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Evid Based Nurs 12:22 doi:10.1136/ebn.12.1.22
  • Treatment

Initial refeeding with a soft diet was better than a clear liquid diet for length of hospital stay in mild acute pancreatitis

E Sathiaraj

Ms E Sathiaraj, Asian Institute of Gastroenterology, Hyderabad, India; esther.sathiaraj{at}gmail.com

QUESTION

In patients with mild acute pancreatitis, is resumption of oral feeding with a soft diet better than a clear liquid diet for reducing length of hospital stay?

METHODS

Design:

randomised controlled trial.

Allocation:

{concealed}.*

Blinding:

blinded {patients and data analysts}.*

Follow-up period:

until hospital discharge.

Setting:

Asian Institute of Gastroenterology, India.

Patients:

101 patients (mean age 38 y, 82% men) who had mild acute pancreatitis (absence of pancreatic necrosis, abscess and pseudocyst, organ dysfunction, hypotension [systolic blood pressure <90 mm Hg], and hypoxaemia [oxygen saturation <90%]), were admitted to hospital with abdominal pain, and had amylase or lipase >3 times the upper limit of normal or >2 times the upper limit of normal and a computerised tomography scan showing unequivocal acute pancreatitis and peripancreatic inflammation. Exclusion criteria included neoplasm, pregnancy, infection (eg, tuberculosis, HIV/AIDS), acute on chronic pancreatitis if on enzyme supplementation, and postsurgical patients or those receiving enteral support or parenteral nutrition and narcotics for abdominal pain on day of refeeding.

Intervention:

soft diet (n = 49) or clear liquid diet progressing to a soft diet when clear liquids were tolerated (n = 52) for resumption of oral feeding.

Outcomes:

length of hospital stay from resumption of oral feeding to discharge. Secondary outcomes included length of hospital stay from admission to discharge and discontinuation of oral feeding for intolerance.

Patient follow-up:

{100%}.*

MAIN RESULTS

Patients allocated to a soft diet had shorter hospital stays than those allocated to a clear liquid diet (table). Groups did not differ for discontinuation of oral feeding because of pain (p = 0.85) or nausea or vomiting (p = 0.12).

Soft diet v clear liquid diet for resumption of oral feeding in patients with mild acute pancreatitis*

CONCLUSION

In patients with mild acute pancreatitis who were resuming oral feeding, a soft diet reduced length of hospital stay more than a clear liquid diet.

*Information provided by author.

ABSTRACTED FROM

Sathiaraj E, Murthy S, Mansard MJ, et al. Clinical trial: oral feeding with a soft diet compared with clear liquid diet as initial meal in mild acute pancreatitis. Aliment Pharmacol Ther 2008;28:777–81.

Clinical impact rating: General/internal medicine 7/7

Footnotes

  • Source of funding: no external funding.

Commentary

Enteral feeding is better than parenteral feeding for moderating the stress response, improving outcomes, and supporting rapid resolution of pancreatitis.1 Recent research has shown that enteral feeding is also well tolerated and safe2 and decreases transluminal infection and the need for surgery.3

Currently, the standard approach to care is to rest the gut for >24 hours, then introduce a clear fluid diet that graduates to a solid diet over a few days. This approach leads to undernutrition over extended periods of time and is based on historical practice.

In 2007, Jacobson et al4 reported no differences in pain, length of hospital stay, or readmission rates in patients with mild acute pancreatitis who were fed a low-fat solid diet compared with those who received a clear fluid diet. In addition, the solid diet delivered more calories. Sathiaraj et al reported similar findings but also observed a reduction in length of hospital stay with solid diet initiation. However, they did not evaluate readmission rates.

The preliminary evidence provided by Sathiaraj et al—that initial feeding with a soft diet is safe and decreases length of hospital stay—is important. Such a change in clinical practice would be simple, easy to implement, and would improve both nutritional content and palatability for patients.

References

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