Abstract:
Acute pancreatitis with its different facets and complexity poses as a fascinating area of research. A distinct clinical entity for more than ten decades, acute pancreatitis continues to contribute significantly to the morbidity, mortality, and cost of treatment. While there is a need to advance the “frontiers of its clinical management” as is substantiated by considerable evidence, this thesis aims to integrate and better understand the concept of patient-centred medicine in an acute pancreatitis setting. Quality of life, particularly during hospitalisation, is the primary endpoint of all the three studies presented in this thesis. The first study is titled “Quality of Life after Acute Pancreatitis: a systematic literature review and meta-analysis”; the second study “The Effect of Enteral Nutrition versus Conventional Nil-By- Mouth on Quality of Life after Acute Pancreatits”; and the third study “The Effect of Oral Feeding Intolerance on Quality of Life of Patients with Acute Pancreatitis”. Studies two and three are dedicated to addressing the gaps identified in the systematic literature review and studying the effect of nasogastric tube feeding (one of the optimal methods of administering enteral nutrition, the most promising supportive care modality) and nil-by-mouth (the conventional nutritional management of acute pancreatitis), and oral feeding intolerance (a common complication of nutrition management in acute pancreatitis patients) on quality of life, respectively. Although it was hypothesised that nasogastric tube feeding would result in a better quality of life than the conventional nil-by-mouth treatment, results obtained from the study did not support the same. Patients on nasogastric tube feeding, however, reported feeling more helpless than those on nil-bymouth. This was the only quality of life subscale found to differ significantly between the two groups. The third study addresses the effect of oral feeding intolerance on quality of life. Results obtained showed that quality of life was significantly impaired in patients who developed oral feeding intolerance compared with those who did not. Lastly, overall quality of life was observed to improve from time of hospital admission to discharge and from hospital discharge to both one and four weeks follow-up in both the groups.