Skip to main content
SpringerLink
Log in

Early Feeding or Enteral Nutrition in Patients with Cirrhosis After Bleeding from Esophageal Varices? (A Randomized Controlled Study)

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The aim of this randomized controlled study wasto assess the nutritional and clinical effects of earlyenteral nutrition (EN) in cirrhotic patients withbleeding from esophageal varices. From August 1994 through August 1995, all patients admitted foracute variceal bleeding underwent emergencysclerotherapy or banding ligation and continuousinfusion of octreotide and were randomized in twogroups. In group A, patients received from day 1 discontinuouspolymeric EN (1665 kcal/day, through nasogastric tube)and in group B, patients were nil by mouth. On day 4,all patients received oral diet. Nutritional status, liver function, and rebleeding were evaluatedon days 4, 7, and 35. Twenty-two patients (17 men, 5women, mean age 56 years) were included. On day 0,patients in group A (N = 12) and group B (N = 10) werecomparable. On day 4, nitrogen balance was 0.7 ± 2.5g/day in group A and –11.2 ± 6.7 g/day ingroup B (P = 0.01, Mann-Whitney test). On days 4, 7, and35, no significant differences between the two groupswere observed for nutritional status and liver function. Four(33%) group A patients rebled compared with one (10%)group B patient (NS). Hospital stay (14.5 ± 4.1days vs 12.9 ± 5.3 days) and mortality (3 vs 2patients), were comparable between the two groups. Inconclusion, our study failed to demonstrate anyfavorable effect of short-term EN on nutritional statusand liver function in cirrhotic patients hospitalizedfor variceal bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Morgan MY: Alcohol and nutrition. Br Med Bull 38:21–29, 1982

    Google Scholar 

  2. Müller MJ: Malnutrition in cirrhosis. J Hepatol 23(suppl 1):31–35, 1995

    Google Scholar 

  3. Kearns PJ, Young H, Garcia G, Blaschke T, O'Hanlon G, Rinki M, Sucher K, Gregory P: Accelerated improvement of alcoholic liver disease with enteral nutrition. Gastroenterology 102:200–205, 1992

    Google Scholar 

  4. Hirsch S, Bunout D, de la Maza P, Iturriaga H, Petermann M, Icazar G, Gattas V, Ugarte G: Controlled trial on nutrition supplementation in outpatients with symptomatic alcoholic cirrhosis. JPEN 17:119–124, 1993

    Google Scholar 

  5. Cabre E, Gonzalez-Huix F, Abad-lacruz A, Esteve M, Acero D, Fernandez-Banares F, Xiol X, Gassull MA: Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. Gastroenterology 98:715–720, 1990

    Google Scholar 

  6. d'Amico G, Pagliaro L, Bosch J: The treatment of portal hypertension: A meta-analytic review. Hepatology 22:332–354, 1995

    Google Scholar 

  7. Pagliaro L, d'Amico G, Luca A, Pasta L, Politi F, Aragona E, Malizia G: Portal hypertension: Diagnosis and treatment. J Hepatol 23(suppl 1):36–44, 1995

    Google Scholar 

  8. Thomsen BL, Moller S, Sorensen TIA, Copenhagen Esophageal Varices Sclerotherapy Project: Optimized analysis of recurrent bleeding and death in patients with cirrhosis and esophageal varices. J Hepatol 21:367–375, 1994

    Google Scholar 

  9. Caly WR, Strauss E: A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 18:353–358, 1993

    Google Scholar 

  10. Mendenhall CL, Moritz TE, Roselle GA, Morgan TR, Nemchausky BA, Tamburro CH, Schiff ER, McClain CJ, Marsano LS, Allen JI, Samanta A, Weesner RE, Henderson W, Gartside P, Chen TS, French SW, Chedid A, Veterans Affairs Cooperative Study Group 275: A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: Results of a department of veterans affairs cooperative study. Hepatology 17:564–576, 1993

    Google Scholar 

  11. Mochizuki H, Trocki O, Dominioni L, Brackett KA, Joffe SN, Alexander JW: Mechanism of prevention of postburn hypermetabolism and catabolism by early enteral feeding. Ann Surg 200:297–310, 1984

    Google Scholar 

  12. Nompleggi DJ, Bonkovsky HL: Nutritional supplementation in chronic liver disease: an analytical review. Hepatology 19:518–533, 1994

