Comparison of Immediate Oral Feeding vs Conventional Oral Feeding in Patients with Mild to Moderately Severe Acute Pancreatitis: A Randomized Controlled Trial from a Tertiary Care Center in North India.

Aim and background: Acute pancreatitis (AP) is an inflammatory condition of the pancreas with varying severity, traditionally managed by delaying oral feeding to prevent enzyme stimulation. However, prolonged fasting may worsen patient outcomes by increasing catabolism and the risk of bacterial translocation. This study aims to compare the effects of immediate oral feeding (IOF) within 24 hours of hospital admission vs conventional oral feeding (COF) after 48 to 72 hours in patients with mild to moderately AP, hypothesizing that IOF will reduce length of hospital stay (LOHS) without increasing complications. Methods: An open labeled, stratified, randomized controlled trial (RCT) involving adult patients with mild to moderate AP, conducted at Government Medical College and Hospital, Chandigarh, India, with 100 adult participants, over a duration of 18 months and registered in the Clinical Trial Registry of India (CTRI/2023/02/049370) on February 1, 2023. Patients were randomized into two treatment groups: IOF (intervention group) and COF (control group). In the IOF group, the diet was started within 24 hours of admission, and in the COF, the diet was started in a stepwise manner after 48-72 hours. Decisions regarding the progression of the diet and the timing of hospital discharge were made by the medical team independently, without involvement from the study team members. The primary outcome was to observe the LOHS, while the secondary outcome was to observe recurrence of abdominal pain and diet intolerance and to analyze the laboratory parameters between the two groups. Results: We randomized 100 patients: 51 to the IOF and 49 to the COF groups. The LOHS was significantly shorter in the IOF group, with a mean of 4.5 ± 6.9 days, compared to 7.5 ± 5.5 days in the COF group ( Conclusion: Administration of an immediate oral low-fat solid diet to patients with mild to moderately severe AP appears safe, feasible, and may reduce the LOHS, with comparable results to COF regarding diet intolerance, recurrence of pain, and complications. Further research is needed to compare low- and normal-fat diets for optimal outcomes. Clinical significance: This study shows that IOF in mild to moderately severe AP can safely reduce hospital stays without increasing complications. It highlights the potential of early nutritional intervention to enhance recovery and streamline care. How to cite this article: Sandeep VS, Dahra A, Singh P,