Bowel rest or early feeding for acute pancreatitis


Clinical question: When should you start enteral feedings in patients with acute pancreatitis?

Background: Oral intake stimulates pancreatic exocrine activity and therefore bowel rest has been one of the mainstays of acute pancreatitis treatment. However, some studies suggest that enteral nutrition may reduce the risk of infection by supporting the gut’s protective barrier limiting bacterial translocation and sepsis. Studies thus far comparing early versus delayed enteral nutrition in acute pancreatitis have been conflicting.

Study design: Systematic review.

Setting: Europe, New Zealand, United States, and China.

Synopsis: Study authors attempted to compare the length of hospital stay, mortality, and readmission in hospitalized patients with acute pancreatitis who received early versus delayed feeding. The authors searched for randomized clinical trials that compared early feeding (less than 48 hours after hospitalization) versus delayed feeding (more than 48 hours after hospitalization).

The authors found and analyzed 11 randomized trials comprising 948 patients in which early and delayed feeding strategies were compared. Their review suggests that early feeding in patients with acute pancreatitis is not associated with increased adverse events and may reduce length of hospital stay. Their analysis was limited by markedly different feeding protocols that precluded performing a meta-analysis. Their analysis was also limited by including studies that had high risk or unclear risk of bias and by the small size of most trials limiting power to detect differences in outcome.

Bottom line: Optimal route and timing of nutrition in patients with acute pancreatitis remains unsettled.

Citation: Vaughn VM, Shuster D, Rogers MAM, et al. Early versus delayed feeding in patients with acute pancreatitis: a systematic review. Ann Intern Med. 2017;166(12):883-92.

Dr. Teixeira is a hospitalist at Ochsner Health System, New Orleans.

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