title: Oral refeeding after onset of acute pancreatitis: a review of literature.
abstract: BACKGROUND
  Oral refeeding in patients recovering from acute pancreatitis may cause pain relapse. Patients with pain relapse may be ill for prolonged periods, thereby consuming additional health care resources. We aimed to determine the incidence and risk factors of pain relapse on the basis of reviewing all studies on oral refeeding in acute pancreatitis.
  
  
  METHODS
  Relevant literature cited in three electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE) as well as the abstracts of major gastroenterological meetings was reviewed. Outcome measures studied were the incidence of pain relapse and length of hospital stay.
  
  
  RESULTS
  A total of three studies met the inclusion criteria. Sixty of 274 patients (21.9%) experienced pain relapse during the course of acute pancreatitis. In 47 of 60 (78.3%) patients pain relapse occurred within 48 h after commencement of oral refeeding. Two studies showed a significantly higher Balthazar's CT score on hospital admission in patients with pain relapse, whereas all three studies found no difference in the severity scores between patients with and without pain relapse. All three studies found a significant increase in the length of hospital stay in patients with pain relapse.
  
  
  CONCLUSIONS
  The incidence of pain relapse after oral refeeding in acute pancreatitis is relatively high. Thereby, the quest for new therapeutical modalities that can prevent pain relapse is of current importance.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
authors.forename: Geert A
authors.initials: GA
authors.lastname: Cirkel
authors.forename: Menno A
authors.initials: MA
authors.lastname: Brink
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D000208:Acute Disease; D004750:Enteral Nutrition / Q000009:adverse effects; D006801:Humans; D010146:Pain; D010195:Pancreatitis / Q000628:therapy*; D012008:Recurrence