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Intensive enteral nutrition does not improve survival in AH

Intensive enteral nutrition therapy combined with corticosteroid therapy did not improve survival among patients with alcoholic hepatitis compared with treatment with corticosteroids alone, according to study data published in Gastroenterology.

Christophe Moreno, MD, of the department of gastroenterology, hepatopancreatology and digestive oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Belgium, and colleagues randomly assigned 136 adults — who were heavy alcohol drinkers and recently diagnosed with onset of jaundice and biopsy-proven severe alcoholic hepatitis (AH) — to either intensive enteral nutrition plus methylprednisolone or conventional nutrition plus methylprednisolone (control group), at various clinical centers in Belgium and France between February 2010 and February 2013.

In the intensive enteral nutrition group, patients were given enteral nutrition via a feeding tube for 14 days.

The cumulative 1-month mortality between the intensive enteral nutrition group (16.2%; 95% CI, 8.6%-25.9%) and the control group (20.7%; 95% CI, 11.9%-31.1%) were not significantly different (P = .534). In an intention-to-treat analysis, there was also no difference in 6-month cumulative mortality rate between the two groups of patients (44.4%; 95% CI, 32.2%-55.9% vs. 52.1%; 95% CI, 39.4%-63.4%).

Among 48.5% of patients, the enteral feeding tube was removed prior to 14 days. Serious adverse events related to enteral nutrition were observed in five patients; three had aspiration pneumonia, one had decompensated diabetes and one had severe worsening of encephalopathy.

More patients with a daily calorie intake less than 21.5 kcal/kg/day died (65.8%; 95% CI, 48.8%-78.4%) compared with patients with a higher intake of calories (33.1%; 95% CI, 23.1%-43.4%), regardless of which group they were in.

The researchers concluded: “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.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.