My research project
Long term effects of pancreatico-duodenectomy
This observational study explores the impact of pre and post operative sarcopenia on surgical outcomes and tolerance of adjuvant chemotherapy. The study also explores long term implications such as micronutrient deficiency, onset of type 3c diabetes, other gastrointestinal complications and osteoporosis.
Affiliations and memberships
Malnutrition in chronic pancreatitis is complex and multifactorial, with malabsorption, pain, toxic dependencies and co-morbidities, such as diabetes, each playing a role. The aims of this systematic review were to assess the impact of nutritional intervention on markers of nutritional status in this complex patient group, A systematic review of EMBASE and PubMed was carried out in February 2020, identifying 2620 articles. After screening to exclude those reporting short term changes (less than 3 months), with only one data point, or in the wrong population, eight papers were selected for analysis. Seven studies documented the impact of a nutritional intervention, one was an observational study only. Overall, studies were limited by predominantly retrospective designs, heterogenous populations and poor control of potentially confounding variables. Data could not be combined due to variability in reporting methods. All studies exploring nutritional intervention, whether that consisted of advice by a specialist dietitian, dose escalation of pancreatic enzymes, oral nutritional supplements or enteral feeding, demonstrated improved body weight and pain control, whereas patients who did not receive an intervention deteriorated nutritionally. Patients with chronic pancreatitis benefit from nutritional intervention. Further work is required to explore the impact of nutritional intervention on body composition and functional outcomes.
Background and aims Patients with pancreatic cancer often experience significant deterioration in nutritional status over time. Malnutrition is complex and multifactorial, with malabsorption, pain, toxic dependencies, co-morbidities and malignant processes all playing a role. The aims of this systematic review were to assess nutritional changes over time and identify tolerance of nutritional intervention, thus identifying potential areas for further research to improve patient outcomes. Materials and methods A systematic review of MEDLINE, EMBASE and PubMed was carried out in February 2020, identifying 2620 articles. After screening to exclude those reporting short-term measures, with only one data point, or in the wrong population, thirteen papers were selected for analysis (four trials in neo-adjuvant treatment, five in populations undergoing palliative treatment for pancreatic cancer, and four in mixed populations undergoing pancreatic resection). Results Overall, studies were limited by predominantly retrospective designs, and poor control of potentially confounding variables. Meta-analysis could not be performed due to heterogenicity in study design and reporting methods. Surgery in mixed cohorts did not appear to result in weight loss. Only one small intervention study was identified. Patients with pancreatic cancer experienced a decline in nutritional status, with 44-63% of patients undergoing neoadjuvant chemotherapy having low muscle mass prior to starting treatment. Conclusion There is a paucity of data regarding nutritional intervention in pancreatic cancer. Future work should include the use of validated functional and clinical assessment tools to further explore the impact of nutritional intervention, and the relationship between nutritional status and outcome.
Peer reviewed publications
- Nutritional assessment and management in acute pancreatitis – ongoing lessons of the NCEPOD report. Phillips M.E; Smith N, McPherson S, O’Reilly D.A. Journal of Human Nutrition and Dietetics 2021 (in press)
- A Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines. Phillips M.E, Hopper A, Leeds J.S, Roberts K.R, McGeeney L.M, Duggan S.N, Kumar R. BMJ Open Gastroenterology (2021)
- Long term changes in nutritional status and body composition in patients with malignant pancreatic disease. Phillips M.E, Robertson M, Hart K, Kumar R, Pencavel T.D. Clinical Nutrition ESPEN 2021;44:85-95
- Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer?, Sarah Blacker, Rajiv P. Lahiri, Mary Phillips, Graham Pinn, Tim D. Pencavel, Rajesh Kumar, Angela T. Riga, Tim R. Worthington, Nariman D. Karanjia & Adam E. Frampton. Expert Review of Gastroenterology & Hepatology, 2021 DOI: 10.1080/17474124.2021.1915127
- COVID PAN collaborative group, SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study. Pandanaboyana S, Moir J, Leeds JS Kofi Oppong, Aditya Kanwar, Ahmed Marzouk, Ajay Belgaumkar, Ajay Gupta, Ajith K Siriwardena, Ali Raza Haque, Altaf Awan, Anita Balakrishnan, Arab Rawashdeh, Bogdan Ivanov, Chetan Parmar, Christopher M Halloran, Clifford Caruana, Cynthia-Michelle Borg, Dhanny Gomez, Dimitrios Damaskos, Dimitrios Karavias, Guy Finch, Husam Ebied, James K Pine, James R A Skipworth, James Milburn, Javed Latif, Jeyakumar Ratnam Apollos, Jihène El Kafsi, John A Windsor, Keith Roberts, Kelvin Wang, Krish Ravi, Maria V Coats, Marianne Hollyman, Mary Phillips, et al. Gut 2021;70:1061-1069
- Complex Enterally Tube-Fed Community Patients Display Stable Tolerance, Improved Compliance and Better Achieve Energy and Protein Targets with a High-Energy, High-Protein Peptide-Based Enteral Tube Feed: Results from a Multi-Centre Pilot Study. Green, B., Sorensen, K., Phillips, M., et al,. Nutrients, 2020; 12. 3538; doi:10.3390/nu12113538
- ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Arvanitakis. M, Ockenga J, Bezmarevic M, Gianotti L, Krznaric Z, Lobo DN, Loser C, Madl C, Meier R, Phillips M.E, et al, Clin Nutr. 2020;39(3);612-631
- Pancreatic exocrine insufficiency and enteral feeding: a practical guide with case studies, Phillips M. E, Berry A, Gettle L.S, Practical Gastroenterology, Series #181 November 2018
- Nutritional Therapy in Chronic Pancreatitis. Domínguez-Muñoz J.E, Phillips M.E. Gastroenterology Clinics. 2017;946: 47(1)
- Pancreatic resection: nutritional implications and long term follow up, Phillips M. E, Practical Gastroenterology, March 2016
- Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: relavelence and diagnostic use. Björn Lindkvist, Mary E. Phillips, Enrique Domínguez-Muñoz, Pancreatology 2015; 15(6): 589-597
- Invited Review: Pancreatic exocrine insufficiency following pancreatic resection. Phillips M.E, Pancreatology 2015;15(5): 449-455
- An Unusual Complication of PEG Feeding After Pancreatico-Gastrostomy. Phillips M.E, Hosie K, Griffiths E.J, Low N, Gallagher M.C, Tibbs C.J, Karanjia N.D. JOP. 2014 May 27;15(3):258-60.
A safe, effective, and cheap method of achieving pancreatic rest in patients with chronic pancreatitis with refractory symptoms and malnutrition. Pancreas. 2009 Aug;38(6):689-92. Lordan JT, Phillips ME, Chun JY, Worthington TR, Menezes NM, Lightwood R, Hussain F, Tibbs C, Karanjia ND.
Feeding patients following pancreaticoduodenectomy: a UK national survey. Ann R Coll Surg Engl 2009 Jul;91(5):385-8. Phillips ME, Lordan JT, Menezes NM, Karanjia ND
- An Evaluation of Gastrostomy Care in a District General Hospital. Khoshnaw H, Phillips ME, Baseby A, Chapman G, Hendry S. Journal of Nutrition, Health and Aging. 2004; 8(4):309
- An elemental diet for bowel obstruction in pregnancy: a case study. J Hum Nutr Diet. 2004 Dec; 17(6):543-5. Phillips ME, Curtis P, Karanjia ND
- Failure to gain weight on long-term parenteral nutrition attributed to tri-iodothyronine thyrotoxicosis. Nutrition 2004 Nov-Dec;20(11-12):1018-21. Livingstone C, Phillips ME, Davis J, Marvin V, Stebbing JF
- Enteral Nutrition in patients with pancreatic exocrine insufficiency. Phillips M E, Exocrine Pancreatic Insufficiency, 3rd Edition Editors: Aleassa E.M; Morris-Stiff G and Domingues-Munoz J.E, 2021 (in press)
- Nutritional Support. Phillips M.E, Exocrine Pancreatic Insufficiency, 3rd Edition Editors: Aleassa E.M, Morris-Stiff G and Domingues-Munoz J.E, 2021 (in press)
- Acute Pancreatitis, Phillips M.E, Advanced Nutrition and Dietetics in Gastroenterology, 2nd Edition, Ed: Lomar M, 2020
- Pancreatic Disease, Phillips M.E Oxford Handbook of Nutrition and Dietetics, 3rd Edition, Ed. Gandy J, Madden A, 2020
- Nutrition in Pancreatic Cancer, Phillips, M.E, Griffin O. Clinical Pancreatology 2020 3rd Edition, Ed. Dominguez-Munoz E.