Which study shows enteral nutrition beyond the ligament of Treitz in severe pancreatitis reduces infectious complications, maintains nitrogen balance, and reduces hyperglycemia?

• A. EN led to fewer infectious complications, maintained equal nitrogen balance and reduced hyperglycemia
• B. EN led to higher infectious complications
• C. EN led to worse nitrogen balance
• D. EN had no effect on infectious complications

Answer: (A)

Feeding distal to the ligament of Treitz (jejunostomy/jejunal feeding) in severe pancreatitis is beneficial because it keeps the gut mucosa functional with minimal pancreatic stimulation. This approach helps preserve the gut barrier and local immunity, which reduces bacterial translocation and systemic infection. That’s why enteral nutrition started after the ligament of Treitz tends to lower infectious complications compared with other feeding strategies.

Providing nutrients directly to the small intestine supports nitrogen balance by delivering amino acids for protein synthesis at a time when the body is in a hypercatabolic state from severe pancreatitis. Enteral protein delivery helps spare lean body mass and reduces nitrogen losses, leading to a more favorable or maintained nitrogen balance.

Hyperglycemia is often driven by large glucose loads from parenteral nutrition; enteral feeding, especially when delivered postduodenally, delivers nutrients in a more physiologic pattern and avoids the excessive dextrose exposure seen with PN. This tends to produce better glucose control and reduce hyperglycemia.

So a study showing fewer infectious complications, maintained nitrogen balance, and reduced hyperglycemia with enteral nutrition beyond the ligament of Treitz aligns with these mechanisms, making it the best answer.