{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:35:37Z","timestamp":1790087737634,"version":"4.0.1"},"reference-count":44,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T00:00:00Z","timestamp":1584489600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven randomized controlled trials (724 patients) were included. Meta\u2010analysis showed significantly shorter length of hospital stay (days) (mean difference [MD], \u22124.49; 95% CI, \u22126.09 to \u22122.90; <jats:italic>P<\/jats:italic> &lt; .00001), shorter length of intensive care unit stay (days) (MD, \u22122.82; 95% CI, \u22124.00 to \u22121.64; <jats:italic>P<\/jats:italic> &lt; .00001), shorter length of severe abdominal pain (days) (MD, \u22122.20; 95% CI, \u22122.50 to \u22121.90; <jats:italic>P<\/jats:italic> &lt; .00001), shorter length of abdominal distention (days) (MD, \u22122.31; 95% CI, \u22122.84 to \u22121.78; <jats:italic>P<\/jats:italic> &lt; .00001), shorter length of abnormal bowel sounds (days) (MD, \u22120.98; 95% CI, \u22121.12 to \u22120.88; <jats:italic>P<\/jats:italic> &lt; .00001), less hospitalization expenditure ($1422.75\/\u00a5 10,000) (MD, \u22121.40; 95% CI, \u22121.23 to \u22120.73; <jats:italic>P<\/jats:italic> &lt; .00001), and smaller Acute Physiology and Chronic Health Evaluation II scores (points) (MD, \u22122.18; 95% CI, \u22122.81 to \u22121.56; <jats:italic>P<\/jats:italic> &lt; .00001) in the rhubarb\/EEN group than in the EEN group. Compared with EEN, rhubarb\/EEN group had lower levels of white blood cells (10<jats:sup>9<\/jats:sup>\/L) (MD, \u22122.77; 95% CI, \u22123.80 to \u22121.74; <jats:italic>P<\/jats:italic> &lt; .00001), C\u2010reactive protein (mg\/L) (MD, \u221210.71; 95% CI, \u221213.40 to \u22128.02; <jats:italic>P<\/jats:italic> &lt; .00001), and interleukin\u20106 (ng\/L) (MD, \u22128.02; 95% CI, \u221211.38 to \u22124.65; <jats:italic>P<\/jats:italic> &lt; .00001). However, there were no significant differences (<jats:italic>P<\/jats:italic> &gt; .05) between the 2\u00a0groups in terms of mortality rate (%) (<jats:italic>P<\/jats:italic> = .40), infection rate (%) (<jats:italic>P<\/jats:italic> = .28), and incidence of multiple organ dysfunction syndrome (%) (<jats:italic>P<\/jats:italic> = .09), but the overall effective rate was higher in the rhubarb\/EEN group (MD, 2.57; 95% CI, 1.22 to \u22485.42; <jats:italic>P<\/jats:italic> = .01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpen.1789","type":"journal-article","created":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T16:50:23Z","timestamp":1584550223000},"page":"1066-1078","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Meta\u2010Analysis of Efficacy of Rhubarb Combined With Early Enteral Nutrition for the Treatment of Severe Acute Pancreatitis"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2561-8694","authenticated-orcid":false,"given":"Xinrong","family":"Chen","sequence":"first","affiliation":[{"name":"West China Hospital\/West China School of Nursing Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery West China Hospital Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanda","family":"Jing","sequence":"additional","affiliation":[{"name":"West China Hospital\/West China School of Nursing Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery West China Hospital Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ka","family":"Li","sequence":"additional","affiliation":[{"name":"West China Hospital\/West China School of Nursing Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.80gr.13001"},{"issue":"1","key":"e_1_2_8_3_1","first-page":"1","article-title":"Severe acute pancreatitis","volume":"19","author":"Hayden P","year":"2008","journal-title":"Crit Care Med"},{"issue":"4","key":"e_1_2_8_4_1","first-page":"525","article-title":"Prognostic biological factors in severe acute pancreatitis","volume":"7","author":"Popa CC.","year":"2014","journal-title":"J Med Life"},{"issue":"11","key":"e_1_2_8_5_1","first-page":"839","article-title":"Clinical experience on the employment of the staged step\u2010up approach in the treatment of local complications secondary to severe acute pancreatitis","volume":"54","author":"Ji L","year":"2016","journal-title":"Zhonghua Wai Ke Za Zhi"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp054958"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2015.135"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9665"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.14423\/SMJ.0000000000000727"},{"issue":"3","key":"e_1_2_8_10_1","first-page":"CD010605","article-title":"Enteral nutrition formulations for acute pancreatitis","volume":"3","author":"Poropat G","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607112440823"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2014.164"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2533"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.6096"},{"issue":"81","key":"e_1_2_8_15_1","first-page":"33","article-title":"An experimental study of emodin assisted early enteral nutrition for the treatment of severe acute pancreatitis","volume":"55","author":"Wang G","year":"2008","journal-title":"Hepatogastroenterology"},{"issue":"3","key":"e_1_2_8_16_1","first-page":"29638","article-title":"The effect of emodin\u2010assisted early enteral nutrition on severe acute pancreatitis and secondary hepatic injury","volume":"2007","author":"Wang G","year":"2007","journal-title":"Mediators Inflamm"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-017-0663-8"},{"issue":"8","key":"e_1_2_8_18_1","first-page":"448","article-title":"[Practical guidelines for management of severe acute pancreatitis with integrated Chinese traditional and Western medicine (Draft)]","volume":"19","author":"Beale RJ","year":"2007","journal-title":"Zhongguo Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","unstructured":"HigginsJP GreenS.Cochrane Handbook for Systematic Reviews of Interventions. Version 5. 