Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study

The aim of this randomized controlled study was to assess the nutritional and clinical effects of early enteral nutrition (EN) in cirrhotic patients with bleeding from esophageal varices. From August 1994 through August 1995, all patients admitted for acute variceal bleeding underwent emergency sclerotherapy or banding ligation and continuous infusion of octreotide and were randomized in two groups. In group A, patients received from day 1 discontinuous polymeric EN (1665 kcal/day, through nasogastric tube) and in group B, patients were nil by mouth. On day 4, all patients received oral diet. Nutritional status, liver function, and rebleeding were evaluated on days 4, 7, and 35. Twenty-two patients (17 men, 5 women, mean age 56 years) were included. On day 0, patients in group A (N = 12) and group B (N = 10) were comparable. On day 4, nitrogen balance was 0.7 +/- 2.5 g/day in group A and -11.2 +/- 6.7 g/day in group B (P = 0.01, Mann-Whitney test). On days 4, 7, and 35, no significant differences between the two groups were observed for nutritional status and liver function. Four (33%) group A patients rebled compared with one (10%) group B patient (NS). Hospital stay (14.5 +/- 4.1 days vs 12.9 +/- 5.3 days) and mortality (3 vs 2 patients), were comparable between the two groups. In conclusion, our study failed to demonstrate any favorable effect of short-term EN on nutritional status and liver function in cirrhotic patients hospitalized for variceal bleeding.