Division of Gastroenterology and Hepatology, Mayo Clinic Health System, Eau Claire, WI, USA.
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
Pancreatology. 2021 Apr;21(3):642-648. doi: 10.1016/j.pan.2021.01.001. Epub 2021 Jan 14.
There is agreement among GI society guidelines for recommending early oral nutrition with non-liquid diet in patients with mild acute pancreatitis (AP). There is less agreement regarding administration of tube feedings (TF) in AP. Data on physicians' adherence to nutrition guidelines and practice variations are limited.
To report practice patterns in the nutritional management of different severity profiles of AP.
We conducted an anonymous electronic survey among physician members of the International Association of Pancreatology and the American Pancreatic Association. We assessed nutrition practices based on severity of AP, and asked relevant questions regarding the preferred administration strategies for enteral nutrition. Responses were compared by practice location and subspecialty.
A total of 178 physicians, mostly medical pancreatologists (40.4%) and surgeons (34.8%) from Europe (43.4%) and North America (32%) responded. Overall, only 26.7% initiated oral nutrition in mild AP on day 1, 40.9% waited >48 h, and 57.3% initiated nutrition with liquid diets. Physicians reported frequently using TF in patients with moderately-severe (30-75%, depending on the amount and location of necrosis) and severe AP (75-80%). Two-thirds of physicians preferred initiating TF after 48 h, administering it post-pylorically, and using semi-elemental or polymeric formulas. Median TF duration was 11 days (IQR, 7-21). Significant variations were noted based on geographic location and physician subspecialty for several aspects of nutritional practices in both mild and non-mild AP.
Adherence to oral nutrition guideline recommendations for mild AP is low. There is significant variability in the use of TF in AP. Our study highlights opportunities for improving consistency of nutrition care in AP and identify potential areas for research.
胃肠病学会指南一致建议轻度急性胰腺炎（AP）患者早期采用非液体饮食进行口服营养。但对于 AP 患者管饲喂养（TF）的应用，指南并未达成一致意见。关于医生遵循营养指南和实践差异的数据有限。
报告不同严重程度 AP 营养管理的实践模式。
我们对国际胰腺病学会和美国胰腺病学会的医生成员进行了匿名电子调查。我们根据 AP 的严重程度评估营养实践，并询问了有关肠内营养首选管理策略的相关问题。根据实践地点和亚专科对回答进行了比较。
共 178 名医生做出了回应，他们主要是来自欧洲（43.4%）和北美（32%）的医学胰腺病学家（40.4%）和外科医生（34.8%）。总体而言，只有 26.7%的医生在轻度 AP 时在第 1 天开始口服营养，40.9%的医生等待超过 48 小时，57.3%的医生开始使用液体饮食进行营养。医生报告称，在中度-重度（取决于坏死的量和位置，为 30-75%）和重度 AP（75-80%）患者中经常使用 TF。三分之二的医生更喜欢在 48 小时后开始 TF，经幽门后给予，并使用半要素或聚合物配方。TF 的中位持续时间为 11 天（IQR，7-21）。根据地理位置和医生的亚专科，在轻度和非轻度 AP 的几个营养实践方面都存在显著差异。
对轻度 AP 口服营养指南建议的依从性较低。AP 中 TF 的应用存在显著差异。我们的研究强调了在 AP 中改善营养护理一致性的机会，并确定了潜在的研究领域。
