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• W3000952308 abstract "Both acute and chronic pancreatitis are frequent diseases of the pancreas, which, despite being of benign nature, are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20% of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis. Abdominal pain leading to decreased oral intake, as well as exocrine and endocrine failure are frequent complications of the disease. All of the above represent risk factors related to malnutrition. Therefore, patients with chronic pancreatitis should be considered at risk, screened and supplemented accordingly. Moreover, osteoporosis and increased facture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered. Both acute and chronic pancreatitis are frequent diseases of the pancreas, which, despite being of benign nature, are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20% of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis. Abdominal pain leading to decreased oral intake, as well as exocrine and endocrine failure are frequent complications of the disease. All of the above represent risk factors related to malnutrition. Therefore, patients with chronic pancreatitis should be considered at risk, screened and supplemented accordingly. Moreover, osteoporosis and increased facture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered. Abdominal Compartment Syndrome Acute Necrotizing Pancreatitis Acute Pancreatitis Body Mass Index Chronic Pancreatitis Direct Percutaneous Endoscopic Jejunostomy Dual-energy X-ray Absorptiometry Enteral Nutrition Intra-abdominal Hypertension Intra-abdominal Pressure Medium Chain Triglycerides Malnutrition Universal Screening Tool Non Alcoholic Fatty Liver Disease Oral Nutritional Supplements Percutaneous Endoscopic Gastrostomy with Jejunal Extension Pancreatic Exocrine Insufficiency Pancreatic Enzyme Replacement Therapy Parenteral Nutrition Proton Pump Inhibitor Randomized Controlled Trial Small Intestinal Bacterial Overgrowth Video-assisted Retroperitoneal Debridement Acute pancreatitis (AP) is the most common acute gastrointestinal disease requiring hospital admission [[1]Banks P.A. Bollen T.L. Dervenis C. Gooszen H.G. Johnson C.D. Sarr M.G. et al.Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus.Gut. 2013; 62: 102-111Crossref PubMed Scopus (1999) Google Scholar], with the outcome being favorable in most cases (80%) [[2]Arvanitakis M. Dumonceau J.M. Albert J. Badaoui A. Bali M.A. Barthet M. et al.Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines.Endoscopy. 2018; 50: 524-546Crossref PubMed Scopus (40) Google Scholar]. However, acute necrotizing pancreatitis (ANP) may develop in up to 20% of patients and is associated with significant rates of early organ failure (38%), need for intervention (38%), and death (15%) [[2]Arvanitakis M. Dumonceau J.M. Albert J. Badaoui A. Bali M.A. Barthet M. et al.Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines.Endoscopy. 2018; 50: 524-546Crossref PubMed Scopus (40) Google Scholar]. Catabolism is very high in this setting; therefore, nutritional support is one of the cornerstones of management [[3]Trikudanathan G. Wolbrink D.R.J. van Santvoort H.C. Mallery S. Freeman M. Besselink M.G. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach.Gastroenterology. 2019; 156: 1994-2007 e3Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar]. A significant amount of research has shown the superiority of enteral over parenteral nutrition in ANP, creating a paradigm shift a decade ago and modifying the management strategy [[3]Trikudanathan G. Wolbrink D.R.J. van Santvoort H.C. Mallery S. Freeman M. Besselink M.G. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach.Gastroenterology. 2019; 156: 1994-2007 e3Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar]. Nevertheless, additional questions regarding the timing, route and type of enteral nutrition (EN), as well as the place of oral refeeding, are still the objects of clinical investigations. Chronic pancreatitis (CP) is a disease in which recurrent inflammatory episodes lead to replacement of the pancreatic parenchyma by fibrous connective tissue [[4]Lohr J.M. Dominguez-Munoz E. Rosendahl J. Besselink M. Mayerle J. Lerch M.M. et al.United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).United Eur Gastroenterol J. 2017; 5: 153-199Crossref PubMed Scopus (33) Google Scholar]. The major consequence of CP is the loss