Clinical Pancreatology for Practising Gastroenterologists and Surgeons. Группа авторов
Moreover, it is important to keep in mind that many patients experience gastrointestinal symptoms after refeeding. In the study published by our group, up to 53% of all patients experienced gastrointestinal symptoms after refeeding. These were mainly meteorism and postprandial fullness of mild degree that only led to refeeding cessation in three cases. Abdominal pain was registered in 21 of 72 (29%) patients, but was severe enough to interrupt refeeding in only 4 of 72 (5.6%) cases (two of whom had signs of relapse of AP) [11].
Summary and Recommendations
The most recent and robust evidence supports early oral refeeding in mild AP. It is recommended that patients with AP should initially be kept nil by mouth after admission, while initial fluid resuscitation and intravenous analgesia is being administered. Once intestinal peristalsis recovers, as demonstrated by the presence of bowel sounds, initiation of refeeding is safe and generally well tolerated. A stepwise increase of caloric and fat content is usually not needed, but it should be considered in some patients, mainly in those with moderate or severe AP.
References
1 1 Meier R, Beglinger C, Layer P, et al. ESPEN guidelines on nutrition in acute pancreatitis. Clin Nutr 2002; 21:173–183.
2 2 Eckerwall GE, Tingstedt BB, Bergenzaun PE, Andersson RG. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery: a randomized clinical study. Clin Nutr 2007; 26:758–763.
3 3 Teich N, Aghdassi A, Fischer J, et al. Optimal timing of oral refeeding in mild acute pancreatitis: results of an open randomized multicentre trial. Pancreas 2010; 39:1088–1092.
4 4 Rajkumar N, Karthikeyan VS, Ali SM, et al. Clear liquid diet vs soft diet as the initial meal in patients with mild acute pancreatitis: a randomized interventional trial. Nutr Clin Pract 2013; 28:365–370.
5 5 Jacobson BC, Vander Vliet MB, Hughes MD, et al. A prospective, randomized trial of clear liquids versus low‐fat solid diet as the initial meal in mild acute pancreatitis. Clin Gastroenterol Hepatol 2007; 5:946–951. quiz 886.
6 6 Moraes JM, Felga GE, Chebli LA, et al. A full solid diet as the initial meal in mild acute pancreatitis is safe and results in a shorter length of hospitalization: results from a prospective, randomized, controlled, double‐blind clinical trial. J Clin Gastroenterol 2010; 44:517–522.
7 7 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; 28:777–781.
8 8 Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013; 108:1400–1415; 1416.
9 9 Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence‐based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13(4 Suppl 2):e1–e15.
10 10 Vege S, Di Magno MJ, Forsmark C, et al. Initial medical treatment of acute pancreatitis: American Gastroenterological Association Institute Technical Review. Gastroenterology 2018; 154:1103–1139.
11 11 Lariño‐Noia J, Lindkvist B, Iglesias‐García J, et al. Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: a randomized open label trial. Pancreatology 2014; 14:167–173.
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