Abstract
BackgroundThe aim of the study was to compare the onset of oral feeding in the first 24 h after hospital admission with usual oral refeeding and determine whether the timing of the onset of oral feeding influences the recurrence of pain or alters the blood levels of pancreatic enzymes in patients with predicted mild acute biliary pancreatitis.MethodsThis non-inferiority randomized controlled trial was carried out between September 2018 and June 2019 after receiving authorization from the ethics committee for health research. Patients with a diagnosis of predicted mild acute biliary pancreatitis were divided into Group A (early oral refeeding, EOR) and Group B (usual oral refeeding, UOR). Outcome measures included pancreatic lipase levels, the systemic inflammatory response (concentrations of leukocytes), feasibility (evaluated by abdominal pain recurrence), the presence and recurrence of gastrointestinal symptoms and the length of hospital stay.ResultsTwo patients in the EOR group experienced pain relapse (3.2%), and four patients in the UOR group experienced pain relapse (6.77%) after oral refeeding (p = 0.379). The presence of nausea or vomiting after the onset of oral refeeding was not different between the two groups (p = 0.293). The onset of oral refeeding was approximately 48 h later in the UOR group. The length of hospital stay was 5 days in the EOR group and 8 days in the UOR group (p = 0.042), and this difference was also manifested in higher hospital costs in the UOR group (p = 0.0235).ConclusionCompared with usual oral refeeding, early oral refeeding is safe in predicted mild acute biliary pancreatitis patients, does not cause adverse gastrointestinal events, and reduces the length of hospital stay and costs.Trial registrationEarly oral refeeding in mild acute pancreatitis (EORVsUOR). NCT04168801, retrospectively registered (November 19, 2019).
Highlights
The aim of the study was to compare the onset of oral feeding in the first 24 h after hospital admission with usual oral refeeding and determine whether the timing of the onset of oral feeding influences the recurrence of pain or alters the blood levels of pancreatic enzymes in patients with predicted mild acute biliary pancreatitis
All patients admitted to the Surgery Department with a diagnosis of biliary acute pancreatitis (BAP), with a predicted mild episode severity based on the criteria and a symptom onset time less than 24 h, were screened for inclusion in the study
Three patients in the Usual oral refeeding (UOR) group were excluded because one patient had no improvement in pain; computed tomography was performed, and peripancreatic collections were identified
Summary
The aim of the study was to compare the onset of oral feeding in the first 24 h after hospital admission with usual oral refeeding and determine whether the timing of the onset of oral feeding influences the recurrence of pain or alters the blood levels of pancreatic enzymes in patients with predicted mild acute biliary pancreatitis. The published IAP/APA guidelines recommended that oral feeding in patients with predicted mild pancreatitis can be restarted once abdominal pain has decreased and the levels of inflammatory markers have improved 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; it is clear that early oral refeeding (OR) for mild PA provides adequate caloric intake and may improve clinical outcomes. It has been hypothesized that the combination of disturbed intestinal motility, microbial overgrowth and increased permeability of the gut can lead to bacterial translocation, causing infection and pancreatic necrosis [9, 10]
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