Meta-Analysis of Efficacy of Rhubarb Combined With Early Enteral Nutrition for the Treatment of Severe Acute Pancreatitis

Abstract

Background: Whether to provide rhubarb combined with early enteral nutrition (rhubarb/EEN) to patients with severe acute pancreatitis (SAP) remains controversial. This study aimed to systematically explore the efficacy and safety of rhubarb/EEN in SAP patients.

Methods: We performed searches in EMBASE, PubMed, Medline, Cochrane Library, Chinese Biomedicine Literature Database (SinoMed), Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI), and Wanfang database to identify relevant literature comparing rhubarb/EEN with EEN for SAP.

Results: Eleven randomized controlled trials (724 patients) were included. Meta-analysis showed significantly shorter length of hospital stay (days) (mean difference [MD], -4.49; 95% CI, -6.09 to -2.90; P < .00001), shorter length of intensive care unit stay (days) (MD, -2.82; 95% CI, -4.00 to -1.64; P < .00001), shorter length of severe abdominal pain (days) (MD, -2.20; 95% CI, -2.50 to -1.90; P < .00001), shorter length of abdominal distention (days) (MD, -2.31; 95% CI, -2.84 to -1.78; P < .00001), shorter length of abnormal bowel sounds (days) (MD, -0.98; 95% CI, -1.12 to -0.88; P < .00001), less hospitalization expenditure ($1422.75/¥ 10,000) (MD, -1.40; 95% CI, -1.23 to -0.73; P < .00001), and smaller Acute Physiology and Chronic Health Evaluation II scores (points) (MD, -2.18; 95% CI, -2.81 to -1.56; P < .00001) in the rhubarb/EEN group than in the EEN group. Compared with EEN, rhubarb/EEN group had lower levels of white blood cells (10⁹ /L) (MD, -2.77; 95% CI, -3.80 to -1.74; P < .00001), C-reactive protein (mg/L) (MD, -10.71; 95% CI, -13.40 to -8.02; P < .00001), and interleukin-6 (ng/L) (MD, -8.02; 95% CI, -11.38 to -4.65; P < .00001). However, there were no significant differences (P > .05) between the 2 groups in terms of mortality rate (%) (P = .40), infection rate (%) (P = .28), and incidence of multiple organ dysfunction syndrome (%) (P = .09), but the overall effective rate was higher in the rhubarb/EEN group (MD, 2.57; 95% CI, 1.22 to ≈5.42; P = .01).

Conclusions: Combination of EEN and rhubarb may improve the gastrointestinal function, inhibit systemic inflammation and disease severity, and enhance the efficacy of enteral nutrition, leading to better therapeutic effectiveness in SAP patients.

Keywords: enteral nutrition; meta-analysis; rhubarb; severe acute pancreatitis.