of functional exocrine and endocrine pancreatic tissue, thus resulting in both exocrine and endocrine insufficiency [[4]Lohr J.M. Dominguez-Munoz E. Rosendahl J. Besselink M. Mayerle J. Lerch M.M. et al.United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).United Eur Gastroenterol J. 2017; 5: 153-199Crossref PubMed Scopus (33) Google Scholar]. Pain is also frequently encountered in patients with CP, and seems to be related to a multitude of factors such as pancreatic neural remodeling and neuropathy, increased intraductal and parenchymal pressure, pancreatic ischemia and acute inflammation during an acute relapse [[5]Dumonceau J.M. Delhaye M. Tringali A. Arvanitakis M. Sanchez-Yague A. Vaysse T. et al.Endoscopic treatment of chronic pancreatitis: European society of gastrointestinal endoscopy (ESGE) guideline - updated August 2018.Endoscopy. 2019; 51: 179-193Crossref PubMed Scopus (15) Google Scholar]. Both pain and loss of pancreatic function can lead to malnutrition in patients with CP [[4]Lohr J.M. Dominguez-Munoz E. Rosendahl J. Besselink M. Mayerle J. Lerch M.M. et al.United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).United Eur Gastroenterol J. 2017; 5: 153-199Crossref PubMed Scopus (33) Google Scholar]. Moreover, other long-term consequences such as osteoporosis are frequently overlooked, despite their potential impact on quality of life in patients with CP. Therefore, screening for malnutrition and nutritional support play a crucial part in the multimodal management required in this setting. Although recent guidelines for AP [[2]Arvanitakis M. Dumonceau J.M. Albert J. Badaoui A. Bali M.A. Barthet M. et al.Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines.Endoscopy. 2018; 50: 524-546Crossref PubMed Scopus (40) Google Scholar] and CP [[4]Lohr J.M. Dominguez-Munoz E. Rosendahl J. Besselink M. Mayerle J. Lerch M.M. et al.United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).United Eur Gastroenterol J. 2017; 5: 153-199Crossref PubMed Scopus (33) Google Scholar] have been published, a dedicated consensus on nutritional support in pancreatic diseases is lacking. The present guideline was developed according to the standard operating procedure for ESPEN guidelines [[6]Bischoff S.C. Singer P. Koller M. Barazzoni R. Cederholm T. van Gossum A. Standard operating procedures for ESPEN guidelines and consensus papers.Clin Nutr. 2015; 34: 1043-1051Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar]. The guideline was developed by an expert group of 13 authors from eleven European countries. Based on the standard operating procedures for ESPEN guidelines and consensus papers, the first step of the guideline development was the formulation of so-called PICO questions which address specific patient groups or problems, interventions, compare different therapies and are outcome-related [[6]Bischoff S.C. Singer P. Koller M. Barazzoni R. Cederholm T. van Gossum A. Standard operating procedures for ESPEN guidelines and consensus papers.Clin Nutr. 2015; 34: 1043-1051Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar]. In total, 31 PICO questions were created and split into two main chapters, “Acute pancreatitis” and “Chronic Pancreatitis”. To answer these PICO questions, a literature search was performed to identify suitable meta-analyses, systematic reviews and primary studies, published from 1977 up to December 2018. The PICO questions were allocated to subgroups/experts for the different subjects who created 42 recommendations and seven statements. For grading the literature, the grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used [[7]Scottish Intercollegiate Guidelines Network (SIGN)SIGN 50: a guideline developer's handbook. SIGN, Edinburgh2014Google Scholar]. Allocation of studies to the different levels of evidence is shown in Table 1. Supportive of the recommendations, the working group added commentaries to the recommendations where the bases of the recommendations are explained.Table 1Levels of evidence.1++High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias1+Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias1-Meta-analyses, systematic reviews, or RCTs with a high risk of bias2++High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal2+Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal2-Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal3Non-analytic studies, e.g. case reports, case series4Expert