title: Early oral refeeding based on hunger in moderate and severe acute pancreatitis: a prospective controlled, randomized clinical trial.
abstract: OBJECTIVE
  Early enteral nutrition is beneficial for acute pancreatitis (AP), but the optimal timing and criteria remain unclear. The aim of this study was to explore the feasibility and safety of early oral refeeding (EORF) based on hunger in patients with moderate or severe AP.
  
  
  METHODS
  In a prospective, single-center, controlled, randomized clinical trial (ChiCTR-TRC-12002994), eligible patients with moderate or severe AP were randomized to either EORF or conventional oral refeeding (CORF). Patients in the EORF group restarted an oral diet when they felt hungry, regardless of laboratory parameters. Those in the CORF group restarted an oral diet only when clinical and laboratory symptoms had resolved. Clinical outcomes were compared between the two groups.
  
  
  RESULTS
  In all, 146 eligible patients with moderate or severe AP were included and randomized to the EORF (n = 70) or CORF (n = 76) group. There were eight dropouts after randomization (three in EORF group; five in CORF group). The groups had similar baseline characteristics. The total length of hospitalization (13.7 ± 5.4 d versus 15.7 ± 6.2 d; P = 0.0398) and duration of fasting (8.3 ± 3.9 d versus 10.5 ± 5.1 d; P = 0.0047) were shorter in the EORF group than in the CORF group. There was no difference in the number of adverse events or complications between the two groups. The mean blood glucose level after oral refeeding was higher in the EORF group than in the CORF group (P = 0.0030).
  
  
  CONCLUSIONS
  This controlled, randomized clinical trial confirmed the effectiveness and feasibility of EORF based on hunger in patients with moderate or severe AP. EORF could shorten the length of hospitalization in patients with moderate or severe AP.
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
authors.forename: Xian L
authors.initials: XL
authors.lastname: Zhao
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
authors.forename: Shi F
authors.initials: SF
authors.lastname: Zhu
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
authors.forename: Gui J
authors.initials: GJ
authors.lastname: Xue
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
authors.forename: Yi L
authors.initials: YL
authors.lastname: Liu
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
authors.forename: Mei H
authors.initials: MH
authors.lastname: Wan
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China; Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Xia
authors.affiliation: Pancreatic Diseases Research Group, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, PR China. Electronic address: Wftang900@gmail.com.
authors.forename: Wen F
authors.initials: WF
authors.lastname: Tang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D002149:Energy Intake; D004750:Enteral Nutrition; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D006815:Hunger; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D014280:Triglycerides; D002784:Cholesterol
keywords: Acute pancreatitis; Hunger; Length of hospitalization; Oral refeeding