The role of glutamine in the treatment of severe acute pancreatitis

Machulina I.A.; Shestopalov A.E.

doi:https://doi.org/10.17116/anaesthesiology202404197

Machulina I.A.

Mukhin City Clinical Hospital;
Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0002-9466-7556

Shestopalov A.E.

Russian Medical Academy for Continuous Professional Education;
Burdenko Main Military Clinical Hospital;
Federal Research Center of Nutrition, Biotechnology and Food Safety

Scopus AuthorID: 8295880000
ORCID: 0000-0002-5278-7058

The role of glutamine in the treatment of severe acute pancreatitis

Authors:

Machulina I.A., Shestopalov A.E.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2024;(4): 97‑101

DOI: 10.17116/anaesthesiology202404197

Read: 1072 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Machulina IA, Shestopalov AE. The role of glutamine in the treatment of severe acute pancreatitis. Russian Journal of Anesthesiology and Reanimatology. 2024;(4):97‑101. (In Russ.)
https://doi.org/10.17116/anaesthesiology202404197

Использование инфографики авторами научных работ

Close metadata

Recommended articles:

Iron supplements and erythropoiesis-stimulating agents in intensive care of postpartum hemorrhage: a Bayesian network meta-analysis. Russian Journal of Anesthesiology and Reanimatology. 2025;(2):59-67

Indirect comparison of anti-angiogenic agents in the treatment of diabetic macular edema. Russian Annals of Ophthalmology. 2024;(6):69-79

Efficacy and tolerability of azilsartan combined with amlodipine and amlodipine monotherapy and combinations of amlodipine with other angiotensin II receptor blockers. Russian Cardiology Bulletin. 2024;(4-2):161-171

Comparing the efficacy of divozilimab and second-line treatments for relapsing-remitting multiple sclerosis in the Russian Federation: a systematic review and network meta-analysis. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(2):58-68

Relationship between intestinal insufficiency syndrome and risk of external intestinal fistulas in patients with severe acute pancreatitis. Pirogov Russian Journal of Surgery. 2025;(4):79-85

Results of an open-label, randomized, multicenter, comparative study of clinical efficacy and safety of Pulmibud drug and Pulmicort drug in patients with partially controlled and uncontrolled persistent bronchial asthma. Journal of Respiratory Medicine. 2025;(3):33-38

Abstract:

Acute pancreatitis is the most common gastrointestinal disease requiring in-hospital treatment. Mortality rate in severe acute pancreatitis is still high (about 15%). The main causes of mortality at the early stages are systemic inflammatory response and multiple organ failure. The main target damaged organs in patients with severe pancreatitis are lungs, kidneys and gastrointestinal tract. In later stages, the cause of mortality is sepsis following parapancreatic infection, intestinal barrier damage and translocation of pathogenic microbes and their toxins through the intestinal wall into the blood and lymph. Glutamine restores function of enterocytes and gastrointestinal tract, as well as reduces manifestations of systemic inflammatory response, incidence of infectious complications and risk of mortality in patients with severe acute pancreatitis.

Keywords:

severe acute pancreatitis

glutamine

network meta-analysis

randomized controlled trial

Authors:

Machulina I.A.

Mukhin City Clinical Hospital;
Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0002-9466-7556

Shestopalov A.E.

Russian Medical Academy for Continuous Professional Education;
Burdenko Main Military Clinical Hospital;
Federal Research Center of Nutrition, Biotechnology and Food Safety

Scopus AuthorID: 8295880000
ORCID: 0000-0002-5278-7058

Received:

09.04.2024

Accepted:

28.04.2024

Close metadata

References:

