Efficacy of enteral saline solution by measuring I-FABP in patients with severe acute pancreatitis: a non-randomized clinical study

BACKGROUND: Intestinal microcirculatory injuries in patients with severe acute pancreatitis result in neuroendocrine dysregulation, intestinal epithelial cell dysfunction, and impaired intestinal motility. AIM: This study aimed to assess the efficacy of enteral corrective therapy of intestinal failure in patients with severe acute pancreatitis using an enteral saline solution. METHODS: A multicenter, non-randomized clinical study included 146 patients with severe acute pancreatitis (112 [76.7%] males and 34 [23.3%] females, mean age: 50.8 [SD ± 13.7] years). The patients were divided into two groups. The control group included 52 patients (35 [67.3%] males and 17 [32.7%] females, mean age: 50.9 [SD ± 15.0] years) who received standard of care. The treatment group included 94 patients (69 [73.4%] males and 25 [26.6%] females, mean age: 46.6 [SD ± 9.5] years) who additionally received enteral therapy using an enteral saline solution. The solution’s composition was identical to that of chyme from the first part of the small intestine in apparently healthy individuals. Its acidic environment (pH 5.0–5.8) has a bacteriostatic effect and inhibits the growth of opportunistic and pathogenic microorganisms. Enteral therapy was provided via a nasointestinal tube, which was placed along the endoscopic instrument channel and attached to the ligament of Treitz. The solution (1500 mL) was administered at a rate of 6–10 mL/min with intra-abdominal pressure monitoring, which did not exceed 16 mmHg. The Mann–Whitney U test was used for intergroup comparisons. Differences were considered significant at p 0.05. RESULTS: The treatment group showed a decrease in intestinal injury marker (I-FABP) levels the day after starting enteral therapy. On days 2 and 7, there was a significant decrease in intestinal fatty acid binding protein (I-FABP) levels to 1.52 ng/mL (p = 0.049) and 1.42 ng/mL (p = 0.01), respectively. These values were comparable to the median I-FABP level in the control group (1.40 ng/mL), which was used as a reference. On day 2, the threshold value was comparable to the reference (p = 0.049), with a significant decrease on day 7 (p = 0.01). CONCLUSION: The findings confirm the efficacy of the enteral saline solution in patients with severe acute pancreatitis.