Incidence and risk factors of nasogastric feeding intolerance in moderately-severe to severe acute pancreatitis

Abstract

Background The importance of enteral nutrition (EN) in acute pancreatitis (AP) has been emphasised. Nasogastric (NG) feeding has been the preferred route for EN delivery in most AP patients intolerant to oral intake. However, gastric feeding intolerance (GFI) was frequently reported, especially in patients with more severe diseases. This study aimed to investigate the incidence and risk factors for GFI in moderately-severe to severe AP. Methods This is a single-centre, retrospective study. All the data were extracted from an electronic database from April 2020 to May 2021. Data were prospectively collected during hospitalisation. Patients diagnosed with moderately-severe to severe AP and admitted within seven days from the onset of abdominal pain were assessed for eligibility. Patients who showed signs of intolerance to gastric feeding and required switching to nasojejunal (NJ) feeding were deemed GFI. Multivariable logistic regression was performed to assess potential risk factors of GFI. Results A total of 93 patients were analysed, of whom 24 were deemed GFI (25.8%), and the rest tolerated NG feeding well (n = 69). In patients with GFI, the median time of switching to NJ feeding was five days (interquartile range: 4–7 days) after admission. The multivariable analysis showed that respiratory failure (odds ratio = 3.135, 95% CI: 1.111–8.848, P = 0.031) was an independent risk factor for GFI.The mean daily energy delivery in the following three days after switching to NJ feeding was significantly higher than the first three days after initiation of NG feeding in patients with GFI [920.83 (493.33–1326) vs. 465 (252.25–556.67) kcal, P < 0.001]. Conclusion GFI is common in moderately-severe to severe AP patients with an incidence of 25.8%, and the presence of respiratory failure may increase the risk of GFI.

Nutrition in Pancreatic Diseases: A Roadmap for the Gastroenterologist

“…Additionally, supplementing enteral formula with soluble dietary fiber might be an option for those patients in whom diarrhea is a bothersome symptom [20, 26]. When these methods have failed to improve EN tolerance, use of medication, like antiemetics and/or prokinetics, can improve tolerance [9, 27, 28].…”

“…BMI, body mass index; COPD, chronic obstructive pulmonary disease; APACHE, acute physiology and chronic health evaluation. like antiemetics and/or prokinetics, can improve tolerance [9,27,28].…”

Nutrition therapy in critically ill patients with severe acute pancreatitis

“…Subsequent clinical trials 26,27 and meta‐analyses 28–32 demonstrated that NG feeding was as effective as or not inferior to NJ feeding in those with SAP. The research results from another single center showed that NG feeding was well‐tolerated in ~74% (69/93) of patients with moderate SAP 23 . The results from clinical studies are summarized in Table 1.…”

“…The ineffectiveness of EN within 24 h may be that immediate feeding may not improve the early inconspicuous damage of the mucosal barrier. In contrast, it may induce an increased risk of gastrointestinal intolerance 22–24 …”

“…Additionally, if the pancreas is in a state of “unresponsiveness” to gastrointestinal stimulation in the early stage of SAP then it is not necessary to bypass the stomach and feed directly into the jejunum 36 . Nevertheless, gastric feeding intolerance was a common finding during early EN, with symptoms such as abdominal pain and vomiting 23,30 . If EN was interrupted or delayed because of feeding intolerance syndrome when implementing NG feeding, the NJ tube should be adopted to ensure appropriate feeding 37 …”