Incidence and risk factors of oral feeding intolerance in acute pancreatitis: results from an international, multicenter, prospective cohort study

Ioannis Pothoulakis, Haq Nawaz, Pedram Paragomi, Kwonho Jeong, Rupjyoti Talukdar, Rakesh Kochhar, Mahesh Kumar Goenka, Aiste Gulla, Vikesh K. Singh, Jose A. Gonzalez, Miguel Ferreira, Sorin T. Barbu, Tyler Stevens, Silvia C. Gutierrez, Narcis O. Zarnescu, Gabriele Capurso, Jeffrey Easler, Konstantinos Triantafyllou, Mario Pelaez-Luna, Shyam ThakkarCarlos Ocampo, Enrique de-Madaria, Bechien U. Wu, Gregory A. Cote, Kaleab Abebe, Gong Tang, Ali Lahooti, Anna E. Phillips, Georgios I. Papachristou

Research output: Contribution to journalArticlepeer-review

Abstract

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 (APPRENTICE), 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 non-biliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 hours (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 hours (odds ratio 3.10; 95% confidence interval 1.83–5.25) and a non-biliary 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 hours and a non-biliary etiology.

Original languageEnglish (US)
JournalUnited European Gastroenterology Journal
DOIs
StateAccepted/In press - 2020

Keywords

  • APPRENTICE
  • Enteral feeding
  • acute pancreatitis
  • diet
  • intolerance
  • oral feeding
  • predictors
  • prognosis
  • severity

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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