title: Early nasogastric tube feeding versus nil per os in mild to moderate acute pancreatitis: a randomized controlled trial.
abstract: OBJECTIVE
  Nasojejunal tube feeding is a standard of care in patients with predicted severe acute pancreatitis (AP) and several recent trials suggested that nasogastric tube feeding (NGT) is as safe and efficient as nasojejunal tube feeding in these patients. The aim was to investigate whether NGT presents any benefit to patients with mild to moderate AP.
  
  
  METHODS
  The study design was a randomized controlled trial. The patients in the intervention group received NGT within 24 h of hospital admission. The patients in the control group were on nil per os (NPO). The severity of acute pancreatitis was determined according to the new international multidisciplinary classification.
  
  
  RESULTS
  There were 17 patients randomly allocated to the NGT group and 18 to the NPO group. The visual analogue pain score decreased to a significantly greater extent in the NGT group (from median 9 (range 7-9) at baseline to 1 (0-3) at 72 h after randomization) compared with the NPO group (from 7 (5-9) to 3 (1-4) (p = 0.036). The number of patients not requiring opiates at 48 h after randomization was significantly different (p = 0.024) between NGT (9/17) and NPO (3/18). Oral food intolerance was observed in 1/17 patient in the NGT group and 9/18 patients in the NPO group (p = 0.004). The overall hospital stay in the NGT group was 9 (5-12) days as compared with 8.5 (6-13) days in the NPO group (p = 0.91).
  
  
  CONCLUSIONS
  NGT commenced within 24 h of hospital admission is well tolerated in patients with mild to moderate acute pancreatitis. Further, when compared with NPO, it significantly reduces the intensity and duration of abdominal pain, need for opiates, and risk of oral food intolerance, but not overall hospital stay.
authors: Department of Surgery, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Electronic address: max.petrov@gmail.com.
authors: Maxim S
authors: MS
authors: Petrov
authors: Kerry
authors: K
authors: McIlroy
authors: Lorraine
authors: L
authors: Grayson
authors: Anthony R J
authors: AR
authors: Phillips
authors: John A
authors: JA
authors: Windsor
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000517:prevention & control*; D000208:Acute Disease; D000328:Adult; D018450:Disease Progression; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010147:Pain Measurement; D010195:Pancreatitis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D009294:Narcotics
keywords: Abdominal pain; Acute pancreatitis; Nasogastric feeding; Oral food intolerance; Pancreas rest