Early nasogastric tube feeding versus nil per os in mild to moderate acute pancreatitis: A randomized controlled trial

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2013-10, Vol.32 (5), p.697-703
• Main Authors: Petrov, Maxim S, McIlroy, Kerry, Grayson, Lorraine, Phillips, Anthony R.J, Windsor, John A
• Format: Article
• Language: English
• Subjects: Abdominal pain; Abdominal Pain - etiology; Abdominal Pain - prevention & control; Acute Disease; Acute pancreatitis; Adult; Biological and medical sciences; Disease Progression; Enteral Nutrition - adverse effects; experimental design; Feeding. Feeding behavior; Female; food intolerance; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Intubation, Gastrointestinal - adverse effects; Kaplan-Meier Estimate; Length of Stay; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Narcotics - administration & dosage; Narcotics - adverse effects; Narcotics - therapeutic use; Nasogastric feeding; Oral food intolerance; Other diseases. Semiology; pain; Pain Measurement; Pancreas rest; pancreatitis; Pancreatitis - diagnosis; Pancreatitis - physiopathology; Pancreatitis - therapy; patients; Practice Guidelines as Topic; randomized clinical trials; risk; Secondary Prevention; Severity of Illness Index; Time Factors; tube feeding; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2012.12.011

Summary Background & aims Nasojejunal tube feeding is a standard of care in patients with predicted severe acute pancreatitis (AP) and several recent trials suggested that nasogastric tube feeding (NGT) is as safe and efficient as nasojejunal tube feeding in these patients. The aim was to investigate whether NGT presents any benefit to patients with mild to moderate AP. Methods The study design was a randomized controlled trial. The patients in the intervention group received NGT within 24 h of hospital admission. The patients in the control group were on nil per os (NPO). The severity of acute pancreatitis was determined according to the new international multidisciplinary classification. Results There were 17 patients randomly allocated to the NGT group and 18 to the NPO group. The visual analogue pain score decreased to a significantly greater extent in the NGT group (from median 9 (range 7–9) at baseline to 1 (0–3) at 72 h after randomization) compared with the NPO group (from 7 (5–9) to 3 (1–4) ( p  = 0.036). The number of patients not requiring opiates at 48 h after randomization was significantly different ( p  = 0.024) between NGT (9/17) and NPO (3/18). Oral food intolerance was observed in 1/17 patient in the NGT group and 9/18 patients in the NPO group ( p  = 0.004). The overall hospital stay in the NGT group was 9 (5–12) days as compared with 8.5 (6–13) days in the NPO group ( p  = 0.91). Conclusions NGT commenced within 24 h of hospital admission is well tolerated in patients with mild to moderate acute pancreatitis. Further, when compared with NPO, it significantly reduces the intensity and duration of abdominal pain, need for opiates, and risk of oral food intolerance, but not overall hospital stay (ClinicalTrials.gov number, NCT01128478).