Effect of Jejunal Long-Term Feeding in Chronic Pancreatitis

Outpatient Pain Management in Children With Chronic Pancreatitis: A Scoping Systematic Review

OBJECTIVES

Although pain management is central to pediatric chronic pancreatitis (CP) care, no evidence-based guidelines exist. In this scoping systematic review, we sought promising strategies for CP pain treatment in children.

METHODS

We systematically reviewed literature on pain management in children and adults with CP, and 2 conditions with similar pain courses: juvenile idiopathic arthritis and sickle cell disease.

RESULTS

Of 8997 studies identified, 287 met inclusion criteria. There are no published studies of analgesic medications, antioxidants, dietary modification, integrative medicine, or regional nerve blocks in children with CP. In adults with CP, studies of nonopioid analgesics, pancreatic enzymes, and dietary interventions have mixed results. Retrospective studies suggest that endoscopic retrograde cholangiopancreatography and surgical procedures, most durably total pancreatectomy with islet autotransplant, improve pain for children with CP. Follow-up was short relative to a child's life. Large studies in adults also suggest benefit from endoscopic therapy and surgery, but lack conclusive evidence about optimal procedure or timing. Studies on other painful pediatric chronic illnesses revealed little generalizable to children with CP.

CONCLUSIONS

No therapy had sufficient high-quality studies to warrant untempered, evidence-based support for use in children with CP. Multicenter studies are needed to identify pain management "best practices."

ESPEN guideline on clinical nutrition in acute and chronic pancreatitis

Both acute and chronic pancreatitis are frequent diseases of the pancreas, which, despite being of benign nature, are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20% of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis. Abdominal pain leading to decreased oral intake, as well as exocrine and endocrine failure are frequent complications of the disease. All of the above represent risk factors related to malnutrition. Therefore, patients with chronic pancreatitis should be considered at risk, screened and supplemented accordingly. Moreover, osteoporosis and increased facture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered.

Efficacy of enteral nutrition for the treatment of pancreatitis using standard enteral formula

BACKGROUND AND AIMS

Elemental formula delivered distal to the ligament of Treitz has demonstrated efficacy in patients with pancreatitis, presumably by decreasing pancreatic stimulation. Few data exist on the use of standard enteral formula in such patients. This study describes the outcomes of pancreatitis patients managed with long-term standard enteral nutrition (EN).

METHODS

One hundred twenty-six patients managed at the University of Virginia Health System with pancreatitis requiring nutritional support between August 2000 and June 2004 received a standard formula delivered distal to the ligament of Treitz and were followed prospectively to resolution of their disease process. Predictors of improvement in CT Severity Index, duration of EN, and length of hospital stay were identified. Changes in body weight and serum albumin were determined.

RESULTS

Mean age was 50.8 +/- 15.2 yr (male, 83). Etiology included alcohol (46), gallstones (49), idiopathic (15), post-ERCP (7), drug (5), hyperlipidemia (3), and pancreas divisum (1). EN lasted a median of 18.9 (2.4 to 111.7) wk. Median CT Severity Index decreased from 4 to 2 (p < 0.001). Underweight patients gained 9.8 lbs; overweight and obese patients lost 7.2 and 28.8 lbs, respectively. Albumin concentration increased from 3 to 3.8 g/dL (p < 0.001).

CONCLUSIONS

Standard enteral formula is effective in the management of patients with complicated pancreatitis.