Pancreatitis

Notes: Sumimoto, Kimi

Uchida, Kazushige

Mitsuyama, Toshiyuki

Fukui, Yuri

Kusuda, Takeo

Miyoshi, Hideaki

Tomiyama, Takashi

Fukata, Norimasa

Koyabu, Masanori

Sakaguchi, Yutaku

Ikeura, Tsukasa

Shimatani, Masaaki

Fukui, Toshiro

Matsushita, Mitsunobu

Takaoka, Makoto

Nishio, Akiyoshi

Okazaki, Kazuichi

eng

Research Support, Non-U.S. Gov’t

Validation Studies

Switzerland

IAP

2013/05/31 06:00

Pancreatology. 2013 May-Jun;13(3):230-7. doi: 10.1016/j.pan.2013.02.010. Epub 2013 Mar 14.

URL: http://www.ncbi.nlm.nih.gov/pubmed/23719593

Author Address: Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, 10-15 Fumizono, Moriguchi, Osaka, Japan.

 

 

Reference Type:  Journal Article

Record Number: 5243Author: Sun, E., Tharakan, M., Kapoor, S., Chakravarty, R., Salhab, A., Buscaglia, J. M. and Nagula, S.

Year: 2013

Title: Poor compliance with ACG guidelines for nutrition and antibiotics in the management of acute pancreatitis: a North American survey of gastrointestinal specialists and primary care physicians

Journal: JOP

Volume: 14

Issue: 3

Pages: 221-7

Date: May

Short Title: Poor compliance with ACG guidelines for nutrition and antibiotics in the management of acute pancreatitis: a North American survey of gastrointestinal specialists and primary care physicians

Alternate Journal: JOP : Journal of the pancreas

ISSN: 1590-8577 (Electronic)

1590-8577 (Linking)

DOI: 10.6092/1590-8577/871

Accession Number: 23669469

Keywords: Acute Disease

Adult

Anti-Bacterial Agents/*therapeutic use

Chi-Square Distribution

Enteral Nutrition/*methods

Gastroenterology/methods/standards

Guideline Adherence/*statistics & numerical data

Humans

Logistic Models

Middle Aged

Multivariate Analysis

Pancreatitis/*therapy

Parenteral Nutrition/*methods

Physicians, Primary Care/statistics & numerical data

Practice Guidelines as Topic/*standards

Questionnaires

Specialization/statistics & numerical data

United States

Abstract: CONTEXT: Despite recent updates in the treatment of acute pancreatitis emphasizing enteral nutrition over parenteral nutrition as well as minimizing antibiotic usage, mortality rates from acute pancreatitis have not improved. Data has been limited regarding physician compliance to these guidelines in the United States. METHODS: A 20 question survey regarding practice patterns in the management of acute pancreatitis was distributed to physicians at multiple internal medicine and gastroenterology conferences in North America between 2009 and 2010. Responses were analyzed using the chi-square test and multivariate logistic regression. RESULTS: Out of 406 available respondents, 43.3% of physicians utilize total parenteral nutrition/peripheral parenteral nutrition (TPN/PPN) and 36.5% utilize nasojejunal (NJ) feedings. The preferred route of nutrition was significantly related to practice type (P<0.001): academic physicians were more likely to use NJ tube feeding than private practice physicians (52.1% vs. 19.9%) while private practitioners were more likely to utilize TPN/PPN than academic physicians (70.2% vs. 20.5%). Gastroenterologists and primary care physicians were equally non-compliant as both groups favored parenteral nutrition. Multivariate logistic regression demonstrated that practice type (P<0.001) was the only independent predictor of route of nutrition. Most survey respondents appropriately do not routinely utilize antibiotics for acute pancreatitis, but when antibiotics are initiated, they are for inappropriate indications such as fever and infection prophylaxis. CONCLUSIONS: Many North American physicians are noncompliant with current ACG practice guidelines for the use of artificial nutrition in the management of acute pancreatitis, with overuse of TPN/PPN and underutilization of jejunal feedings. Antibiotics are initiated in acute pancreatitis for inappropriate indications, although there are conflicting recommendations for antibiotics in severe acute pancreatitis. Improved compliance with guidelines is needed to improve patient outcomes.

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