Tolerance of enteral nutrition in children with acute pancreatitis

AIM: evaluation of tolerance and efficacy of enteral nutrition inpatients with acute pancreatitis hospitalised in 2005-2006 in Department of Paediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz. MATERIAL AND METHODS: analysis involved the course of enteral nutrition in 15 children hospitalised in 2005-2006 (aged 11.24+/-3.31 year), in whom 19 episodes of acute pancreatitis were observed caused by: trauma (n=4), SPINK1 mutation (n=1, in analysing period 5 episodes was observed in patient) -mutation of serine protease inhibitor Kazal type 1, pancreas divisum (n=1), cholelithiasis (n=1), parasitic AP (n=2), drug-induced (n=3), idiopathic (n=3). 16 episodes were mild and 3 severe (2 pseudocysts and 1 rapture of pancreas). Half-elementary / low-fat diet (Peptisorb / NUTRICIA) was applied by nasojejunal cathether, using pomp (Flocare). Duration, clinical tolerance of enteral nutrition, amount of calories, change of body weight were estimated. RESULTS: the length of enteral nutrition varied from 3 to 46 days (average 16.15+/-10.71). The shortest course involved a patient with hereditary acute pancreatitis (average 7.4+/-2.6) the longest one -posttraumatic pancreatitis (average 28.5+/-12.28). By enteral nutrition we ensured the supply of 40.46+/-13.21 kcal/kg per day on average, reaching increase of body weight 733+/-714.23 g in 6 children; maintenance of initial weight in 3 and decrease in 10 patients (average 600+/-534.52 g). Undesirable effects (nausea, diarrhoea, vomitus), observed in 9 episodes of acute pancreatitis (47.4%) were short term in 6 (31%), needed modification of nutritional therapy in 3 (15.7%) (lowering dose of EN in 2, TPN in 1). CONCLUSIONS: 1. Enteral nutrition in children with mild acute pancreatitis is a useful method of therapy and undesirable effects appearing in some patients have transient character. 2. Developing complications in patients with posttraumatic pancreatitis may decrease tolerance to enteral nutrition.