Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study.
Abdominal Pain
/ etiology
Adult
Age Factors
Alcohol Drinking
/ adverse effects
Blood Urea Nitrogen
Eating
Female
Food Intolerance
/ etiology
Hematocrit
Humans
Length of Stay
Male
Middle Aged
Pancreatitis
/ complications
Prospective Studies
ROC Curve
Regression Analysis
Risk Factors
Sex Factors
Smoking
/ adverse effects
Vomiting
/ etiology
APPRENTICE
acute pancreatitis
diet
enteral feeding
intolerance
oral feeding
predictors
prognosis
severity
Journal
United European gastroenterology journal
ISSN: 2050-6414
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
15
05
2020
accepted:
06
08
2020
pubmed:
5
9
2020
medline:
28
12
2021
entrez:
5
9
2020
Statut:
ppublish
Résumé
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.
Sections du résumé
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.
Identifiants
pubmed: 32883182
doi: 10.1177/2050640620957243
pmc: PMC8259260
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
54-62Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK123704
Pays : United States
Informations de copyright
© 2020 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.
Références
Am J Gastroenterol. 2015 Dec;110(12):1707-16
pubmed: 26553208
Clin Nutr. 2007 Dec;26(6):758-63
pubmed: 17719703
Ann Gastroenterol. 2017;30(1):106-113
pubmed: 28042246
Crit Care Med. 2014 Apr;42(4):860-7
pubmed: 24201172
Clin Gastroenterol Hepatol. 2009 Nov;7(11):1247-51
pubmed: 19686869
Am J Gastroenterol. 2006 Nov;101(11):2605-10
pubmed: 17029614
Am J Gastroenterol. 1998 Nov;93(11):2130-4
pubmed: 9820385
Clin Nutr. 2017 Jun;36(3):722-729
pubmed: 27346178
Am J Gastroenterol. 2004 Apr;99(4):731-8
pubmed: 15089909
Gut. 1997 Feb;40(2):262-6
pubmed: 9071942
Crit Care Med. 2008 Jun;36(6):1735-41
pubmed: 18520640
Nutrition. 2015 Nov-Dec;31(11-12):1379-84
pubmed: 26429659
Pancreas. 2016 Aug;45(7):997-1002
pubmed: 27101573
Clin Gastroenterol Hepatol. 2007 Aug;5(8):946-51; quiz 886
pubmed: 17613280
Pancreas. 2010 Oct;39(7):1088-92
pubmed: 20357692
Pancreas. 2012 Nov;41(8):1325-30
pubmed: 22722255
Nutrition. 2015 Jan;31(1):171-5
pubmed: 25441594
Gut. 2013 Jan;62(1):102-11
pubmed: 23100216
Nat Rev Gastroenterol Hepatol. 2010 Mar;7(3):131-45
pubmed: 20125091
Pancreas. 2000 May;20(4):367-72
pubmed: 10824690
World J Gastroenterol. 2008 Jul 28;14(28):4558-61
pubmed: 18680239
Am J Gastroenterol. 2010 Nov;105(11):2492-7
pubmed: 20531398
Clin Gastroenterol Hepatol. 2020 Jun;18(7):1567-1575.e2
pubmed: 31712075
Pancreatology. 2020 Apr;20(3):325-330
pubmed: 32107193
Gastroenterology. 2009 Jul;137(1):129-35
pubmed: 19344722
Expert Rev Gastroenterol Hepatol. 2015;9(10):1305-12
pubmed: 26289104
N Engl J Med. 2014 Nov 20;371(21):1983-93
pubmed: 25409371
World J Surg. 2007 Oct;31(10):2002-7
pubmed: 17687599
Br J Surg. 2002 Mar;89(3):298-302
pubmed: 11872053
Arch Intern Med. 2011 Apr 11;171(7):669-76
pubmed: 21482842
Pancreatology. 2014 May-Jun;14(3):167-73
pubmed: 24854611
Clin Nutr. 2013 Oct;32(5):697-703
pubmed: 23340042
Gastroenterology. 2018 Mar;154(4):1103-1139
pubmed: 29421596
J Clin Invest. 1991 Jan;87(1):362-6
pubmed: 1985109
J Gastroenterol Hepatol. 2005 Sep;20(9):1385-9
pubmed: 16105125