Running head: PANCREATITIS EVIDENCE ABSTRACT

Pancreatitis (Gastrointestinal) Evidence Abstract

Molly Chaffin
The University of Southern Mississippi

PANCREATITIS EVIDENCE ABSTRACT

Citation:

Sathiaraj, E., Murthy, S., Mansard, M. J., Rao, G. V.,

Mahukar, S., & Reddy, D. N. (2008). Clinical trial:
oral feeding with a soft diet compared with clear
liquid diet as initial meal in mild acute pancreatitis.
Alimentary Pharmacology and Therapeutics, 28.

Study Design:
Class:
Quality Rating:
Research Purpose:
Inclusion Criteria:

Exclusion Criteria:

Description of Study
Protocol

Data Collection
Summary:

777-781. doi:10.1111/j.1365-2036.2008.03794.x.
Randomized, controlled trial
A
0
To determine if an association exists between the type of
diet (clear liquids versus soft diet) and length of hospital
stay in patients experiencing acute pancreatitis.
Patients must be admitted to the Asian Institute of
Gastroentology between September 2007 to February 2008
with symptoms of abdominal pain and diagnosis of mild
acute pancreatitis. Patients lipase and/or amylase levels
must be > three times the normal limit or > twice the upper
limit with pancreatic inflammation.
Patients were excluded if any of the following
characteristics were observed: organ dysfunction, neoplasm,
pregnancy, infections such as TB or HIV/AIDS, severe
acute pancreatitis, and/or recent surgical history. Patients
who received enteral or parenteral nutrition or those who
were receiving pancreatic enzyme supplementation were
excluded from the study.
Patients who were admitted for acute pancreatitis were
initially nil per os (NPO). When abdominal pain and
gastrointestinal (GI) symptoms subsided, patients were
randomized to receive either a solid diet (SD) or a clear
liquid diet (CLD) with advancement to SD as tolerated. The
CLD provided 485 kcal and 11 g fat per day, and the SD
provided 1040 kcal and 20 g fat per day. The hospital
medical team determined patient discharge and dietary
advancement.
The clinical dietitian recorded patient outcomes daily which
included diet tolerance, daily intake of calories and fat, and
pain (using a 10-point Likert scale). The primary outcome
observed in the study was the length of hospital stay (LOH),
with secondary outcomes observing the frequency of diet
discontinuation due to patient intolerance and GI symptoms.

PANCREATITIS EVIDENCE ABSTRACT

Description of Actual
Data Sample:

Summary of Results

Author Conclusion:

Review Comments:

A total of 101 patients from the Asian Institute of

Gastroentology were enrolled in the study (52 in the CLD
and 49 in the SD). Patient characteristics were similar
between the CLD and SD groups with average ages of 39
and 37 and percentage of males of 44% and 39 %
respectively. Proportions of the causes of pancreatitis were
similar in both groups with the greatest percentage from
alcohol, unknown causes, and gallstones.
Total LOH and post-refeeding LOH were significantly lower
in subjects in the SD group compared to the CLD group.
Average post-refeeding days to discharge were 6.75 days in
the CLD group and 4.18 days in the SD group with an
average difference of 2.57 days (P < 0.001). Average total
LOH was also 2.79 days shorter in the SD group compared
to the CLD (P < 0.001). Time between admission and diet
initiation was not significantly different between groups (P
= 0.462).
Initiating dietary intake with a solid diet as opposed to a
clear liquid diet significantly shortened length of
hospitalization in patients with mild acute pancreatitis.
Patients who advance to a SD as opposed to a CLD also had
greater energy intake without an increase in GI pain or
symptoms.
Strengths of this study included the large sample size (n =
101) and strength of the intervention. Experimenters could
directly control or record subjects intake due to inpatient
stay.
One limitation of the study was the lack of control over the
time of diet advancement and discharge. However, the
medical team involved in these decisions were not tied to the
studys outcomes, therefore research bias was unlikely.

Running head: PANCREATITIS EVIDENCE ABSTRACT

Nutrition Prescription (The patients/clients individualized recommended dietary intake of energy and/or selected foods or nutrients based on
current reference standards and dietary guidelines and the patients/clients health condition and nutrition diagnosis):
Energy needs using MSJ: (10 x 72.9 kg) + (6.25 x 176 cm) (5 x 26 years) 161 = 1538 kcal/day
--Stress factor (1.2) = 1846 kcal/day
--Activity factor (1.3, light active) = 1,999 kcal/day (usual day after discharge)
Protein needs (1.2-1.5 g/kg) = 87.6 109.5 g/day
Fat needs (~25% total kcal) = 51 55.5 g/ day
Fluid needs: 1.8 2.0 L/day
Assess
Interpret data needed to
identify nutrition related
problems, their causes, and
significance
Anthropometrics:
26YOWF
Ht: 176 cm
Wt: 72.9 kg
BMI: 23.5 kg/m2 (normal)
IBW: 145 lbs (65.9 kg)
--%IBW: 111%
No recent weight changes

Priority

Diagnosis (PES
Statement)
______RT______
AEB_______

Intervention
What are you going to do to
fix the problem?

Monitoring
What data do you
need to assess your
intervention?

Evaluation
Quantifiable goal(s)

Inadequate oral intake RT

GI symptoms AEB
pancreatitis diagnosis,
reported N/V, NPO diet
order.

