title: Oral refeeding in patients with mild acute pancreatitis: prevalence and risk factors of relapsing abdominal pain.
abstract: OBJECTIVE
  In acute pancreatitis (AP), oral refeeding may stimulate pancreatic secretion, increasing the inflammation of the glandular tissue causing relapse of abdominal pain or even exacerbation of the disease. This study aimed to assess the prevalence and risk factors of abdominal pain relapse over oral refeeding in patients convalescing with AP as well as the impact of pain recurrence on the hospital stay.
  
  
  METHODS
  Inclusion criteria were AP confirmed by biochemical and/or radiological data in the absence of severe disease or extensive necrosis. The same diet was offered to all patients during oral refeeding. Demographic, clinical, biochemical and radiological data were prospectively recorded and analyzed.
  
  
  RESULTS
  A total of 130 patients were included. During the oral refeeding period, 32 (24.6%) patients had pain relapse, which was more common on days 1 (68.8%) and 2 (28.1%). Pain relapse was related to higher serum levels of lipase on the day before refeeding, higher serum levels of C-reactive protein on the fourth day, and presence of peripancreatic fluid collections (P < 0.01). Pain relapse significantly increased total hospital stay (P < 0.01).
  
  
  CONCLUSIONS
  In patients with mild AP, pain relapse during oral refeeding was relatively high (24.6%), particularly on the first or second day. Their risk appeared be associated with more intense or persistent pancreatic inflammation on the day before refeeding, and presence of peripancreatic fluid collections. Pain relapse increased hospital stay, and likely overall costs on disease treatment.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University Hospital of the Federal University of Juiz de Fora, Minas Gerais, Brazil. chebli@globo.com
authors.forename: Julio Maria Fonseca
authors.initials: JM
authors.lastname: Chebli
authors.forename: Pedro Duarte
authors.initials: PD
authors.lastname: Gaburri
authors.forename: Aécio Flávio Meirelles
authors.initials: AF
authors.lastname: De Souza
authors.forename: Elson Vidal Martins
authors.initials: EV
authors.lastname: Junior
authors.forename: Ana Karla
authors.initials: AK
authors.lastname: Gaburri
authors.forename: Guilherme Eduardo Gonçalves
authors.initials: GE
authors.lastname: Felga
authors.forename: Eliane Aparecida
authors.initials: EA
authors.lastname: De Paula
authors.forename: Cecília Ganimi
authors.initials: CG
authors.lastname: Forn
authors.forename: Gerusa Vilela
authors.initials: GV
authors.lastname: De Almeida
authors.forename: Flavia
authors.initials: F
authors.lastname: De Castro Nehme
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D004435:Eating; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism; D010195:Pancreatitis / Q000150:complications*; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors