University of Wisconsin School of Medicine & Public Health Madison, WI, United States
William Barge, MD1, Gabrielle Waclawik, MD1, Patrick Pfau, MD1, Deepak Gopal, MD, FRCP(C), FACG1, Anurag Soni, MD1, Melissa Phillips, RD2, Kelley Wilson, RD1, Mark Benson, MD1 1University of Wisconsin School of Medicine & Public Health, Madison, WI; 2University of Wisconsin Hospital and Clinics, Madison, WI
Introduction: Chronic Pancreatitis (CP) is a debilitating disease with significant complications including chronic pain, malabsorption, nutritional deficiencies, weight loss and failure to thrive. Despite the importance of dietary modification in the management of CP, an outpatient nutrition evaluation is not a formal society guideline recommendation. The aim of our study is to examine whether formal outpatient nutrition consultation, as well as other lifestyle factors, are associated with improved clinical outcomes in patients with CP.
Methods: Using ICD-10 codes to query the electronic health record, we performed a retrospective cohort study of patients with CP receiving gastroenterology ambulatory care at a single academic tertiary care center from 1/1/2015 to 1/1/ 2020. Patients were excluded from the study if CP diagnosis was not confirmed by cross-sectional imaging (CT or MR) or endoscopic ultrasound, or if patient had a chronic feeding tube for nutrition. Patient lifestyle factors studied included alcohol use, tobacco use and narcotic use. Clinical outcomes (weight change, emergency room evaluations for abdominal pain) in patients who had nutrition consultation were compared to those who had not. Nutrition consultation was defined as an outpatient appointment with a registered dietitian for the sole purpose of dietary management of CP.
Results: Of 321 charts reviewed, 144 patients met inclusion criteria. During the study period, 10.4% (15) of patients received nutrition consultation, and as a result had significantly fewer ER visits for pain than those that did not see nutrition (20% vs 53%, P=0.027). At follow-up, the nutrition consult cohort had gained, rather than lost weight as compared to the cohort that did not see nutrition (87 % vs 55 %, P < 0.001). Patients on pancreas enzyme supplements were more likely to gain weight (61% vs 33%, P = 0.052). Patients who used narcotics for chronic pain control presented more frequently to the ER for abdominal pain (75% vs 31%, P < 0.001). Patients who used tobacco also presented to the ER more often (69% vs 44%, P=0.016).
Discussion: 1. Formal outpatient nutrition consultations significantly improved clinical outcomes for patients with chronic pancreatitis. 2. Both ongoing narcotic use and tobacco use were associated with significantly more ER visits for abdominal pain management. 3. Larger prospective studies are warranted on the influence of nutrition consultation, tobacco cessation and narcotic use in the management of chronic pancreatitis.
Figure: ER Visit frequency compared to Nutrition Consultation and Tobacco Use
William Barge indicated no relevant financial relationships.
Gabrielle Waclawik indicated no relevant financial relationships.
Patrick Pfau indicated no relevant financial relationships.
Deepak Gopal indicated no relevant financial relationships.
Anurag Soni indicated no relevant financial relationships.
Melissa Phillips indicated no relevant financial relationships.
Kelley Wilson indicated no relevant financial relationships.
Mark Benson indicated no relevant financial relationships.
William Barge, MD1, Gabrielle Waclawik, MD1, Patrick Pfau, MD1, Deepak Gopal, MD, FRCP(C), FACG1, Anurag Soni, MD1, Melissa Phillips, RD2, Kelley Wilson, RD1, Mark Benson, MD1. P1076 - Outpatient Nutrition Consultation Is Associated With Improved Clinical Outcomes for Patients With Chronic Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.