Applied nutritional investigationEarly oral refeeding based on hunger in moderate and severe acute pancreatitis: A prospective controlled, randomized clinical trial

The optimal timing of oral refeeding in acute pancreatitis remains unclear. Our previous study found that early oral refeeding based on hunger in patients with mild acute pancreatitis was safe and reduced the length of hospitalization. This study aimed to explore the feasibility and safety of early oral refeeding based on hunger in patients with moderate and severe AP.Innovation of our study:
- Proposed the new reinitiating oral feeding protocol based on hunger in patients with moderate or severe acute pancreatitis rather than the completely remission of clinical symptoms and signs with the normalization of laboratory parameters.
- Compared with traditional refeeding protocol, the new reinitiating oral-feeding protocol based on hunger is safe with shorter length of hospitalization, which can reduce the medical burden on the patients.
- The proposed oral refeeding standard of hunger is easy to be popularized without the laboratory tests.

ObjectiveEarly enteral nutrition is beneficial for acute pancreatitis (AP), but the optimal timing and criteria remain unclear. The aim of this study was to explore the feasibility and safety of early oral refeeding (EORF) based on hunger in patients with moderate or severe AP.MethodsIn a prospective, single-center, controlled, randomized clinical trial (ChiCTR-TRC-12002994), eligible patients with moderate or severe AP were randomized to either EORF or conventional oral refeeding (CORF). Patients in the EORF group restarted an oral diet when they felt hungry, regardless of laboratory parameters. Those in the CORF group restarted an oral diet only when clinical and laboratory symptoms had resolved. Clinical outcomes were compared between the two groups.ResultsIn all, 146 eligible patients with moderate or severe AP were included and randomized to the EORF (n = 70) or CORF (n = 76) group. There were eight dropouts after randomization (three in EORF group; five in CORF group). The groups had similar baseline characteristics. The total length of hospitalization (13.7 ± 5.4 d versus 15.7 ± 6.2 d; P = 0.0398) and duration of fasting (8.3 ± 3.9 d versus 10.5 ± 5.1 d; P = 0.0047) were shorter in the EORF group than in the CORF group. There was no difference in the number of adverse events or complications between the two groups. The mean blood glucose level after oral refeeding was higher in the EORF group than in the CORF group (P = 0.0030).ConclusionsThis controlled, randomized clinical trial confirmed the effectiveness and feasibility of EORF based on hunger in patients with moderate or severe AP. EORF could shorten the length of hospitalization in patients with moderate or severe AP.