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The initial meal given to patients with AP is considered to be important in determining whether reintroduction of oral intake is tolerated. Patients following the conventional stepwise refeeding protocol are traditionally started on a hypocaloric clear liquid diet and, if this first meal is well tolerated, soft diet (modified in texture, and in caloric and fat content) and solid low‐fat diet are introduced in a stepwise manner until the patient can tolerate a normal oral diet [13].

In the study performed by our group [11], a protocol for refeeding with a solid low‐fat diet (about 1800 kcal, 19 g of fat) versus standard stepwise increasing caloric diet over three days was evaluated (see Table 11.1). We found that a solid low‐fat diet from the start was similarly tolerated compared to stepwise increasing caloric intake, and it was associated with a shorter LOHS if associated with early refeeding.

Different protocols for refeeding in subjects with mild AP have been investigated in five previous randomized clinical trials [2,4–7]. Jacobson et al. [5] compared a clear liquid diet (588 kcal, 2 g of fat per day) to a low‐caloric, low‐fat diet (1200 kcal, 35 g of fat per day) in patients with mild AP and showed no difference in tolerance or LOHS. Moraes et al. [6] performed a study with three treatment arms comparing a hypocaloric clear liquid diet, an intermediate hypocaloric soft diet (both around 250 kcal, 2 and 4 g of fat, respectively) and a full solid diet (around 1200 kcal, 30 g fat per day) in patients with mild AP. No differences in pain relapse rates or LOHS between the three treatment arms were found. Sathiaraj et al. [7] compared refeeding with a clear liquid diet (458 kcal, 11 g of fat) to a soft diet (1040 kcal, 20 g fat per day) in patients with mild AP. LOHS was significantly reduced in the soft diet group. Finally, Rajkumar et al. [4] investigated clear liquid diet compared to soft diet. Total and post‐refeeding LOHS was shorter in the soft diet group. None of the previously published randomized clinical trials observed any increased risk of refeeding intolerance or other adverse events related to the more aggressive refeeding protocols [2,4,6,7].