Acute Pancreatitis: What Is It, Why Is It on the Rise, and What Are the Current Nutrition Recommendations?

Abstract

Acute pancreatitis (AP) is defined as reversible inflammation of the pancreatic parenchyma, subsequently setting off the systemic inflammatory response syndrome (SIRS). 1 Mekitarian Filho E. Carvalho WBd Silva F.D. Acute pancreatitis in pediatrics: A systematic review of the literature. J Pediatr. 2012; 88: 101-114 Crossref Scopus (17) Google Scholar , 2 Srinath A. Lowe M. Pediatric pancreatitis. Pediatr Rev Am Acad Pediatr. 2013; 34: 79-90 Crossref PubMed Scopus (39) Google Scholar , 3 Eckerwall G.E. Tingstedt B.B. Bergenzaun P.E. Andersson R.G. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery: A randomized clinical study. Clin Nutr. 2007; 26: 758-763 Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar , 4 Morinville V.D. Husain S.Z. Harrison Bai B.B. et al. Definitions of pediatric pancreatitis and survey of current clinical practices: Report from INSPPIRE (International Study Group Of Pediatric Pancreatitis: In Search For A Cure). J Pediatr Gastroenterol Nutr. 2012; 55: 261 Crossref PubMed Scopus (294) Google Scholar , 5 Banks P.A. Bollen T.L. Dervenis C. et al. Classification of acute pancreatitis—2012: Revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62: 102-111 Crossref PubMed Scopus (3525) Google Scholar SIRS is an inflammatory state affecting the whole body, defined by the presence of two or more of the following criteria: heart rate >90 beats/min, core temperature <36°C or >38°C, white blood count <4,000/μL or >12,000/μL, and respirations greater than 20 breaths/min or partial pressure of carbon dioxide <32 mm Hg. 5 Banks P.A. Bollen T.L. Dervenis C. et al. Classification of acute pancreatitis—2012: Revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62: 102-111 Crossref PubMed Scopus (3525) Google Scholar The top leading causes of AP in children are biliary disease, drug-induced, idiopathic, systemic disease, and trauma, followed by metabolic, hereditary, and infectious diseases. 1 Mekitarian Filho E. Carvalho WBd Silva F.D. Acute pancreatitis in pediatrics: A systematic review of the literature. J Pediatr. 2012; 88: 101-114 Crossref Scopus (17) Google Scholar , 6 Restrepo R. Hagerott H.E. Kulkarni S. Yasrebi M. Lee E.Y. Acute pancreatitis in pediatric patients: Demographics, etiology, and diagnostic imaging. Am J Roentgenol. 2016; 206: 632-644 Crossref PubMed Scopus (49) Google Scholar Common biliary diseases that lead to AP include biliary gallstones, biliary sludge, or anatomical anomalies of the ductal system such as sphincter of Oddi dysfunction, pancreas divisum, or annular pancreas. 1 Mekitarian Filho E. Carvalho WBd Silva F.D. Acute pancreatitis in pediatrics: A systematic review of the literature. J Pediatr. 2012; 88: 101-114 Crossref Scopus (17) Google Scholar In pediatrics, the most commonly reported cases of drug-induced AP are caused by valproic acid and l-asparaginase. 1 Mekitarian Filho E. Carvalho WBd Silva F.D. Acute pancreatitis in pediatrics: A systematic review of the literature. J Pediatr. 2012; 88: 101-114 Crossref Scopus (17) Google Scholar Systemic diseases leading to AP include sepsis, shock, hemolytic uremic syndrome, systemic lupus erythematosus, inflammatory bowel disease, and diabetes mellitus. 2 Srinath A. Lowe M. Pediatric pancreatitis. Pediatr Rev Am Acad Pediatr. 2013; 34: 79-90 Crossref PubMed Scopus (39) Google Scholar Traumatic abdominal injuries both nonaccidental and accidental, such as those sustained from motor vehicle accidents, sports injuries, and falls, can result in AP. 1 Mekitarian Filho E. Carvalho WBd Silva F.D. Acute pancreatitis in pediatrics: A systematic review of the literature. J Pediatr. 2012; 88: 101-114 Crossref Scopus (17) Google Scholar , 6 Restrepo R. Hagerott H.E. Kulkarni S. Yasrebi M. Lee E.Y. Acute pancreatitis in pediatric patients: Demographics, etiology, and diagnostic imaging. Am J Roentgenol. 2016; 206: 632-644 Crossref PubMed Scopus (49) Google Scholar Genetic mutations are a less common cause of AP. 1 Mekitarian Filho E. Carvalho WBd Silva F.D. Acute pancreatitis in pediatrics: A systematic review of the literature. J Pediatr. 2012; 88: 101-114 Crossref Scopus (17) Google Scholar , 2 Srinath A. Lowe M. Pediatric pancreatitis. Pediatr Rev Am Acad Pediatr. 2013; 34: 79-90 Crossref PubMed Scopus (39) Google Scholar Effective Treatment for Acute Pancreatitis Depends on Underlying EtiologiesJournal of the Academy of Nutrition and DieteticsVol. 119Issue 4PreviewHeinzman and colleagues,1 in the Practice Applications section of the June 2018 issue of this Journal, discuss the increasing incidence of acute pancreatitis (AP) in the pediatric population, emphasizing the lack of data on medical nutrition therapy for this condition. They discuss the lack of clarity among dietitians about the term “low-fat diet” for treatment for this population. A sample of dietitians surveyed recommended definitions varying from <10% to <30% of calories from fat. Some dietitians did not recommend a low-fat diet for patients with AP. Full-Text PDF