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A Shift Toward Early Oral Feeding in Acute Pancreatitis
Tarek Nammour1, Alice A Lee, Julia McNabb-Baltar
1From the Center for Pancreatic Disease, Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Insights
Early oral feeding for acute pancreatitis (AP) increased after 2018 American Gastroenterological Association (AGA) guidelines. Delayed feeding was linked to opioid use, pancreatic necrosis, and organ failure.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Internal Medicine
Background:
- The 2018 American Gastroenterological Association (AGA) guidelines advocate for early oral feeding in acute pancreatitis (AP).
- Assessing adherence to these guidelines is crucial for optimizing patient care.
- Previous practices may not have fully aligned with recommended early feeding protocols.
Purpose of the Study:
- To compare early oral feeding rates in acute pancreatitis patients before and after the 2018 AGA guideline publication.
- To evaluate the impact of the AGA guidelines on clinical practice regarding AP management.
- To identify factors influencing the initiation of early oral feeding in AP patients.
Main Methods:
- Retrospective cohort study design.
- Inclusion of acute pancreatitis patients presenting to the emergency department.
- Definition of early oral feeding as diet initiation within 48 hours of presentation.
Main Results:
- A significant increase in early oral feeding rates was observed post-guideline publication (70.2% vs. 43.5%).
- Initiation of solid diet also increased in the post-guideline period (34.6% vs. 20.3%).
- Independent predictors of delayed feeding included early opioid use, pancreatic necrosis, and organ failure.
Conclusions:
- Publication of the AGA guidelines correlated with increased early oral feeding for acute pancreatitis.
- Early opioid analgesics, pancreatic necrosis, and organ failure are associated with delayed oral feeding.
- Adherence to early feeding recommendations improved following guideline dissemination.
Objectives:
The 2018 American Gastroenterological Association (AGA) guidelines strongly recommended early oral feeding as tolerated in patients with acute pancreatitis (AP). We compare early oral feeding rates in AP patients hospitalized in the periods before (2013-2016, Period A) and after (2019-2020, Period B) publication of the AGA guidelines, hypothesizing increased adherence in Period B.
Methods:
We performed a retrospective cohort study of AP patients presenting to the emergency department during each period. Early oral feeding was defined as diet initiation within the first 48 hours of presentation.
Results:
The cohort included 276 AP cases in period A and 104 in period B. A higher percentage of patients were offered early oral feeding during period B as compared to period A (70.2% vs. 43.5%). Similarly, more patients in period B were started on solid diet as compared to period A (34.6% vs. 20.3%). On multivariable regression analysis, the independent predictors of delayed oral feeding included early opioid analgesics use (OR 0.37), presence of pancreatic necrosis (OR 0.14), and organ failure (OR 0.33).
Conclusions:
More AP patients were initiated on early oral feeding in the period following the publication of the AGA guidelines. Opioid analgesics use, pancreatic necrosis, and organ failure were associated with delayed oral feeding.
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