Practice patterns and adherence to nutrition guidelines in acute pancreatitis: An international physician survey

Jorge D Machicado; Sachin Wani; Elit Quingalahua; Samuel Han; Violette Simon; Peter Hegyi; Georgios I Papachristou; Dhiraj Yadav

doi:10.1016/j.pan.2021.01.001

Practice patterns and adherence to nutrition guidelines in acute pancreatitis: An international physician survey

Pancreatology. 2021 Apr;21(3):642-648. doi: 10.1016/j.pan.2021.01.001. Epub 2021 Jan 14.

Authors

Jorge D Machicado¹, Sachin Wani², Elit Quingalahua³, Samuel Han⁴, Violette Simon², Peter Hegyi⁵, Georgios I Papachristou⁴, Dhiraj Yadav⁶

Affiliations

¹ Division of Gastroenterology and Hepatology, Mayo Clinic Health System, Eau Claire, WI, USA.
² Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
³ Universidad Católica de Santiago de Guayaquil, Guayas, Ecuador.
⁴ Division of Gastroenterology and Hepatology, Ohio State Wexner Medical Center, Columbus, OH, USA.
⁵ Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary; Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary.
⁶ Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: yadavd@upmc.edu.

PMID: 33632665
DOI: 10.1016/j.pan.2021.01.001

Abstract

Background: 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.

Aims: To report practice patterns in the nutritional management of different severity profiles of AP.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Acute pancreatitis; Guideline adherence; International survey; Nutrition; Practice patterns; Tube feedings.

MeSH terms

Acute Disease
Cross-Sectional Studies
Enteral Nutrition / methods
Enteral Nutrition / standards*
Enteral Nutrition / statistics & numerical data
Guideline Adherence / statistics & numerical data*
Healthcare Disparities / statistics & numerical data
Humans
Pancreatitis / therapy*
Practice Guidelines as Topic
Practice Patterns, Physicians' / standards
Practice Patterns, Physicians' / statistics & numerical data*
Prospective Studies
Severity of Illness Index
Surveys and Questionnaires