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Cited by 25Clinical Nutrition and GastroenterologyGastrointestinal Bleeding Diagnosis and TreatmentAbdominal vascular conditions and treatments

Early enteral nutrition versus delayed enteral nutrition in patients with gastrointestinal bleeding: A PRISMA-compliant meta-analysis

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Zhang, Hongyan, Wang, Yu, Sun, Shujun, Huang, Xin, Tu, Guangjie, Wang, Jingxu, Lin, Yun, Xia, Haifa +2 more·2019·Medicine
DOI 10.1097/md.0000000000014864PMC PMC6426535
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Abstract

Background: Controversy persists about whether early enteral nutrition administration is related to worse prognosis than delayed enteral nutrition for patients with gastrointestinal bleeding. Objectives: To systematically evaluate the effect of early enteral nutrition on the patient with gastrointestinal bleeding through the meta-analysis. Methods: Such electronic databases including PubMed, EMBASE, Cochrane Library, CNKI, and CBM were searched from 1985 to March 2018. Randomized controlled trials that compared early enteral nutrition versus delayed enteral nutrition in patients with gastrointestinal bleeding were considered eligible. Data extraction and the methodological quality assessment of the included trials were carried out according to the Cochrane Handbook. We calculated the pooled risk ratio, weighted mean difference, and the corresponding 95% confidential interval using RevMan5.3. Result: A total of 5 trials involving 313 patients were included. Compared with delayed enteral nutrition, there was a tendency for a decreased rebleeding rate in the early enteral nutrition group, but the trend was not statistically significant (risk ratio = 0.75, 95% confidential interval: 0.34–1.64, I 2 = 0). As for mortality within 30 days, no significant difference was found between the 2 groups (risk ratio = 0.74, 95% confidential interval: 0.23–2.39, I 2 = 0). In addition, the pooled analysis showed that early enteral nutrition was related to reduced hospitalized days (weighted mean difference = −1.69, 95% confidential interval: −2.15 to −1.23; I 2 = 27%) Conclusion: For patients with gastrointestinal bleeding, early enteral nutrition within 24 hours does not result in the significantly higher risk of rebleeding and mortality compared with delayed enteral nutrition, but decrease hospitalized days. Patients who are at low risk for rebleeding can be fed early and discharged early. However, larger, high-quality randomized controlled trials are needed to verify these findings, and when the gastrointestinal bleeding patient start enteral nutrition is worth studying.

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  • Starting early feeding with clear liquids, soft diet, low-fat diet, or solid food was shown to be safe in different RCTs.

    “Starting early feeding with clear liquids, soft diet, low-fat diet,”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [193]

    The Results (Study outcomes; page unavailable) report that early enteral nutrition was not associated with increased rebleeding across five RCTs of patients with gastrointestinal bleeding. The Results (Search results and study characteristics; page unavailable) describe the nutrients as mixed warm liquids, such as soup, milk, or liquid rice. The paper does not establish the safety of the full list of clear liquids, soft diets, low-fat diets, and solid food. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In patients with mild acute pancreatitis, early oral feeding with the subjective feeling of hunger is safe, feasible, and reduces length of hospital stay.

    “early oral feeding, with the subjective feeling of hunger, is safe,”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [193]

    The Discussion (page not provided) reports that early enteral nutrition shortened hospital stay in patients with severe acute pancreatitis. It does not establish that hunger-guided early oral feeding is safe or feasible in patients with mild acute pancreatitis. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 38

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Cited by

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Authors
Zhang, H., Wang, Y., Sun, S., Huang, X., Tu, G., Wang, J., Lin, Y., Xia, H., Yuan, Y., & Yao, S.
Affiliations
  • Department of Cardiology
  • Department of Anesthesia
  • Wuhan Union Hospital (CN)
Corresponding author
  • Xia, Haifa
  • Yuan, Yin
ORCID
Venue
Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-03
Volume
98
Issue
11
Pages
e14864
ISSN
  • 0025-7974 (ISSN-L)
  • 1536-5964
DOI
10.1097/md.0000000000014864
PMC
PMC6426535
OpenAlex
W2922097250
Cited by
25
References
0
Citations by year
2025: 3 · 2024: 7 · 2023: 5 · 2022: 7 · 2021: 2 · 2020: 1
FWCI
0.34
Type
journal article
Language
en
Open access
Licence
Locations
  • Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Natural Science Foundation of China (81401568, 81701887)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
Keywords
early enteral nutrition, delayed enteral nutrition, gastrointestinal bleeding, rebleeding, 30-day mortality, length of hospital stay, timing of enteral feeding
MeSH terms
Enteral Nutrition, Gastrointestinal Hemorrhage, Humans, Time Factors, Odds Ratio, Treatment Outcome

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