opinionAccording to the Scottish Intercollegiate Guidelines Network (SIGN) grading system. Source: SIGN 50: A guideline developer's handbook. Quick reference guide October 2014 [SIGN 50]. RCT = randomized controlled trial. Open table in a new tab According to the Scottish Intercollegiate Guidelines Network (SIGN) grading system. Source: SIGN 50: A guideline developer's handbook. Quick reference guide October 2014 [SIGN 50]. RCT = randomized controlled trial. The recommendations were graded according to the levels of evidence assigned (Table 2). The wording of the recommendations reflect the grades of recommendations, level A is indicated by “shall”, level B by “should” and level 0 by “can/may”. The good practice point (GPP) is based on experts' opinions due to the lack of studies, here, the wording can be chosen deliberately.Table 2Grades of recommendation [[6]Bischoff S.C. Singer P. Koller M. Barazzoni R. Cederholm T. van Gossum A. Standard operating procedures for ESPEN guidelines and consensus papers.Clin Nutr. 2015; 34: 1043-1051Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar].AAt least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of resultsBA body of evidence including studies rated as 2++, directly applicable to the target population; or A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 1++ or 1+0Evidence level 3 or 4; or Extrapolated evidence from studies rated as 2++ or 2+GPPGood practice points/expert consensus: Recommended best practice based on the clinical experience of the guideline development groupRCT = randomized controlled trial. Open table in a new tab RCT = randomized controlled trial. Online voting on the recommendations was performed on the guideline-services.com platform. All ESPEN members were invited to agree or disagree with the recommendations and to comment on them. A first draft of the guideline was also made available to the participants; on that occasion 36 recommendations and all seven statements reached an agreement of >90%, six recommendations reached an agreement of 75–90% and no recommendation an agreement of <75%. Those recommendations with an agreement of >90%, which means a strong consensus (Table 3) were passed directly; all others were revised according to the comments and voted on again during a consensus conference, which took place on 29th April 2019. All recommendations received an agreement of >90%. During the consensus conference, one of the original recommendations was considered redundant and one statement was transformed into a recommendation. Therefore, the guideline comprises 42 recommendations and six statements. To support the recommendations and the assigned grades of recommendation, the ESPEN guideline office created evidence tables of relevant meta-analyses, systematic reviews and randomized controlled trials (RCTs). These evidence tables are available online as supplemental material to this guideline.Table 3Classification of the strength of consensus.Strong consensusAgreement of >90% of the participantsConsensusAgreement of >75–90% of the participantsMajority agreementAgreement of 50–75% of the participantsNo consensusAgreement of <50% of the participantsAccording to the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Association of the Scientific Medical Societies in Germany) methodology [[8]Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) – Ständige Kommission LeitlinienAWMF-Regelwerk “Leitlinien”.2012Google Scholar]. Open table in a new tab According to the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Association of the Scientific Medical Societies in Germany) methodology [[8]Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) – Ständige Kommission LeitlinienAWMF-Regelwerk “Leitlinien”.2012Google Scholar]. A comprehensive literature research including systematic reviews, controlled clinical trials and cohort studies, with the keywords and filters presented in Table 4 was performed. We initially searched Pubmed, Cochrane Library and EMBASE for recent, rigorous systematic reviews and meta-analyses that answered our clinical questions. In the absence of these, we looked for comparative studies, whether randomized or not. The search phrases included the following terms: (acute pancreatitis OR acute necrotizing pancreatitis OR chronic pancreatitis OR pancreatitis OR hypertriglyceridemic pancreatitis OR hyperlipidemic pancreatitis) AND (nutritional status OR nutritional assessment OR