[Digestive refeeding in acute pancreatitis. When and how?].
BACKGROUND
Digestive refeeding in acute pancreatitis represent a difficult issue. It requires the resolution of intestinal ileus and carries a risk of reactivation.


OBJECTIVE
To evaluate criteria that may guide in early refeeding avoiding unnecessary prolonged fasting.


METHODS
Thirty patients with acute pancreatitis were evaluated in a prospective trial. The severity of the pancreatitis was evaluated according to APACHE II score and Balthazar CT scan alterations. The criteria proposed to start early refeeding were absence of nausea and vomiting, decreased abdominal pain, presence of bowel sounds and lowering of serum amylase levels. Balthazar CT scan classification, was used to decide between oral or enteral refeeding.


RESULTS
Eighty percent of patients had alterations in pancreatic density, necrosis or pancreatic or peripancreatic liquid collections in the CT scan (corresponding to Balthazar stages C, D, or E). Ten patients fullfilled the criteria for enteral refeeding at 8.1 +/- 3.5 days (range 3 to 15 days), and 21 patients fulfilled criteria fo enteral refeeding at 8.7 +/- 4.5 (range 4-19). No patient had a reactivation of his pancreatitis.


CONCLUSIONS
Digestive refeeding can be done safely by using the criteria proposed in this study. Pancreatic necrosis or peripancreatic fluid collections do not contraindicate refeeding. Oral feeding may be employed (as the first option) in selected patients, without increasing the risk of complication, regardless of CT scan alterations of the pancreas.
Papapietro
K
K
Unidad de Nutrición Intensiva, Departamento de Cirugía y Centro de Gastroenterología Hospital Clínico de la Universidad de Chile.
Marin
M
M
Díaz
E
E
Watkins
G
G
Berger
Z
Z
Rappoport
J
J
D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000681:Amylases / Q000097:blood; D004750:Enteral Nutrition; D005248:Feeding Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000681:Amylases