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Background: Intravenous (IV) fluid resuscitation remains the cornerstone for early management of acute pancreatitis (AP), but many questions remain unanswered, including how to determine whether patients will benefit from additional fluids. The aim was to investigate the utility of serum biomarkers of responsiveness IV fluid resuscitation in patients with AP and systemic inflammatory response syndrome (SIRS)., Methods: Eligible adult patients had abdominal pain for <36 h and ≥2 SIRS criteria. Mean arterial pressure (>65 mmHg) and urine output (>0.5 ml/kg/h) were used to assess responsiveness at 2 and 6-8 h after initiation of IV fluids. Comparison was made between responsive and refractory patients at time points for fluid volume, biomarkers and outcomes., Results: At 2 h 19 patients responded to fluids (Group 1) while 4 were refractory (Group 2); at 6-8 h 14 responded (Group 3) and 9 were refractory (Group 4). No demographic differences between patient groups, but Group 4 had worse prognostic features than Group 3. Refractory patients received significantly more fluid (Group 4 mean 7082 ml vs. Group 3 5022 mL, P < 0.001) in first 24 h and had worse outcome. No significant differences in biomarkers between the groups., Conclusions: The serum biomarkers did not discriminate between fluid responsive and refractory patients. Refractory patients at 6-8 h had more severe disease on admission, did not benefit from additional fluids and had a worse outcome. New approaches to guide fluid resuscitation in patients with AP are required., (Copyright © 2018. Published by Elsevier Ltd.)

Objective: Oral feeding intolerance (OFI) is a common complication of nutritional management in acute pancreatitis (AP) and is associated with significantly worse clinical outcomes and increased cost of treatment. However, changes in patient-reported outcomes associated with OFI during AP and effect of OFI on quality of life (QoL) have, to our knowledge, never been studied. The aim of this study was to investigate the relationship between OFI and QoL in patients with AP., Methods: We conducted a prospective cohort study of patients with AP. Patients were grouped according to whether they developed OFI during hospitalization. QoL was recorded daily during hospitalization and at 1 and 4 wk after discharge. One-way analysis of covariance and repeated measures analysis were conducted. P < 0.05 was accepted as statistically significant., Results: The study included 131 patients with AP. Fifty-two (40%) developed OFI during hospitalization. Overall QoL was significantly impaired in the OFI group (mean difference = -16.1; 95% confidence interval, -24.4 to -7.8; P ≤ 0.001). Five individual domains-physical limitations, psychological function, sleep, pain, and visceral function-were significantly impaired in the OFI group during hospitalization. Overall QoL improved significantly within each group from hospitalization to follow-up (P < 0.001) with no significant difference between the two groups at follow-up (mean difference = -2; 95% confidence interval, -7.1 to 3.2; P = 0.449)., Conclusions: QoL is significantly impaired in patients with AP who develop OFI. Nutritional management of acute pancreatitis needs to be optimized to prevent the occurrence of OFI., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Tolerance of oral refeeding is an essential goal of nutritional management of acute pancreatitis. However, oral feeding intolerance remains one of the most common complications in patients with this disease. It often results in longer periods of hospitalization, increased treatment costs, increased risk of readmission, and reduced quality of life. The traditional practice involves keeping patients nil by mouth followed by gradual stepwise reintroduction of food. However, it does not have a solid evidence base and, hence, there is increasing interest in determining alternative strategies that may be beneficial in reducing the occurrence of oral feeding intolerance. This review focuses on the randomized controlled trials that investigated the key questions informing the nutritional management of acute pancreatitis: when to feed, what to feed and who is in charge of the decision-making.

Background: There is emerging evidence that glutamine supplementation should be considered in patients with acute and critical illness associated with a catabolic response. There are reports of glutamine supplementation in acute pancreatitis but the results of these studies are conflicting. The aim of this study was to systematically review the randomised controlled trials (RCT) of glutamine in patients with acute pancreatitis., Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SCOPUS and 3 major Chinese databases were searched. The outcomes studied were mortality, total infectious complications, and length of hospital stay. A random effects model was used for meta-analysis of the outcomes in the included trials. A number of pre-specified subgroup analyses were also conducted. The summary estimates were reported as risk ratio (RR) for categorical variables and mean difference (MD) for continuous variables together with the corresponding 95% confidence interval., Results: Twelve RCT that enrolled 505 patients with acute pancreatitis were included in the final analysis. Overall, glutamine supplementation resulted in a significantly reduced risk of mortality (RR 0.30; 95% CI, 0.15 to 0.60; P < 0.001) and total infectious complications (RR 0.58; 95% CI, 0.39 to 0.87; P = 0.009) but not length of hospital stay (MD -1.35; 95% CI, -3.25 to 0.56, P = 0.17). In the subgroup analyses, only patients who received parenteral nutrition and those who received glutamine in combination with other immunonutrients demonstrated a statistically significant benefit in terms of all the studied outcomes., Conclusions: This meta-analysis demonstrates a clear advantage for glutamine supplementation in patients with acute pancreatitis who receive total parenteral nutrition. Patients with acute pancreatitis who receive enteral nutrition do not require glutamine supplementation. Further studies are warranted to determine whether patients who receive combined enteral and parenteral nutrition need glutamine supplementation., (Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.)