nutritional screening OR malnutrition OR oral feeding OR enteral nutrition OR tube feeding OR parenteral nutrition OR intravenous nutrition OR timing OR formula OR formulation OR nasogastric tube OR nasojejunal tube OR digestive intolerance OR necrosectomy OR minimally invasive OR increased intra-abdominal pressure OR abdominal compartment syndrome OR open abdomen OR immunonutrition OR glutamine OR antioxidants OR probiotics OR enzyme supplementation OR enzyme replacement therapy OR micronutrients OR macronutrients OR nutrient deficiency OR diet OR fat OR nitrogen OR dietary protein OR carbohydrates oral supplementation OR medium chained triglycerides OR osteoporosis OR osteopenia).Table 4Criteria for systematic search for literature – databases, filters and keywords.Publication dateFrom 1977 to December 2018LanguageEnglishDatabasesPubmed, EMBASE, Cochrane libraryFiltershumanPublication typeCohort study, controlled trial, systematic reviewKeywordsAcute pancreatitis, chronic pancreatitis, nutrition Open table in a new tab Finally, 88 articles were selected for the AP chapter, and 111 articles for the CP chapter. 1.Which patients with AP are considered at nutritional risk?Statement 1Patients with AP should be considered at moderate to high nutritional risk, because of the catabolic nature of the disease and because of the impact of the nutritional status for disease development.Strong consensus (97% agreement).Recommendation 1All patients with predicted mild to moderate AP should be screened using validated screening methods such as the Nutritional Risk Screening – 2002 (NRS-2002); however, the patients with predicted severe AP should always be considered at nutritional risk.Grade of Recommendation B – Strong consensus (100% agreement).Commentary Patients with AP should be considered at moderate to high nutritional risk, because of the catabolic nature of the disease and because of the impact of the nutritional status for disease development. Strong consensus (97% agreement). All patients with predicted mild to moderate AP should be screened using validated screening methods such as the Nutritional Risk Screening – 2002 (NRS-2002); however, the patients with predicted severe AP should always be considered at nutritional risk. Grade of Recommendation B – Strong consensus (100% agreement). Fortunately, the majority of patients with AP have predicted mild or moderately severe forms of the disease that are self-limited with fully recovery in less than a week, in whom oral feeding can be started within few days after the onset of AP [[9]Eckerwall G.E. Tingstedt B.B. Bergenzaun P.E. Andersson R.G. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery--a randomized clinical study.Clin Nutr. 2007; 26: 758-763Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar]. Gut-barrier dysfunction may occur in up to 60% of patients with AP; mostly in severe AP and it is thought to lead to bacterial translocation and infection of necrosis [[10]Wu L.M. Sankaran S.J. Plank L.D. Windsor J.A. Petrov M.S. Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis.Br J Surg. 2014; 101: 1644-1656Crossref PubMed Scopus (54) Google Scholar]. Along with the increased catabolic state related to the disease, patients with predicted severe AP are considered at nutritional risk [[11]Roberts K.M. Nahikian-Nelms M. Ukleja A. Lara L.F. Nutritional aspects of acute pancreatitis.Gastroenterol Clin N Am. 2018; 47: 77-94Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Nevertheless, malnourished patients should also be considered at nutritional risk, even if they have predicted mild AP, because of their pre-existing condition. Similarly, patients with increased alcohol consumption are frequently malnourished [[12]Sobral-Oliveira M.B. Faintuch J. Guarita D.R. Oliveira C.P. Carrilho F.J. Nutritional profile of asymptomatic alcoholic patients.Arq Gastroenterol. 2011; 48: 112-118Crossref PubMed Scopus (0) Google Scholar]. Scoring systems such as the NRS 2002 [[13]Kondrup J. Rasmussen H.H. Hamberg O. Stanga Z. Ad Hoc E.W.G. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.Clin Nutr. 2003; 22: 321-336Abstract Full Text Full Text PDF PubMed Scopus (1151) Google Scholar], can be helpful in identifying these patients [14Guerra R.S. Fonseca I. Sousa A.S. Jesus A. Pichel F. Amaral T.F. ESPEN diagnostic criteria for malnutrition - a validation study in hospitalized patients.Clin Nutr. 2017; 36: 1326-1332Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 15Cederholm T. Barazzoni R. Austin P. Ballmer P. Biolo G. Bischoff S.C. et al.ESPEN guidelines on definitions and terminology of clinical nutrition.Clin Nutr. 2017; 36: 49-64Abstract Full Text Full Text PDF PubMed Google Scholar, 16Cederholm T. Jensen G.L. Correia M. Gonzalez M.C. Fukushima R. Higashiguchi T. et al.GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community.Clin Nutr. 2019; 38: 1-9Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar, 17McClave S.A. Taylor B.E. Martindale R.G. Warren M.M. Johnson D.R. Braunschweig C. et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine (SCCM) and American society for parenteral and enteral nutrition (A.S.P.E.N.).J Parenter Enter Nutr. 2016; 40: 159-211Crossref PubMed Google Scholar]. These scores have been validated in hospitalized, as well as critically ill patients. Nevertheless, no studies have validated these scoring systems in a specific population of patients with AP [[18]Knudsen A.W. Naver A. Bisgaard K. Nordgaard-Lassen I. Becker U. Krag A. et al.Nutrition impact symptoms, handgrip strength and nutritional risk in hospitalized patients with gastroenterological and liver diseases.Scand J Gastroenterol. 2015; 50: 1191-1198Crossref PubMed Scopus (5) Google Scholar]. A low body mass index (BMI) may also identify patients who are at nutritional risk. Nevertheless, obesity is a known risk factor for severe AP and is, therefore, a disease severity-related nutritional risk [[19]Khatua B. El-Kurdi B. Singh V.P. Obesity and pancreatitis.Curr Opin Gastroenterol. 2017; 33: 374-382Crossref PubMed Scopus (14) Google Scholar].2.Is early oral feeding feasible in patients with predicted mild AP?Recommendation 2Oral feeding shall be offered as soon as clinically tolerated and independent of serum lipase concentrations in patients with predicted mild AP.Grade of Recommendation A – Strong consensus (100% agreement).Recommendation 3Low-fat, soft oral diet shall be used when reinitiating oral feeding in patients with mild AP.Grade of Recommendation A – Strong consensus (100% agreement).Commentary Oral feeding shall be offered as soon as clinically tolerated and independent of serum lipase concentrations in patients with predicted mild AP. Grade of Recommendation A – Strong consensus (100% agreement). Low-fat, soft oral diet shall be used when reinitiating oral feeding in patients with mild AP. Grade of Recommendation A – Strong consensus (100% agreement). Most patients with AP suffer from disease of a mild to moderate severity, non-necrotizing type with an uncomplicated clinical course. Four RCTs have shown that patients with mild to moderate AP can tolerate early oral feeding and this strategy is related with a shorter length of stay compared with conventional oral feeding (introduced after enzyme decrease, pain resolution and bowel movement) [[9]Eckerwall G.E. Tingstedt B.B. Bergenzaun P.E. Andersson R.G. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery--a randomized clinical study.Clin Nutr. 2007; 26: 758-763Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,20Teich N. Aghdassi A. Fischer J. Walz B. Caca K. Wallochny T. et al.Optimal timing of oral refeeding in mild acute pancreatitis: results of an open randomized multicenter trial.Pancreas. 2010; 39: 1088-1092Crossref PubMed Scopus (52) Google Scholar, 21Zhao X.L. Zhu S.F. Xue G.J. Li J. Liu Y.L. Wan M.H. et al.Early oral refeeding based on hunger in moderate and severe acute pancreatitis: a prospective controlled, randomized clinical trial.Nutrition. 2015; 31: 171-175Crossref PubMed Scopus (31) Google Scholar, 22Li J. Xue G.J. Liu Y.L. Javed M.A. Zhao X.L. Wan M.H. et al.Early oral refeeding wisdom in patients with mild acute pancreatitis.Pancreas. 2013; 42: 88-91Crossref PubMed Scopus (32) Google Scholar, 23Larino-Noia J. Lindkvist B. Iglesias-Garcia J. Seijo-Rios S. Iglesias-Canle J. Dominguez-Munoz J.E. Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: a randomized open-label trial.Pancreatology. 2014; 14: 167-173Crossref PubMed Scopus (0) Google Scholar]. Furthermore, one of these trials revealed that oral food intake is safe and well-tolerated independently of the course and normalization of serum lipase [[20]Teich N. Aghdassi A. Fischer J. Walz B. Caca K. Wallochny T. et al.Optimal timing of oral refeeding in mild acute pancreatitis: results of an open randomized multicenter trial.Pancreas. 