-Advance diet order to clear

liquid diet or GI soft diet as
patient prefers/tolerates
-Encourage adequate intake
of meals as soon as possible

-Intake according to
patient and nurses
reports
-Toleration of diet
advancement
(according to GI
symptoms)
-Weight

-Intake >75% of
meals
-Diet advancement
to GI soft diet within
three days
- Weight
maintenance

Biochemical Data:
Labs:
BUN
5 mg/dL
L
Glucose
87 mg/dL
Sodium
135 mmol/L
L
Calcium
8.4 mg/dL

Altered GI function RT
pancreatitis AEB
recurrent GI symptoms
(abdominal pain, nausea,
vomiting), hx of
hospitalization due to
pancreatitis (5/14),
NPO/lack of appetite,

-Conduct a 24-hour recall to

determine current dietary
intake and areas for
improvement
-Educate patient on diet to
follow for pancreatitis.
Promote a healthy, well
balanced diet low in

-Food journal or 24hour recall upon

follow up session
-Recorded onset of
symptoms recorded
with dietary intake
-Future
hospitalizations

-Improvement in
dietary choices from
initial recall (less
overall fat intake,
increased percentage
of healthy fats)
-Decreased
occurrence of GI

PANCREATITIS EVIDENCE ABSTRACT

L
Total protein
L
Albumin
L
Amylase
H
Lipase
H

intolerance/malabsorption concentrated sweets with

of fatty foods.
moderate fat (25% of kcal or
<55 g/day)
-Encourage healthy fats
(nuts, oils) and discourage
fried, greasy foods
-Provided education material
on GI soft diet when
abdominal pain is present

5.7 g/dL
3.3 gm/dL
2918 unit/L
1483 unit/L

Clinical:
Medical dx: Acute recurrent
pancreatitis; experiencing
severe nausea, vomiting
-Admission date 11/2/2014
Hx of prior pancreatitis
(5/2014), alcohol abuse
Prior cholescystectomy
Family hx: CAD (father and
paternal grandmother)
Medications:
-Clonazepam
-Pantoprazole
-Ondansetron
-Acetaminophen
-Morphine
-Seroquel
-Effexor XR

Excessive alcohol intake

RT lack of value for
behavior change AEB
reported intake of 1-2
glasses of wine per day
and average 12 beers per
week, reported
unwillingness to change,
and recurrent pancreatitis
secondary to alcohol
intake.

-Discuss alcohol intake,

current recommendations
(less than 1-2 drinks per
day), and consequences of
excessive intake with
patient.
-Educate patient on the
consequences of excess
intake (recurrent symptoms
of pancreatitis, liver
cirrhosis, weight gain,
nutrient deficiencies, etc.)
-Assess patients willingness
to change, set goals,
encourage self-monitoring of
goals, and promote healthy
habits to replace current
drinking habits.
-Refer patient to alcohol
abuse therapist or social
support group.

symptoms.
Determination of
specific foods that
cause further
symptoms
-Decreased
frequency of
hospitalization for
pancreatitis
-Self-monitoring
strategy (likely daily
intake log) to
determine if
established goals are
being met
-Report of average
weekly alcohol
intake at follow up

-Established goals
met 80% of the time
(for example:
reducing habits to 12 drinks per day and
meeting this goal 4
out of every 5 days)
-Decrease in average
weekly intake from
19-26 average drinks
per week

PANCREATITIS EVIDENCE ABSTRACT

Herbal/dietary supplements:
None reported
Diet history:
Current diet order: NPO
Regular diet prior to admission
Reported consuming 12
beers/wk + 1-2 glasses
wine/day
Cigarette smokers
Eco-social:
Employed, nurse
Lives with significant other
and children
No household alcohol
concerns reported

Running head: PANCREATITIS EVIDENCE ABSTRACT

Recommendations
Pancreatitis, either chronic or acute, often produces severe gastrointestinal (GI)
pain, nausea, and vomiting. These symptoms may decrease nutritional intake, therefore
increasing the risk of malnutrition and the length of hospitalization. According to
Sathiaraj and colleagues (2008), early feeding of a low-fat (20 grams/day), solid diet may
improve inpatient outcomes and decrease length of hospitalization in patients with mild
acute pancreatitis when compared to the usual diet advancement to clear liquids. Another
extensive literature review agreed with these findings, concluding that solid diets
decreased the length of hospital stay and did not increase the occurrence of pain in
patients experiencing acute pancreatitis (The Cochrane Library, 2014).
Patient AK was admitted to the unit with alcohol-induced pancreatitis presenting
symptoms of severe abdominal pain, nausea, and vomiting. At the time of admission, AK
was not consuming any oral intake. Pancreatitis patients at Memorial Hospital are
typically advanced to a clear liquid diet as tolerated; recommendations were made to
advance AK to a GI soft diet (low-fat, bland diet) as soon as nausea and vomiting
subside. Advancement to this diet may decrease her length of stay at the hospital without
increasing GI symptoms. If the patient is able to tolerate a GI soft diet for 24 hours, diet
should be advanced to a low-fat diet. Education material should be provided for a wellbalanced, moderate-fat diet that is low in concentrated sweets to follow upon discharge.

PANCREATITIS EVIDENCE ABSTRACT

References
Sathiaraj, E., Murthy, S., Mansard, M. J., Rao, G. V., Mahukar, S., & Reddy, D. N.
(2008). Clinical trial: oral feeding with a soft diet compared with clear liquid diet
as initial meal in mild acute pancreatitis. Alimentary Pharmacology and
Therapeutics, 28. 777-781. doi:10.1111/j.1365-2036.2008.03794.x.
The Cochrane Library. (2014). Three initial diets for management of mild acute
pancreatitis: a metaanalysis (Structured abstract). Database of Abstracts of
Reviews of Effects, 4. Retrieved from http://onlinelibrary.wiley.com