In the Journals

Early feeding may improve outcomes in patients with acute pancreatitis

Limited evidence suggests that early enteral feeding for patients hospitalized with mild-to-moderate acute pancreatitis may reduce length of hospital stay and gastrointestinal symptoms, compared with delayed feeding, according to data published in Annals of Internal Medicine.

“Acute pancreatitis is among the most common and costly reasons for hospitalization in the United States,” Valerie M. Vaughn, MD, MSc, from Michigan Medicine and VA Ann Arbor Health System, and colleagues wrote.

According to the researchers, various reviews have found that enteral feeding in patients with acute pancreatitis may reduce length of hospital stay when given early; however, despite these findings, there is still uncertainty regarding whether to feed patients during active inflammation or to delay feeding until inflammation has subsided. Furthermore, current guidelines are unclear and inconsistent, they added.

Vaughn and colleagues conducted a systematic review to compare length of hospital stay, mortality and readmission following early vs. delayed enteral feeding ( 48 hours vs. > 48 hours after hospitalization) in adults with pancreatitis. They identified 11 eligible randomized clinical trials that included 948 patients hospitalized with pancreatitis. Study data and risk of bias were extracted and rated using the Cochrane Collaboration tool. Patients with mild-to-moderate pancreatitis were enrolled in seven trials, while patients with predicted severe pancreatitis were enrolled in four trials. The studies used oral (4 studies), nasogastric (2 studies), nasojejunal (4 studies) and oral or nasoenteric (1 study) routes for early feeding.

In four of seven studies, early enteral feeding reduced length of stay among patients with mild-to-moderate pancreatitis. In three studies, patients who were randomized to receive early feeding showed fewer gastrointestinal symptoms, such as feeding intolerance, nausea and abdominal pain. Although protocols and outcomes of each study varied, there were no reports of increased adverse events or worsening of symptoms related to early feeding regardless of disease severity. However, among patients with severe pancreatitis, outcomes of early and delayed feeding did not significantly differ.

“Early feeding for patients with mild-to-moderate acute pancreatitis does not seem to be associated with adverse events and may reduce length of hospital stay and gastrointestinal symptoms,” Vaughn and colleagues concluded. “However, limitations, including the sample size of included studies, variation in outcomes and protocols, and unclear or high risk of bias, limit generalizability. Further studies evaluating the optimal timing and method of feeding are necessary.”

In an accompanying editorial, Kristen M. Roberts, PhD, RD, LD, and Darwin Conwell, MD, both from the Ohio State University, warn that the conclusion of Vaughn and colleagues’ review should be considered with caution.

They noted that enteral feeding protocols and formulas are crucial to understanding how enteral feeding affects outcomes; however, the current review did not report this information.

“Vaughn and colleagues' systematic review adds to the body of literature aimed at identifying the optimal nutritional management of patients with acute pancreatitis while highlighting the need for additional clinical trials to more clearly define the benefits of early enteral nutrition,” Roberts and Conwell concluded. – by Alaina Tedesco

Disclosures: All authors report no relevant financial disclosures.

 

Limited evidence suggests that early enteral feeding for patients hospitalized with mild-to-moderate acute pancreatitis may reduce length of hospital stay and gastrointestinal symptoms, compared with delayed feeding, according to data published in Annals of Internal Medicine.

“Acute pancreatitis is among the most common and costly reasons for hospitalization in the United States,” Valerie M. Vaughn, MD, MSc, from Michigan Medicine and VA Ann Arbor Health System, and colleagues wrote.

According to the researchers, various reviews have found that enteral feeding in patients with acute pancreatitis may reduce length of hospital stay when given early; however, despite these findings, there is still uncertainty regarding whether to feed patients during active inflammation or to delay feeding until inflammation has subsided. Furthermore, current guidelines are unclear and inconsistent, they added.

Vaughn and colleagues conducted a systematic review to compare length of hospital stay, mortality and readmission following early vs. delayed enteral feeding ( 48 hours vs. > 48 hours after hospitalization) in adults with pancreatitis. They identified 11 eligible randomized clinical trials that included 948 patients hospitalized with pancreatitis. Study data and risk of bias were extracted and rated using the Cochrane Collaboration tool. Patients with mild-to-moderate pancreatitis were enrolled in seven trials, while patients with predicted severe pancreatitis were enrolled in four trials. The studies used oral (4 studies), nasogastric (2 studies), nasojejunal (4 studies) and oral or nasoenteric (1 study) routes for early feeding.

In four of seven studies, early enteral feeding reduced length of stay among patients with mild-to-moderate pancreatitis. In three studies, patients who were randomized to receive early feeding showed fewer gastrointestinal symptoms, such as feeding intolerance, nausea and abdominal pain. Although protocols and outcomes of each study varied, there were no reports of increased adverse events or worsening of symptoms related to early feeding regardless of disease severity. However, among patients with severe pancreatitis, outcomes of early and delayed feeding did not significantly differ.

“Early feeding for patients with mild-to-moderate acute pancreatitis does not seem to be associated with adverse events and may reduce length of hospital stay and gastrointestinal symptoms,” Vaughn and colleagues concluded. “However, limitations, including the sample size of included studies, variation in outcomes and protocols, and unclear or high risk of bias, limit generalizability. Further studies evaluating the optimal timing and method of feeding are necessary.”

In an accompanying editorial, Kristen M. Roberts, PhD, RD, LD, and Darwin Conwell, MD, both from the Ohio State University, warn that the conclusion of Vaughn and colleagues’ review should be considered with caution.

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They noted that enteral feeding protocols and formulas are crucial to understanding how enteral feeding affects outcomes; however, the current review did not report this information.

“Vaughn and colleagues' systematic review adds to the body of literature aimed at identifying the optimal nutritional management of patients with acute pancreatitis while highlighting the need for additional clinical trials to more clearly define the benefits of early enteral nutrition,” Roberts and Conwell concluded. – by Alaina Tedesco

Disclosures: All authors report no relevant financial disclosures.