Open AccessIncidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study
Author(s) -
Pothoulakis Ioannis,
Nawaz Haq,
Paragomi Pedram,
Jeong Kwonho,
Talukdar Rupjyoti,
Kochhar Rakesh,
Goenka Mahesh Kumar,
Gulla Aiste,
Singh Vikesh K.,
Gonzalez Jose A.,
Ferreira Miguel,
Barbu Sorin T.,
Stevens Tyler,
Gutierrez Silvia C.,
Zarnescu Narcis O.,
Capurso Gabriele,
Easler Jeffrey,
Triantafyllou Konstantinos,
PelaezLuna Mario,
Thakkar Shyam,
Ocampo Carlos,
deMadaria Enrique,
Wu Bechien U.,
Cote Gregory A.,
Abebe Kaleab,
Tang Gong,
Lahooti Ali,
Phillips Anna E.,
Papachristou Georgios I.
Publication year - 2021
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640620957243
Subject(s) - medicine , acute pancreatitis , pancreatitis , food intolerance , prospective cohort study , incidence (geometry) , etiology , abdominal pain , gastroenterology , vomiting , allergy , immunology , physics , optics
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, 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.