2010; 39: 1088-1092Crossref PubMed Scopus (52) Google Scholar]. Immediate oral feeding with a soft diet seems to be more beneficial regarding caloric intake and equally tolerated compared with clear liquid diets [23Larino-Noia J. Lindkvist B. Iglesias-Garcia J. Seijo-Rios S. Iglesias-Canle J. Dominguez-Munoz J.E. Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: a randomized open-label trial.Pancreatology. 2014; 14: 167-173Crossref PubMed Scopus (0) Google Scholar, 24Sathiaraj E. Murthy S. Mansard M.J. Rao G.V. Mahukar S. Reddy D.N. Clinical trial: oral feeding with a soft diet compared with clear liquid diet as initial meal in mild acute pancreatitis.Aliment Pharmacol Ther. 2008; 28: 777-781Crossref PubMed Scopus (71) Google Scholar, 25Moraes J.M. Felga G.E. Chebli L.A. Franco M.B. Gomes C.A. Gaburri P.D. et al.A full solid diet as the initial meal in mild acute pancreatitis is safe and result in a shorter length of hospitalization: results from a prospective, randomized, controlled, double-blind clinical trial.J Clin Gastroenterol. 2010; 44: 517-522PubMed Google Scholar]. A meta-analysis confirmed that early oral feeding was feasible in patients with predicted mild AP and reduced length of stay [[26]Horibe M. Nishizawa T. Suzuki H. Minami K. Yahagi N. Iwasaki E. et al.Timing of oral refeeding in acute pancreatitis: a systematic review and meta-analysis.United European Gastroenterol J. 2016; 4: 725-732Crossref PubMed Scopus (2) Google Scholar]. A recent meta-analysis including 17 studies identified that 16.3% of patients with AP will subsequently have intolerance to oral feeding [[27]Bevan M.G. Asrani V.M. Bharmal S. Wu L.M. Windsor J.A. Petrov M.S. Incidence and predictors of oral feeding intolerance in acute pancreatitis: a systematic review, meta-analysis, and meta-regression.Clin Nutr. 2017; 36: 722-729Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar]. Predictive factors included the presence of pleural effusions and/or collections and severity (higher Ranson/Glasgow and Balthazar scores). Hyperlipidemia is the third most common cause of AP and accounts for 4–10% of cases [[28]Adiamah A. Psaltis E. Crook M. Lobo D.N. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis.Clin Nutr. 2018; 37: 1810-1822Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar]. It was reported that hyperlipidemia is associated with a worse prognosis of AP than other etiological factors [28Adiamah A. Psaltis E. Crook M. Lobo D.N. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis.Clin Nutr. 2018; 37: 1810-1822Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 29Valdivielso P. Ramirez-Bueno A. Ewald N. Current knowledge of hypertriglyceridemic pancreatitis.Eur J Intern Med. 2014; 25: 689-694Abstract Full Text Full Text PDF PubMed Google Scholar, 30Carr R.A. Rejowski B.J. Cote G.A. Pitt H.A. Zyromski N.J. Systematic review of hypertriglyceridemia-induced acute pancreatitis: a more virulent etiology?.Pancreatology. 2016; 16: 469-476Crossref PubMed Google Scholar]. The initial management of hyperlipidemic AP is the same as for all other causes of the disease, but subsequent management in addition to generalized supportive measures may include etiology-specific targeted therapies. These include initially putting patients on a nil by mouth regimen for 24–48 h, subsequent dietary modifications, medical management with the different classes of anti-hyperlipidemic agents, in-hospital pharmacological treatment with insulin and/or heparin and plasmapheresis. Whilst these measures are effective in lowering triglyceride concentrations, they do not appear to affect the outcome of AP [[28]Adiamah A. Psaltis E. Crook M. Lobo D.N. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis.Clin Nutr. 2018; 37: 1810-1822Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar,[29]Valdivielso P. Ramirez-Bueno A. Ewald N. Current knowledge of hypertriglyceridemic pancreatitis.Eur J Intern Med. 2014; 25: 689-694Abstract Full Text Full Text PDF PubMed Google Scholar]. However, tight regulation of triglyceride concentration after presentation with AP was found to reduce the risk of recurrence. These include a low fat diet, encouragement of weight loss and treatment with a fibrate, with the addition of a statin if hypercholesterolemia is present in addition to hypertriglyceridemia [[28]Adiamah A. Psaltis E. Crook M. Lobo D.N. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis.Clin Nutr. 2018; 37: 181" @default.
