A randomized trial of oral refeeding compared with jejunal tube refeeding in acute pancreatitis.
BACKGROUND
Relapse of pain during refeeding in acute pancreatitis may have a relation to the route of refeeding.


OBJECTIVE
To compare the efficacy of oral refeeding with jejunal tube refeeding in patients with acute pancreatitis, and determine the frequency of refeeding pain and factors associated with it.


METHODS
Consecutive patients with acute pancreatitis, severe enough to stop oral feeding for 48 hours, were randomized to receive either oral or jejunal tube refeeding. The feeds were similar in calorie, lipid and protein content (400 Kcal on day 1, 1000 Kcal on day 2, 1400 Kcal on day 3, 1500 Kcal on day 4, and 1700 Kcal on day 5). Clinical and biological factors (serum amylase, lipase, C-reactive protein) and Balthazar CT severity index were recorded. Frequency of pain relapse and factors associated with it were analyzed.


RESULTS
28 patients with acute pancreatitis (biliary 14, alcohol 9, idiopathic 3, post-ERCP 2) were included. Fifteen patients received oral and 13 received enteral tube refeeding. Four patients in the oral group and none in the enteral tube group had relapse of pain (p=0.06). The factors associated with refeeding pain were longer duration of initial pain (p<0.02) and higher CT severity index (p<0.02). Pain relapse increased the total hospital stay (p<0.004) and hospital stay after the first attempt at feeding (p<0.001).


CONCLUSIONS
Jejunal tube refeeding may reduce the frequency of pain relapse as compared to oral refeeding although the difference was not significant in this study. Longer duration of pain and higher CT severity index score were associated with occurrence of refeeding pain.
Pandey
Sandeep Kumar
SK
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110 029.
Ahuja
Vineet
V
Joshi
Y K
YK
Sharma
M P
MP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum; D008297:Male; D008875:Middle Aged; D009747:Nutritional Physiological Phenomena; D010147:Pain Measurement; D010186:Pancreatic Function Tests; D010195:Pancreatitis / Q000175:diagnosis / Q000628:therapy*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome