Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study
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...
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| Published in: | United European gastroenterology journal Vol. 9; no. 1; pp. 54 - 62 |
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| Format: | Journal Article |
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John Wiley & Sons, Inc
01-02-2021
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| Abstract | 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. |
|---|---|
| AbstractList | 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. BACKGROUNDInability 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. OBJECTIVEWe aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. METHODSPatients 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. RESULTSOf 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. CONCLUSIONOral 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. 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. 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. 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. We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. 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. 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. 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. |
| Author | Goenka, Mahesh Kumar Thakkar, Shyam Pelaez‐Luna, Mario de‐Madaria, Enrique Nawaz, Haq Barbu, Sorin T. Lahooti, Ali Capurso, Gabriele Cote, Gregory A. Singh, Vikesh K. Zarnescu, Narcis O. Pothoulakis, Ioannis Abebe, Kaleab Ferreira, Miguel Ocampo, Carlos Wu, Bechien U. Gulla, Aiste Paragomi, Pedram Tang, Gong Triantafyllou, Konstantinos Papachristou, Georgios I. Gonzalez, Jose A. Gutierrez, Silvia C. Kochhar, Rakesh Easler, Jeffrey Talukdar, Rupjyoti Jeong, Kwonho Stevens, Tyler Phillips, Anna E. |
| AuthorAffiliation | 8 Department of Medicine Institute of Clinical Medicine Vilnius University Vilnius Lithuania 15 Department of Gastroenterology University Emergency Hospital Carol Davila University of Medicine and Pharmacy Bucharest Romania 20 Department of Gastroenterology Allegheny General Hospital Pittsburgh Pennsylvania USA 2 Department of Medicine MedStar Washington Hospital Center Washington District of Columbia USA 4 Department of Gastroenterology Asian Gastroenterology Institute Hyderabad India 18 Attikon University General Hospital Athens Greece 14 Department of Gastroenterology Hospital Nacional “Profesor Alejandro Posadas” Buenos Aires Argentina 6 Department of Gastroenterology Apollo Gleneagles Hospitals Kolkata India 19 Department of Gastroenterology Instituto Nacional de Ciencias Módicas y Nutrición Salvador Zubirán‐Universidad Autonoma d Mexico Mexico City Mexico 17 Department of Gastroenterology Indiana University School of Medicine Indianapolis Indiana USA 1 Department of Gastroenterology Univer |
| AuthorAffiliation_xml | – name: 20 Department of Gastroenterology Allegheny General Hospital Pittsburgh Pennsylvania USA – name: 6 Department of Gastroenterology Apollo Gleneagles Hospitals Kolkata India – name: 21 Department of Surgery Hospital General de Argudos “Dr. Cosme Argerich” Buenos Aires Argentina – name: 10 Department of Gastroenterology Universidad Autonoma de Nueva León Monterrey Mexico – name: 13 Department of Gastroenterology Cleveland Clinic Foundation Cleveland Ohio USA – name: 1 Department of Gastroenterology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA – name: 11 Department of Gastroenterology Hospital Nacional de Itaguá Itagua Paraguay – name: 25 Department of Gastroenterology Ohio State University Wexner Medical Center Columbus Ohio USA – name: 3 Department of Gastroenterology Eastern Maine Medical Center Bangor Maine USA – name: 16 Pancreato‐Biliary Endoscopy and Endosonography Division Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Milan Italy – name: 8 Department of Medicine Institute of Clinical Medicine Vilnius University Vilnius Lithuania – name: 17 Department of Gastroenterology Indiana University School of Medicine Indianapolis Indiana USA – name: 18 Attikon University General Hospital Athens Greece – name: 19 Department of Gastroenterology Instituto Nacional de Ciencias Módicas y Nutrición Salvador Zubirán‐Universidad Autonoma d Mexico Mexico City Mexico – name: 23 Department of Gastroenterology Kaiser Permanente Pasadena California USA – name: 7 Department of Gastroenterology Georgetown University Hospital Washington District of Columbia USA – name: 9 Department of Gastroenterology John Hopkins Medical Institution Baltimore Maryland USA – name: 24 Department of Gastroenterology Medical University of South Carolina Charleston South Carolina USA – name: 22 Gastroenterology Department Alicante University General Hospital Alicante Institute for Health and Biomedical Research (ISABIAL) Alicante Spain – name: 14 Department of Gastroenterology Hospital Nacional “Profesor Alejandro Posadas” Buenos Aires Argentina – name: 4 Department of Gastroenterology Asian Gastroenterology Institute Hyderabad India – name: 2 Department of Medicine MedStar Washington Hospital Center Washington District of Columbia USA – name: 5 Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India – name: 12 Department of Surgery University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj‐Napoca Romania – name: 15 Department of Gastroenterology University Emergency Hospital Carol Davila University of Medicine and Pharmacy Bucharest Romania |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32883182$$D View this record in MEDLINE/PubMed |
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| Keywords | predictors severity enteral feeding APPRENTICE acute pancreatitis intolerance oral feeding diet prognosis |
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| Snippet | Background
Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with... Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical... Current knowledge on this subject Oral feeding intolerance is a relatively common complication of acute pancreatitis. Oral feeding intolerance results in... Background Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with... BACKGROUNDInability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse... |
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| SubjectTerms | 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 |
| Title | Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study |
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