Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study

• Published in: United European gastroenterology journal Vol. 9; no. 1; pp. 54 - 62
• Main Authors: Pothoulakis, Ioannis, Nawaz, Haq, Paragomi, Pedram, Jeong, Kwonho, Talukdar, Rupjyoti, Kochhar, Rakesh, Goenka, Mahesh Kumar, Gulla, Aiste, Singh, Vikesh K., Gonzalez, Jose A., Ferreira, Miguel, Barbu, Sorin T., Stevens, Tyler, Gutierrez, Silvia C., Zarnescu, Narcis O., Capurso, Gabriele, Easler, Jeffrey, Triantafyllou, Konstantinos, Pelaez‐Luna, Mario, Thakkar, Shyam, Ocampo, Carlos, de‐Madaria, Enrique, Wu, Bechien U., Cote, Gregory A., Abebe, Kaleab, Tang, Gong, Lahooti, Ali, Phillips, Anna E., Papachristou, Georgios I.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-02-2021; John Wiley and Sons Inc
• Subjects: Abdomen; Abdominal Pain - etiology; acute pancreatitis; Adult; Age Factors; Alcohol; Alcohol Drinking - adverse effects; APPRENTICE; Blood Urea Nitrogen; Clinical outcomes; Demographics; diet; Eating; Endoscopy; enteral feeding; Etiology; Female; Food Intolerance - etiology; Gender; Hematocrit; Hospitalization; Humans; intolerance; Length of Stay; Male; Middle Aged; Necrosis; Nutrition research; oral feeding; Original; Ostomy; Pancreas; Pancreatitis; Pancreatitis - complications; Parenteral nutrition; Patients; predictors; prognosis; Prospective Studies; Regression Analysis; Risk Factors; ROC Curve; severity; Sex Factors; Smoking - adverse effects; Statistical analysis; Vomiting - etiology; predictors; severity; enteral feeding; APPRENTICE; acute pancreatitis; intolerance; oral feeding; diet; prognosis
• ISSN: 2050-6406; 2050-6414
• DOI: 10.1177/2050640620957243

Background
Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied.
Objective
We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis.
Methods
Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience, an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance.
Results
Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day (p = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%), and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dl; p < 0.001) and hematocrit levels (41.7% vs. 40.5%; p = 0.017) on admission; were more likely to have a nonbiliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 h (50% vs. 26%), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%), and have a longer hospital stay (10 vs. 6 days; all p < 0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 h (odds ratio 3.10; 95% confidence interval 1.83–5.25) and a nonbiliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01–2.69) were independent risk factors for oral feeding intolerance.
Conclusion
Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 h and a nonbiliary etiology.
Key Summary
Current knowledge on this subject
Oral feeding intolerance is a relatively common complication of acute pancreatitis.
Oral feeding intolerance results in longer hospitalization and frequent readmissions.
What is new in this study
The incidence of oral feeding intolerance is similar irrespective of the timing of the initial feeding attempt.
Oral feeding intolerance is independently associated with systemic inflammatory response syndrome at 48 h and nonbiliary etiology.