1. 0. The Cochrane Collaboration;2009.","DOI":"10.1002\/9780470712184"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1164"},{"issue":"07","key":"e_1_2_8_21_1","first-page":"1667","article-title":"Clinical observation of dahuang tongbian granule combined with early enteral nutrition in treating severe pancreatitis","volume":"39","author":"Luo J","year":"2016","journal-title":"J Chin Med Mater"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.11569\/wcjd.v24.i17.2720"},{"issue":"4","key":"e_1_2_8_23_1","first-page":"555","article-title":"Efficacy of enteral nutrition combined rhubarb in treatment of severe acute pancreatitis","volume":"37","author":"Zou H","year":"2015","journal-title":"Journal of Youjiang Medical University for Nationalities"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2014.958523"},{"issue":"2","key":"e_1_2_8_25_1","first-page":"247","article-title":"Study on the use of rhubarb in jejunal nutrition in the early stage of severe acute pancreatitis","volume":"20","author":"Wang L","year":"2014","journal-title":"Chinese Journal of Basic Chinese Medicine in Traditional Chinese Medicine"},{"issue":"1","key":"e_1_2_8_26_1","first-page":"61","article-title":"Rhubarb combined with early enteral nutrition in the treatment of severe acute pancreatitis","volume":"38","author":"Wang B","year":"2014","journal-title":"J Chongqing Med Univ"},{"issue":"2","key":"e_1_2_8_27_1","first-page":"118","article-title":"Clinical effect of enteral nutrition combined with rhubarb on severe acute pancreatitis","volume":"16","author":"Zhu YB","year":"2011","journal-title":"Zhejiang Practical Medicine"},{"issue":"1","key":"e_1_2_8_28_1","first-page":"61","article-title":"Clinical research of rhubarb combining with early enteral nutrition on severe acute pancreatitis","volume":"16","author":"Wu XL","year":"2011","journal-title":"Chin J Clin Pharmacol Thera"},{"issue":"1","key":"e_1_2_8_29_1","first-page":"38","article-title":"Effects of rhubarb combined with early enteral nutrition on immune function of severe acute pancreatitis patients","volume":"22","author":"Wu XL","year":"2010","journal-title":"Journal of Hepatopancreatobiliary Surgery"},{"issue":"2","key":"e_1_2_8_30_1","first-page":"69","article-title":"The effects of combination of rhubarb and early enteral nutrition on severe acute pancreatitis","volume":"16","author":"Wu XL","year":"2009","journal-title":"Parenteral & Enteral Nutrition"},{"issue":"17","key":"e_1_2_8_31_1","first-page":"118","article-title":"Clinical study on the preventive and therapeutic effects of rhubarb on gastrointestinal hemorrhage in patients with severe acute pancreatitis","volume":"13","author":"Shen X","year":"2003","journal-title":"China Journal of Modern Medicine"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-018-0036-x"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1189\/jlb.0607372"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i38.13879"},{"issue":"1","key":"e_1_2_8_35_1","first-page":"81","article-title":"Intestinal microbial community differs between acute pancreatitis patients and healthy volunteers","volume":"31","author":"Zhang XM","year":"2018","journal-title":"Biomed Environ Sci"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060518782070"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011871"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000001080"},{"issue":"1","key":"e_1_2_8_39_1","first-page":"136","article-title":"Applying hot compresses with rhubarb and mirabilite to reduce pancreatic leakage occurrence in the treatment of severe acute pancreatitis","volume":"46","author":"Wang Y","year":"2017","journal-title":"Iran J Public Health"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jep.2016.09.053"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2018.00075"},{"issue":"8","key":"e_1_2_8_42_1","first-page":"1419","article-title":"Clinical observation of the effect of rhubarb nasal feeding and mirabilite external applying combined with western medicine on the treatment of severe acute pancreatitis","volume":"44","author":"Tang QQ","year":"2015","journal-title":"Pancreas"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000339"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2013.0353"},{"issue":"3","key":"e_1_2_8_45_1","first-page":"1","article-title":"CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials","volume":"65","author":"Moher D","year":"2012","journal-title":"J Clin Epidemiol"}],"container-title":["Journal of Parenteral and Enteral Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjpen.1789","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpen.1789","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jpen.1789","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpen.1789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T09:02:18Z","timestamp":1760864538000},"score":1,"resource":{"primary":{"URL":"https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/10.1002\/jpen.1789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,18]]},"references-count":44,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1002\/jpen.1789"],"URL":"https:\/\/doi.org\/10.1002\/jpen.1789","archive":["Portico"],"relation":{},"ISSN":["0148-6071","1941-2444"],"issn-type":[{"value":"0148-6071","type":"print"},{"value":"1941-2444","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,18]]},"assertion":[{"value":"2019-04-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}