Efficacy of rhubarb combined with early enteral nutrition for the treatment of severe acute pancreatitis: a randomized controlled trial.

To investigate the effect of rhubarb combined with early enteral nutrition (EEN) on the gastrointestinal function, disease severity and systemic inflammation in patients with severe acute pancreatitis (SAP). A total of 126 patients with SAP were randomly assigned into three groups: parenteral nutrition group, treated with standard solution first and EN 14 days later; EEN group, treated with EN suspension; or EEN combined with rhubarb group, treated with rhubarb and then EN 2 h later. The gastrointestinal function, APACHE II scores, the levels of plasma IL-6, IL-11, C-reactive proteins (CRP) and the liver and kidney functional measures were longitudinally analyzed. Patients in the EEN/rhubarb group had the shortest period of abdominal pain and the fastest recovery from abnormal bowel movement and high fever as well as significantly shorter periods of intensive-care unit and hospital stays. The combination of EEN and rhubarb significantly reduced the values of APACHE II scores. Combination therapies significantly reduced abnormally higher white blood cell (WBC) counts and levels of plasma CRP and IL-6, but increased the levels of plasma IL-11. Finally, combination therapies improved the SAP-related damages of liver and kidney function by reducing abnormally higher levels of plasma alanine aminotransferase, aspartate aminotransferase, and creatinine (Cr). Combination of EEN and rhubarb significantly improved the gastrointestinal function, inhibited systemic inflammation and disease severity and mitigated the disease-related damages of liver and kidney function in SAP patients.