Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicentre prospective study of 116 patients.

Lévy, Philippe; Héresbach, D.; Pariente, Emile-Alexandre; Boruchowicz, A; Delcenserie, Richard; Millat, Bertrand; Moreau, J; Bodic, L. Le; Calan, L. De; Barthet, Marc; Sauvanet, Alain; Bernadès, P

doi:10.1136/gut.40.2.262

Cited by 107 publications

(67 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fourteen of 17 publications were subsequently excluded because they were guidelines, editorials, or studies in which the outcome variables were not reported. A total of three trials were included in the review (8)(9)(10). The characteristics of included studies are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Because patients with pain relapse tended to have a longer duration of initial abdominal pain (10), persistent elevation of serum enzymes (10), and higher Balthazar's scores on admission (8,9), it may well be that patients with pain relapse are those with more severe acute pancreatitis (11). However, due to the significantly longer postrefeeding length of hospital stay (8,9) and the absence of difference in the severity scores between patients with and without pain relapse (8)(9)(10), premature oral refeeding could also be responsible for the pain relapse. Refeeding pain may be caused by restimulation of pancreatic secretion by oral bolus feeding, which may activate both dormant enzymes and the inflammatory process (12).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Oral Refeeding After Onset of Acute Pancreatitis: A Review of Literature

Petrov¹,

Santvoort²,

Besselink³

et al. 2007

Am J Gastroenterology

View full text Add to dashboard Cite

BACKGROUND: Oral refeeding in patients recovering from acute pancreatitis may cause pain relapse. Patients with pain relapse may be ill for prolonged periods, thereby consuming additional health care resources. We aimed to determine the incidence and risk factors of pain relapse on the basis of reviewing all studies on oral refeeding in acute pancreatitis. METHODS:Relevant literature cited in three electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE) as well as the abstracts of major gastroenterological meetings was reviewed. Outcome measures studied were the incidence of pain relapse and length of hospital stay. RESULTS:A total of three studies met the inclusion criteria. Sixty of 274 patients (21.9%) experienced pain relapse during the course of acute pancreatitis. In 47 of 60 (78.3%) patients pain relapse occurred within 48 h after commencement of oral refeeding. Two studies showed a significantly higher Balthazar's CT score on hospital admission in patients with pain relapse, whereas all three studies found no difference in the severity scores between patients with and without pain relapse. All three studies found a significant increase in the length of hospital stay in patients with pain relapse.CONCLUSIONS: The incidence of pain relapse after oral refeeding in acute pancreatitis is relatively high. Thereby, the quest for new therapeutical modalities that can prevent pain relapse is of current importance.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Oral Refeeding After Onset of Acute Pancreatitis: A Review of Literature

Petrov¹,

Santvoort²,

Besselink³

et al. 2007

Am J Gastroenterology

View full text Add to dashboard Cite

show abstract

“…Petrov [17] pointed out in Moraes study that the rate of feeding intolerance was around 20%, regardless of the type of initial diet used for oral refeeding and this was unacceptable both from the perspective of patient's quality of life and the cost of treatment. However, this rate of intolerance was observed also in other trials [5,6] and it seems a rule in oral refeeding of patients with mild AP.…”

Section: Refeeding In Apmentioning

confidence: 89%

“…In 1997, Lévy et al [5] , in a multivariate multicenter prospective study, tried to analyze the frequency and risk factors of recurrent pain during oral refeeding in 116 patients with mild AP. The conclusion was that pain relapse occurred in 20% of the patients and was more common in patients with necrotizing pancreatitis who had longer periods of pain.…”

Section: Refeeding In Apmentioning

confidence: 99%

Oral refeeding in mild acute pancreatitis: An old challenge

Chebli

Gaburri²,

Chebli

2011

WJGP

View full text Add to dashboard Cite

Although the idea that pancreas rest has long been considered as a very relevant topic in acute pancreatitis (AP) therapy, the right time and type of diet to be offered to patients recovering from an acute attack are a great challenge to clinicians who treat this condition. Fortunately, the last decade was noted for several trials looking for the best answer to the question: "when and how to start oral refeeding in AP?" It is well known that 80% of patients present with mild disease characterized by usually uncomplicated clinical course are managed with pancreatic rest through nil per oral; while the use of specific nutritional intervention is an exception. Therefore, mild AP has been the most investigated form of AP and researchers have tried different kind of meals to offer calories and reduce costs by shortening hospitalization time. Usually in mild AP, the oral refeeding is introduced between the first 3 d and 7 d after hospitalization but, the type of diet and patients' tolerance have been scrutinized in detail with mixed results. Although 20% to 25% have pain recurrence requiring nutritional support and greater time of hospitalization, most patients seem to tolerate oral refeeding well. We propose analyzing the most recent investigations of this matter and their conclusions to develop a better understanding of the management of AP.

show abstract

“…Bei Patienten mit nekrotisierender Pankreatitis siedeln sich die translozierten Bakterien bevorzugt in der Pankreasnekrose an und können eine der gefürchtetsten Komplikationen der Pankreatitis -die infizierte Nekrose oder den Pankreasabszess verursachen. Eine enterale Sondenernäh-rung, die über eine tief liegende Dünndarmsonde oder, nach neuesten Studien, mit gleicher Effektivität auch über eine Magensonde verabreicht wird, wirkt der Translokation entgegen und hat sich als Alternative zur parenteralen Ernährung bewährt [194 -197] Schweregrad der Pankreatitis, abhängig ist [199]. Eine Metaanalyse, die alle 3 der hierzu publizierten Studien einschließt (274 Patienten), bestätigt dieses Ergebnis [200].…”

Section: Leitlinie 1187unclassified