lesser consumption of diet. Amongst the studied concentrations 7.5% and 10% seem to be more favorable, suggesting that this prebiotics is an important preventive procedure in sight of the iron deficiency. Disclosure of Interest: None declared
PP315 COMPARISON OF REFERRAL PATHWAYS FOR PATIENTS ON HOME PARENTERAL NUTRITION (HPN) IN SCOTLAND, NEW ZEALAND AND DENMARK J. Baxter1 , L. Gillanders2 , H. Rasmussen3 , B. Wilson4 , B. Perry2 , M. Staun5 . 1 Centre for MCNs, Kings Cross Hospital, Dundee, United Kingdom; 2 Auckland City Hospital, Auckland, New Zealand; 3 Arhus University Hospital, Arhus, 4 Odense University Hospital, Odense, 5 Rigshospitalet, Copenhagen, Denmark Rationale: The provision of adult HPN in New Zealand and Scotland has been described. Denmark has similar population demographics with a developing registry. The aim of this study was to compare prevalence and referral pathways to identify if there is access to equitable care. Methods: The HPN registries for each country were examined for 2009 period prevalence. The referral pathways for treatment were explored to identify whether this may affect prevalence. Results: The 2009 period prevalence rates for adult HPN are presented in the table. 2009
Adult patients (n)
Population (M)
Period prevalence (/M)
Scotland NZ Denmark
119 21 277
5.1 4.2 5.5
23.3 5.6 50.3
Diagnostic categories for the populations studied were similar except that 6% of the Danish patients were provided HPN due to cancer. In Scotland, a Managed Clinical Network exists to support referral for adult HPN. Patients living a distance from a tertiary centre are managed nearer to home using nationally agreed procedures and protocols. New Zealand has no nationally organised service and inequality of service has previously been reported. HPN is managed regionally with the largest centre (Auckland) offering an advisory service and education protocols. The service in Denmark to support adult HPN patients is not organised at a national level. Regional centres approved by the Danish Board of Health manage patients, the largest being located in Copenhagen. Educational activities among centres support the equality of service and postgraduate education provide knowledge of the service available to departments referring patients. Conclusion: This study shows that rates of provision of HPN significantly differs and raises the question whether