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Return to normal diet OK in mild pancreatitis.

PHILADELPHIA -- An early return to a normal diet was not harmful and might even have expedited the hospital discharge of patients with mild, acute pancreatitis in a randomized, prospective study with 62 patients.

"Early feeding appears safe and may lead to reduced emotional and financial costs," Dr. Nison L. Badalov said at the annual meeting of the American College of Gastroenterology.

"The dogma has been that stimulating the pancreas [by a usual, oral diet] leads to enzyme secretion and complications" of pancreatitis, which has led to a standard approach of "resting the pancreas" by relying on parenteral nutrition and intravenous hydration, said Dr. Badalov, a gastroenterologist at Maimonides Medical Center in New York. But the potential benefits of an early return to oral feeding, such as stimulated bowel function and reductions in both systemic inflammation and bacterial overgrowth, led to the idea of restarting patients on oral nutrition as soon as possible.

Dr. Badalov and his associates randomized consecutive patients with mild, acute pancreatitis seen at Maimonides during September 2006-September 2007 to three different feeding strategies. The patients' average age was about 55 years.

Patients were diagnosed with acute pancreatitis by meeting at least two of these three criteria: pain consistent with pancreatitis, an imaging study (such as CT) that confirmed the diagnosis, and a serum amylase level of more than three times the upper limit of normal.

Mild pancreatitis was defined as having a Ranson score of less than 3, and an acute physiology and chronic health evaluation (APACHE) II score of less than 8, with no evidence of organ dysfunction or pancreatic necrosis at admission.

Consenting patients were placed on either a nothing-by-mouth (NPO) regimen, a semi-elemental formula as tolerated within 12 hours of admission, or a regular diet as tolerated within 12 hours of admission.

There were no significant differences in the rates of narcotic use, organ failure, pancreatic necrosis, or multisystem organ failure among the three groups.

But there was a significant difference in the median duration of hospitalization between the NPO and regular diet groups: The median length of stay was 3.1 days among the 22 patients who were quickly placed on a regular diet, compared with 5.8 days among 22 patients who were NPO, Dr. Badalov reported. The 18 patients treated with semi-elemental formula had a median length of stay of 3.9 days, which was not significantly different from the other two groups.

BY MITCHEL L. ZOLER Philadelphia Bureau
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Article Details
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Title Annotation:Gastroenterology
Author:Zoler, Mitchel L.
Publication:Internal Medicine News
Article Type:Report
Geographic Code:1USA
Date:May 1, 2008
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