Intensive Enteral Nutrition Is Ineffective for Patients With Severe Alcoholic Hepatitis Treated With Corticosteroids

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• 作者：Christophe Moreno¹ ; ² ; ^{Christophe.Moreno@erasme.ulb.ac.be" class="auth_mail" title="E-mail the corresponding author} ; Pierre Deltenre¹ ; ³ ; ⁴ ; Christelle Senterre⁵ ; Alexandre Louvet⁶ ; Thierry Gustot¹ ; ² ; Boris Bastens⁷ ; Axel Hittelet⁸ ; Marie-Astrid Piquet⁹ ; Wim Laleman¹⁰ ; Hans Orlent¹¹ ; Luc Lasser¹² ; Thomas Serst&eacute ; ¹³ ; Peter Starkel¹⁴ ; Xavier De Koninck¹⁵ ; Sergio Negrin Dastis¹⁶ ; Jean Delwaide¹⁷ ; Isabelle Colle¹⁸ ; Chantal de Galocsy¹⁹ ; Sven Francque²⁰ ; Philippe Langlet²¹ ; Virginie Putzeys²² ; Hendrik Reynaert²³ ; Delphine Degr&eacute ; ¹ ; ² ; Eric Tr&eacute ; po¹ ; ²
• 关键词：Nutrients ; Ethanol ; Liver Disease ; Cirrhosis
• 刊名：Gastroenterology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：150
• 期：4
• 页码：903-910.e8
• 全文大小：1969 K

文摘

Severe alcoholic hepatitis (AH) is a life-threatening disease for which adequate oral nutritional support is recommended. We performed a randomized controlled trial to determine whether the combination of corticosteroid and intensive enteral nutrition therapy is more effective than corticosteroid therapy alone in patients with severe AH.

Methods

We enrolled 136 heavy consumers of alcohol (age, 18–75 y) with recent onset of jaundice and biopsy-proven severe AH in our study, performed at 18 hospitals in Belgium and 2 in France, from February 2010 through February 2013. Subjects were assigned randomly (1:1) to groups that received either intensive enteral nutrition plus methylprednisolone or conventional nutrition plus methylprednisolone (controls). In the intensive enteral nutrition group, enteral nutrition was given via feeding tube for 14 days. The primary end point was patient survival for 6 months.

Results

In an intention-to-treat analysis, we found no significant difference between groups in 6-month cumulative mortality: 44.4% of patients died in the intensive enteral nutrition group (95% confidence interval [CI], 32.2%–55.9%) and 52.1% of controls died (95% CI, 39.4%–63.4%) (P = .406). The enteral feeding tube was withdrawn prematurely from 48.5% of patients, and serious adverse events considered to be related to enteral nutrition occurred in 5 patients. Regardless of group, a greater proportion of patients with a daily calorie intake less than 21.5 kcal/kg/day died (65.8%; 95% CI, 48.8–78.4) than patients with a higher intake of calories (33.1%; 95% CI, 23.1%–43.4%) (P < .001).

Conclusions

In a randomized trial of patients with severe AH treated with corticosteroids, we found that intensive enteral nutrition was difficult to implement and did not increase survival. However, low daily energy intake was associated with greater mortality, so adequate nutritional intake should be a main goal for treatment. ClinicalTrials.gov number: NCT01801332.