    Google Scholar 

  13. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649, 1973

    Google Scholar 

  14. Zeegen R, Drinkwater JE, Dawson AM: Method for measuring cerebral dysfunction in patients with liver disease. Br Med J 1:633–636, 1970

    Google Scholar 

  15. Conn HO, Leevy CM, Vlahcevic ZR: Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy: A double blind controlled trial. Gastroenterology 72:573–583, 1977

    Google Scholar 

  16. Armitage P, Berry G: Statistical Methods in Medical Research, 2nd ed. Oxford, England, Blackwell, 1987

    Google Scholar 

  17. SAS/STAT Guide for Personal Computers, Version 6 ed. Cary, North Carolina, SAS Institute, 1987

  18. Graham DY, Smith JL: The course of patients after variceal hemorrhage. Gastroenterology 80:800–809, 1981

    Google Scholar 

  19. Moller S, Sorensen TIA, Tygstrup N, Copenhagen Esophageal Varices Sclerotherapy Project: Who benefits from endoscopic sclerotherapy of bleeding esophageal varices? Proposal for different indications. J Hepatol 15:184–191, 1992

    Google Scholar 

  20. Paquet KJ, Feussner H: Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: A prospective controlled randomized trial. Hepatology 5:580–583, 1985

    Google Scholar 

  21. Burroughs AK, Hamilton G, Phillips A, Mezzanotte G, McIntyre N, Hobbs KEF: A comparison of sclerotherapy with staple transection of the esophagus for the emergency control of bleeding from esophageal varices. N Engl J Med 321:857–862, 1989

    Google Scholar 

  22. Planas R, Quer JC, Boix J, Canet J, Armengol M, Cabre E, Pintanel T, Humbert P, Oller B, Broggi MA, Gassull MA: A prospective randomized trial comparing somatostatin and sclerotherapy in the treatment of acute variceal bleeding. Hepatology 20:370–375, 1994

    Google Scholar 

  23. Sung JJY, Chung SCS, Lai CW, Chan FKL, Leung JWC, Yung MY, Kassianides C, Li AKC: Octreotide infusion or emergency sclerotherapy for variceal haemorrhage. Lancet 342:637–641, 1993

    Google Scholar 

  24. Besson I, Ingrand P, Person B, Boutroux D, Heresbach D, Bernard P, Hochain P, Larricq J, Gourlaouen A, Ribard D, Mostefa-Kara N, Legoux JL, Pillegand B, Becker MC, Di Costanzo J, Metreau JM, Silvain C, Beauchant M: Sclerotherapy with or without octreotide for acute variceal bleeding. N Engl J Med 333:555–560, 1995

    Google Scholar 

  25. Sung JJY, Chung SCS, Yung MY, Lai CW, Lau JYW, Lee YT, Leung VKS, Li MKK, Li AKC: Prospective randomised study of effect of octreotide on rebleeding from oesophageal varices after endoscopic ligation. Lancet 346:1666–1669, 1995

    Google Scholar 

  26. Nielsen K, Kondrup J, Martinsen C, Shilling B, Wikman B: Nutritional assessment and adequacy of dietary intake in hospitalized patients with alcoholic liver cirrhosis. Br J Nutr 69:665–679, 1993

    Google Scholar 

  27. Franco D, Belghiti J, Cortesse A, Boucquey BM, Charra M, Lacaine F, Bismuth H: Nutrition et immunité du cirrhotique alcoolique. Gastroenterol Clin Biol 5:839–846, 1981

    Google Scholar 

  28. Kirby DF, Delegge MH, Fleming CR: American Gastroenterological Association Technical Review on tube feeding for enteral nutrition. Gastroenterology 108:1282–1301, 1995

    Google Scholar 

  29. Koretz RL: Nutritional support in alcoholic liver disease—losing control(s)? Gastroenterology 102:2186–2187, 1992

    Google Scholar 

Download references

Authors
  1. Catherine Borderie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie-Pierre Ripault
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine Silvain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Victor De Ledinghen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philippe Beau
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul-Regis Mannant
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michel Beauchant
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Borderie, C., Ripault, MP., Silvain, C. et al. Early Feeding or Enteral Nutrition in Patients with Cirrhosis After Bleeding from Esophageal Varices? (A Randomized Controlled Study). Dig Dis Sci 42, 536–541 (1997). https://doi.org/10.1023/A:1018838808396

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1018838808396

Search

Navigation