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• W3000952308 title "ESPEN guideline on clinical nutrition in acute and chronic pancreatitis" @default.
• W3000952308 cites W1243872314 @default.
• W3000952308 cites W1564544043 @default.
• W3000952308 cites W1582646601 @default.
• W3000952308 cites W1588012644 @default.
• W3000952308 cites W1835443657 @default.
• W3000952308 cites W1838124139 @default.
• W3000952308 cites W1917321661 @default.
• W3000952308 cites W1964043765 @default.
• W3000952308 cites W1965116105 @default.
• W3000952308 cites W1967510932 @default.
• W3000952308 cites W1969123505 @default.
• W3000952308 cites W1971316765 @default.
• W3000952308 cites W1974209079 @default.
• W3000952308 cites W1980565045 @default.
• W3000952308 cites W1981864996 @default.
• W3000952308 cites W1981961866 @default.
• W3000952308 cites W1982379219 @default.
• W3000952308 cites W1982487291 @default.
• W3000952308 cites W1982541064 @default.
• W3000952308 cites W1985462234 @default.
• W3000952308 cites W1985539141 @default.
• W3000952308 cites W1988251774 @default.
• W3000952308 cites W1991921053 @default.
• W3000952308 cites W1993122603 @default.
• W3000952308 cites W1994000234 @default.
• W3000952308 cites W1994671308 @default.
• W3000952308 cites W2001960390 @default.
• W3000952308 cites W2002500439 @default.
• W3000952308 cites W2003537755 @default.
• W3000952308 cites W2004088562 @default.
• W3000952308 cites W2005862989 @default.
• W3000952308 cites W2006346717 @default.
• W3000952308 cites W2007795584 @default.
• W3000952308 cites W2008722708 @default.
• W3000952308 cites W2010002300 @default.
• W3000952308 cites W2010117160 @default.
• W3000952308 cites W2015544914 @default.
• W3000952308 cites W2016552474 @default.
• W3000952308 cites W2019456090 @default.
• W3000952308 cites W2020197652 @default.
• W3000952308 cites W2023878113 @default.
• W3000952308 cites W2023985405 @default.
• W3000952308 cites W2028540789 @default.
• W3000952308 cites W2030703059 @default.
• W3000952308 cites W2033822121 @default.
• W3000952308 cites W2040524323 @default.
• W3000952308 cites W2042348991 @default.
• W3000952308 cites W2043735721 @default.
• W3000952308 cites W2047978782 @default.
• W3000952308 cites W2048448600 @default.
• W3000952308 cites W2052139208 @default.
• W3000952308 cites W2055811141 @default.
• W3000952308 cites W2062462380 @default.
• W3000952308 cites W2063361333 @default.
• W3000952308 cites W2065734714 @default.
• W3000952308 cites W2065775215 @default.
• W3000952308 cites W2066910287 @default.
• W3000952308 cites W2067545003 @default.
• W3000952308 cites W2067814497 @default.
• W3000952308 cites W2070472789 @default.
• W3000952308 cites W2071201153 @default.
• W3000952308 cites W2071477732 @default.
• W3000952308 cites W2075105997 @default.
• W3000952308 cites W2076440509 @default.
• W3000952308 cites W2076956367 @default.
• W3000952308 cites W2077083610 @default.
• W3000952308 cites W2082015256 @default.
• W3000952308 cites W2083236708 @default.
• W3000952308 cites W2084736804 @default.
• W3000952308 cites W2086291215 @default.
• W3000952308 cites W2089568269 @default.
• W3000952308 cites W2091893451 @default.
• W3000952308 cites W2092391192 @default.
• W3000952308 cites W2093213888 @default.
• W3000952308 cites W2095872413 @default.
• W3000952308 cites W2096126661 @default.
• W3000952308 cites W2099872676 @default.
• W3000952308 cites W2102503776 @default.
• W3000952308 cites W2102902503 @default.
• W3000952308 cites W2103388076 @default.

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