Clear Liquid Diet vs Soft Diet as the Initial Meal in Patients With Mild Acute Pancreatitis

Abstract

In patients with mild acute pancreatitis, a soft diet as the initial meal is well tolerated and leads to a shorter total length of hospitalization.

The oral refeeding trilemma of acute pancreatitis: what, when and who?

“…Also, none of the patients receiving light diet in the study by Rajkumar et al were readmitted in the 30 days following discharge [8]. However, the generalizability of the data from this study is questionable, given that 90% of AP cases were of alcoholic etiology and the study population had an 11:1 male to female ratio, which is clearly not representative of the general population.…”

“…No difference in tolerance was found between the two arms in either study, suggesting that a light diet is as safe as the current conventional protocol. In contrast to the study by Jacobson et al, both studies found that patients starting on a light diet had a significantly reduced length of hospitalization (an average difference of 2 days in both studies) [7,8]. It is interesting to note that, although discharge was ultimately at the discretion of the treating team, both these studies had pre-defined discharge criteria included in their protocol, following the tolerance of a full diet.…”

“…The effect of these diets on length of hospitalization has proved to be more variable: two studies have shown that commencing refeeding on a light or full solid diet resulted in a reduction in hospital stay [7,8], whereas others have not [6,9,11]. Study-level factors should be considered when investigating OFI, and further studies that use pre-defined discharge criteria are needed to confirm these findings.…”

“…While a light diet was well tolerated by the majority of patients and made no statistically significant difference in the hospital length of stay or rate of readmission between the two groups, it is worth noting that the combination of an open-label design and poorly defined discharge criteria could have led to the possibility of patients in the intervention group being kept longer for observation. The safety of refeeding with a light diet was also investigated in later studies conducted by Sathiaraj et al [7] and Rajkumar et al [8] in which 101 and 60 patients, respectively, were randomized to receive either a light diet or conventional refeeding beginning with a CLD. All patients in the study by Sathiaraj et al had confirmed mild AP (no pancreatic necrosis, abscess, pseudocyst, organ dysfunction, hypotension or hypoxemia) and were monitored daily for evidence of OFI.…”

Treating acute pancreatitis: what’s new?

“…A meta-analysis of three RCTs with 326 patients with mild acute pancreatitis showed that a solid diet reduced the length of hospital stay, compared to a liquid diet, but did not affect the rates of recurrent pain after refeeding [90]. Decreased length of hospital stay has also been shown in the most recent RCTs with a solid as opposed to a liquid diet in mild acute pancreatitis [91,92]. One recent RCT compared early nasogastric tube feeding to nothing per os in patients with mild-to-moderate acute pancreatitis and found that the patients in the nasogastric tube feeding group had significantly less abdominal pain, need for opiates and refeeding intolerance but did not decrease length of stay [93].…”