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis — 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102e11.
Arvanitakis M, Dumonceau JM, Albert J, Badaoui A, Bali MA, Barthet M, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy. 2018;50:524e46.
Lankisch PG, Assmus C, Lehnick D, Maisonneuve P, Lowenfels AB. Acute pancreatitis: does gender matter? Dig Dis Sci. 2001;46:2470-2474.
Franco-Pons N, Gea-Sorlí S, Closa D, Chen T, Tian JY, Si HR. Release of inflammatory mediators by adipose tissue during acute pancreatitis. J Pathol. 2010;221:175-182. https://doi.org/10.1002/path.2691
Hussain N, Wu F, Zhu L, Thrall RS, Kresch MJ. Neutrophil apoptosis during the development and resolution of oleic acid-induced acute lung injury in the rat. Am J Respir Cell Mol Biol. 1998;19:867-874. https://doi.org/10.1165/ajrcmb.19.6.3118
Dal M, Ulutas K. Assessment of visceral and subcutaneous obesity to understand the efficiency of adipose tissue in acute pancreatitis. Niger J Clin Pract. 2021;24:993-993. https://doi.org/10.4103/njcp.njcp_370_19
Qiao SF, Sun JB, Li F. Analysis of related factors and prevention measures of pancreatic infection in patients with severe acute pancreatitis. Clin Med Ch. 2006;22:252-253.
Roth E, Funovics J, Muhlbacher F, Schemper M, Mauritz W, Sporn P, Fritsch A. Metabolic disorders in severe abdominal sepsis: glutamine deficiency in skeletal muscle. Clin Nutr. 1982;1:25-41.
Rodas PC, Rooyackers O, Hebert C, Norberg Å, Wernerman J. Glutamine and glutathione at ICU admission in relation to outcome. Clin Sci (Lond). 2012 June;122(12):591-597. PMID: 22248298; PMCID: PMC3294430. https://doi.org/10.1042/CS20110520
Yong L, Lu QP, Liu SH, Fan H. Efficacy of Glutamine-Enriched Nutrition Support for Patients With Severe Acute Pancreatitis: A Meta-Analysis. JPEN J Parenter Enteral Nutr. 2016 Jan;40(1):83-94. Epub 2015 Feb 05. PMID: 25655622. https://doi.org/10.1177/0148607115570391
Spolarics Z, Lang CH, Bagby GJ, Spitzer JJ. Glutamine and fatty acid oxidation are the main sources of energy for Kupffer and endothelial cells. Am J Physiol. 1991 Aug;261(2 Pt 1):G185-G190. PMID: 1872392.
Petrikov SS, Khubutiya MSh, Popova TS. Natsional’noe rukovodstvo «Parenteral’noe i enteral’noe pitanie». 2-e izd. 2023:259-271. (In Russ.).
Stehle P, Ellger B, Kojic D, Feuersenger A, Schneid C, Stover J, Scheiner D, Westphal M. Glutamine dipeptide-supplemented parenteral nutrition improves the clinical outcomes of critically ill patients: A systematic evaluation of randomised controlled trials. Clin Nutr ESPEN. 2017 Feb;17:75-85. Epub 2016 Oct 27. PMID: 28361751. https://doi.org/10.1016/j.clnesp.2016.09.007
Grau T, Bonet A, Miñambres E, et al. The effect of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients. Crit Care Med. 2011;39:1263-1268.
Zhang D, Li Y, Ding L, Fu Y, Dong X, Li H. Prevalence and outcome of acute gastrointestinal injury in critically ill patients: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Oct;97(43):e12970. PMID: 30412121; PMCID: PMC6221717. https://doi.org/10.1097/MD.0000000000012970
Hu B, Sun R, Wu A, Ni Y, Liu J, Guo F, Ying L, Ge G, Ding A, Shi Y, Liu C, Xu L, Jiang R, Lu J, Lin R, Zhu Y, Wu W, Xie B. Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study. Crit Care. 2017 July 14;21(1):188. PMID: 28709443; PMCID: PMC5513140. https://doi.org/10.1186/s13054-017-1780-4
Reintam Blaser A, Bachmann KF, Deane AM. Gastrointestinal function in critically ill patients. Curr Opin Clin Nutr Metab Care. 2023 Sept 01; 26(5):463-469. Epub 2023 June 19. PMID: 37389469. https://doi.org/10.1097/MCO.0000000000000955
