Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: a randomized open-label trial.
Refeeding after acute pancreatitis (AP) is traditionally started in a successively increasing manner when abdominal pain is absent and pancreatic enzymes are decreasing. We aimed to evaluate length of hospital stay (LOHS) and refeeding tolerance for early refeeding and/or immediately full caloric intake in patients recovering from AP.


METHODS
In this randomized, open-label trial, patients with AP were randomized into four different refeeding protocols. Group 1 and 2 received a stepwise increasing diet during three days while 3 and 4 received an immediately full caloric, low fat diet. Group 2 and 4 started refeeding early (once bowel sounds returned) and 1 and 3 started at standard time (bowel sounds present, no abdominal pain, no fever, leucocytes and pancreatic enzymes decreasing). Main outcomes measurements were LOHS and tolerance (ability to ingest >50% of meals without severe pain, nausea or AP relapse).


RESULTS
Eighty patients were evaluated and 72 randomized (median age 60 years, range 24-85, 33 male). LOHS was significantly reduced after early refeeding (median 5 versus 7 days (p = 0.001)) but not in patients receiving immediately full caloric diet, compared to standard management (6 versus 6 days (p = 0.12)). There was no difference in refeeding tolerance comparing immediately full caloric diet versus stepwise increasing diet (31/35 (89%) versus 33/37 (89%) patients tolerating the treatment, p = 1.00) or early versus standard time for refeeding (33/37 (89%) versus 31/35 (89%), (p = 1.00)).


CONCLUSIONS
Refeeding after AP when bowel sounds are present with immediately full caloric diet is safe and well tolerated. Early refeeding shortens LOHS.
Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain. Electronic address: jlarnoi1976@hotmail.com.
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Lariño-Noia
Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Lindkvist
Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain.
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J
Iglesias-García
Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain.
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Seijo-Ríos
Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain.
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J
Iglesias-Canle
Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain.
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Domínguez-Muñoz
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018752:Diet, Fat-Restricted / Q000379:methods*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
Acute pancreatitis; Length of hospital stay; Oral refeeding; Treatment