Minireviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2017; 23(6): 957-963
Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.957
Restoration of energy level in the early phase of acute pediatric pancreatitis
Dóra Mosztbacher, Nelli Farkas, Margit Solymár, Gabriella Pár, Judit Bajor, Ákos Szűcs, József Czimmer, Katalin Márta, Alexandra Mikó, Zoltán Rumbus, Péter Varjú, Péter Hegyi, Andrea Párniczky
Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary
Dóra Mosztbacher, Nelli Farkas, Margit Solymár, Katalin Márta, Alexandra Mikó, Zoltán Rumbus, Péter Varjú, Péter Hegyi, Andrea Párniczky, Institute for Translational Medicine, University of Pécs, 7624 Pécs, Hungary
Nelli Farkas, Institute for Bioanalyses, University of Pécs, 7624 Pécs, Hungary
Gabriella Pár, Judit Bajor, József Czimmer, Department of Gastroenterology, First Department of Medicine, University of Pécs, 7624 Pécs, Hungary
Judit Bajor, Péter Hegyi, Department of Translational Medicine, First Department of Medicine, University of Pécs, 7624 Pécs, Hungary
Ákos Szűcs, First Department of Surgery, Semmelweis University, 1082 Budapest, Hungary
Péter Hegyi, Hungarian Academy of Sciences - University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, 6720 Szeged, Hungary
Andrea Párniczky, Heim Pál Children’s Hospital, 1089 Budapest, Hungary
Author contributions: Solymár M, Pár G, Bajor J, Szűcs Á and Czimmer J searched for the articles in Pubmed and screened them using the titles and abstracts; Márta K, Mikó A, Rumbus Z and Varjú P searched for the articles in Embase and screened them using the titles and abstracts; data was collected from the eligible papers by Mosztbacher D and Párniczky A; Farkas N performed the statistical analysis; Mosztbacher D, Hegyi P and Párniczky A drafted the manuscript.
Supported by the Hungarian Scientific Research Fund, No. K116634 to Hegyi P; and the Momentum Grant of the Hungarian Academy of Sciences, No. LP2014-10/2014 to Hegyi P.
Conflict-of-interest statement: All the authors disclaim any form of conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andrea Párniczky, MD, Institute for Translational Medicine, University of Pécs, Szigeti út 12., II. em., 7624 Pécs, Hungary. andrea.parniczky@gmail.com
Telephone: +36-72-536246 Fax: +36-72-536247
Received: October 3, 2016
Peer-review started: October 7, 2016
First decision: October 20, 2016
Revised: November 21, 2016
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: February 14, 2017
Processing time: 131 Days and 23 Hours
Abstract

Acute pancreatitis (AP) is a serious inflammatory disease with rising incidence both in the adult and pediatric populations. It has been shown that mitochondrial injury and energy depletion are the earliest intracellular events in the early phase of AP. Moreover, it has been revealed that restoration of intracellular ATP level restores cellular functions and defends the cells from death. We have recently shown in a systematic review and meta-analysis that early enteral feeding is beneficial in adults; however, no reviews are available concerning the effect of early enteral feeding in pediatric AP. In this minireview, our aim was to systematically analyse the literature on the treatment of acute pediatric pancreatitis. The preferred reporting items for systematic review (PRISMA-P) were followed, and the question was drafted based on participants, intervention, comparison and outcomes: P: patients under the age of twenty-one suffering from acute pancreatitis; I: early enteral nutrition (per os and nasogastric- or nasojejunal tube started within 48 h); C: nil per os therapy; O: length of hospitalization, need for treatment at an intensive care unit, development of severe AP, lung injury (including lung oedema and pleural effusion), white blood cell count and pain score on admission. Altogether, 632 articles (PubMed: 131; EMBASE: 501) were found. After detailed screening of eligible papers, five of them met inclusion criteria. Only retrospective clinical trials were available. Due to insufficient information from the authors, it was only possible to address length of hospitalization as an outcome of the study. Our mini-meta-analysis showed that early enteral nutrition significantly (SD = 0.806, P = 0.034) decreases length of hospitalization compared with nil per os diet in acute pediatric pancreatitis. In this minireview, we clearly show that early enteral nutrition, started within 24-48 h, is beneficial in acute pediatric pancreatitis. Prospective studies and better presentation of research are crucially needed to achieve a higher level of evidence.

Keywords: pediatric pancreatitis; enteral nutrition; nil per os diet; ATP restoration; length of hospitalization

Core tip: Acute pancreatitis is a serious inflammatory disease with rising incidence both in adult and pediatric medicine. Despite the existing research activities in this field, no specific therapy is available to treat this disease. Results in basic science strongly suggest that early energy restoration could be the first-line treatment for acute pancreatitis. Our minireview suggests that early enteral nutrition should have priority in the treatment of acute pediatric pancreatitis.