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.

GOALS: To compare the safety and length of hospitalization (LOH) between a full solid diet as the initial meal for refeeding after mild acute pancreatitis (AP) as compared with 2 other diets. BACKGROUND: In mild AP, the need for fat restriction during refeeding has not been studied. It was hypothesized that the reintroduction of oral feeding with a full solid diet after mild AP was safe and might result in a shorter LOH. STUDY: Subjects with mild AP were randomized to receive 1 of 3 diets (clear liquid, soft, or full solid) as the initial meal during oral refeeding. Diet progression and hospital discharge were decided by the physicians that were not members of trial team. During hospital stay, patients were monitored for relapse of pain (primary endpoint), dietary intake, LOH (secondary endpoint), and 7 days postdischarge to record pain relapse rates. RESULTS: A total of 210 patients were included, 70 in each arm. On a per-protocol basis, there was no difference in pain relapse rates during refeeding between the 3 diet arms (P=0.80). Subjects initiated on a full solid diet consumed significantly more calories and fats on trial days 1 and 2 (P<0.001). A shorter LOH (median of -1.5 d) was observed among patients receiving a full solid diet without abdominal pain relapse (P=0.000). CONCLUSIONS: Oral refeeding with a full solid diet in mild AP was well tolerated and resulted in a shorter LOH in patients without abdominal pain relapse.

Psychological distress in Brazilian Crohn's disease patients: screening, prevalence, and risk factors.

BACKGROUND: Psychological disturbances are frequent in Crohn's disease (CD) patients. However, epidemiological studies of non-western CD populations are limited and may be confounded by genetic and disease-related influences. The aim of this study was to assess the prevalence and risk factors for depression and symptoms of anxiety in Brazilian patients with CD. MATERIAL/METHODS: In this cross-sectional study, 110 CD patients and 110 control subjects with erosive esophagitis were assessed for depression and anxiety symptoms using the Beck Depression Inventory and the Hospital Anxiety and Depression Scale. RESULTS: The Crohn's and control groups were similar with regard to socio-demographic data. Compared with the controls, the CD patients had a significantly higher prevalence of depressed mood (25.4% vs. 8.2%, P=0.003). There was no significant difference in the prevalence of anxiety between CD subjects (33.6%) and controls (22.7%). Depressed mood rates were higher among those who had active disease and greater CDAI scores (OR: 3.4, 95%CI 1.1-10.8). Family history of depression (OR: 5.3, 95%CI: 2.7-15.1) was related to the co-occurrence of anxiety symptoms. CONCLUSIONS: In CD patients, depression and anxiety are highly concurrent conditions. Disease activity was strongly associated with depressed mood, while a family history of depression was related to anxiety. Screening for depression and anxiety should be carried out routinely as part of quality of care improvement in CD individuals.