Zhong M, Xu W, Qiu Y, Li L, Qu H, Chen E. Association of Changes in Acute Gastrointestinal Injury Grade with Prognosis in Critically Ill Patients: A Prospective, Single-Center, Observational Study. J Multidiscip Healthc. 2021 Feb 05;14:279-286. PMID: 33574672; PMCID: PMC7872930.
McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G; A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care Medicine. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009 May-June;33(3):277-316. PMID: 19398613.
Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009;53(3):318-324.
Mittal R, Coopersmith CM. Redefining the gut as the motor of critical illness. Trends Mol Med. 2014;20(4):214-223.
Sertaridou E, Papaioannou V, Kolios G, Pneumatikos I. Gut failure in critical care: old school versus new school. Ann Gastroenterol. 2015;28(3):309-322.
Krezalek MA, DeFazio J, Zaborina O, Zaborin A, Alverdy JC. The shift of anintestinal “microbiome” to a “pathobiome” governs the course and outcome ofsepsis following surgical injury. Shock. 2016;45(5):475-482.
Zaborin A, Smith D, Garfield K, Quensen J, Shakhsheer B, Kade M, et al. Membership and behavior of ultra-low-diversity pathogen communitiespresent in the gut of humans during prolonged critical illness. mBio. 2014;5(5):e01361-14.
Morowitz MJ, Carlisle EM, Alverdy JC. Contributions of intestinal bacteria tonutrition and metabolism in the critically ill. Surg Clin North Am. 2011;91(4):771-785.
Reintam Blaser A, Bachmann KF, Deane AM. Gastrointestinal function in critically ill patients. Curr Opin Clin Nutr Metab Care. 2023 Sep 1;26(5):463-469. Epub 2023 June 19. PMID: 37389469. https://doi.org/10.1097/MCO.0000000000000955
Petrikov SS, Khubutiya MSh, Popova TS. Natsional’noe rukovodstvo «Parenteral’noe i enteral’noe pitanie». 2-e izd. 2023:637-639. (In Russ.).
Tremel H, Kienle B, Weilemann LS, Stehle P, Fürst P. Glutamine dipeptide-supplemented parenteral nutrition maintains intestinal function in the critically ill. Gastroenterology. 1994 Dec;107(6):1595-1601. PMID: 7958669.
Yong L, Lu Q-P, Liu S-H, Fan H. Efficacy of Glutamine-Enriched Nutrition Support for Patients With Severe Acute Pancreatitis: A Meta-Analysis. JPEN J Parenter Enteral Nutr. 2016 Jan;40(1):83-94. Epub 2015 Feb 05. PMID: 25655622. https://doi.org/10.1177/0148607115570391
Tao X, Yang Y, Xu S, Xiong Q. Efficacy of immune nutrients in severe acute pancreatitis: A network meta-analysis. Medicine (Baltimore). 2023 Oct 27; 102(43):e35615. PMID: 37904469; PMCID: PMC10615524.
Petrov MS, van Santvoort HC, Besselink MG, van der Heijden GJ, Windsor JA, Gooszen HG. Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis: a meta-analysis of randomized trials. Arch Surg. 2008;143(11):1111-1117.
Singer P, ed. Nutrition in Intensive Care Medicine: Beyond Physiology. Basel, Switzerland: Karger; 2013.
Zhukov AV, Gritsan AI, Belyaev KYu, Belyaeva IP. Nutritional and Metabolic Status Control and Nutritional Support in Patients with Pancreatic Sepsis (Review). General Reanimatology. 2024;20(2):70-82. (In Russ.). https://doi.org/10.15360/1813-9779-2024-2-70-82
Sivkov OG, Leyderman IN, Sivkov AO, Kolchanov AA, Bashlykov GD. Prognostic Tests of Intolerance to Postpyloric Feeding in Early Acute Pancreatitis. General Reanimatology. 2022;18(3):11-20. (In Russ.). https://doi.org/10.15360/1813-9779-2022-3-11-20
Arvanitakis M, Ockenga J, Bezmarevic M, Gianotti L, Krznarić Ž, Lobo DN, Löser C, Madl C, Meier R, Phillips M, Rasmussen HH, Van Hooft JE, Bischoff SC. ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis. Clinical Nutrition. 2024;43(2):395-412. Published: December 27, 2023.