Oral refeeding in mild acute pancreatitis: An old challenge

Abstract

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.

Association between oral feeding intolerance and quality of life in acute pancreatitis: A prospective cohort study

“…This study also contributed to the debate in the literature about whether OFI is influenced by disease severity or is a complication of AP [1,23]. Given that the APACHE II scores on admission were similar in patients who developed and did not develop OFI (Table 1) and taking into account that statistical adjustment for severity on admission did not change the estimates significantly (Fig.…”

Non-inferiority comparative clinical trial between early oral REFEEDING and usual oral REFEEDING in predicted mild acute biliary pancreatitis

“…This recommendation is reinforced by other authors with similar clinical results [ 6 , 7 ]. Pancreatic rest by the nil per os (NPO) strategy has been considered necessary in patients with AP until the resolution of abdominal pain and decreases in the levels of pancreatic and inflammatory markers [ 8 ]. This trend has changed; now, it is clear that early oral refeeding (OR) for mild PA not only provides adequate caloric intake but also may improve clinical outcomes.…”

Efficacy of early oral refeeding in patients of mild acute pancreatitis

“… 1 Pancreatic rest by Nil Per Oral(NPO) strategy is considered necessary in AP till abdominal pain get resolved and the levels of pancreatic and inflammatory markers decrease. 2 …”