Nowadays, nutrition is said to be an integral aspect of acute pancreatitis (AP) treatment. Early enteral nutrition (EEN) is safe and beneficial for patients. This was confirmed by clinical experience and can be found in guidelines on managing adults with AP. Furthermore, paediatric recommendations encourage EEN use in AP. However, paediatric guidelines are based exclusively on studies in adults. Therefore, we present a review of published studies on the time of nutritional interventions in children with AP. A search was independently conducted in April 2022 by two of the authors. Only full-text papers published in English involving children between 0–21 were considered. Only four papers met our inclusion criteria: one randomised-control trial (RCT), one prospective study with retrospective chart review, and two retrospective chart reviews. All studies supported EEN and there was no recommendation of any delay in its initiation. The results of all four papers suggested EEN with a regular, normal-fat diet. EEN is safe in children with mild or moderately severe AP and may decrease the length of hospitalisation. Unfortunately, all the conclusions are based on a small amount of heterogeneous data that are mostly retrospective. Future prospective RCTs are needed.

The coexistence of inflammatory bowel disease (IBD) with pancreatic pathology is rare in children. A retrospective analysis of data from 1538 children diagnosed with IBD in 2014–2021 was conducted to determine the frequency and causes of pancreatitis and asymptomatic hyperlipasemia (HL) or hyperamylasemia (HA) in this group of patients. Among the 176 children (11.4%) with pancreatic involvement (PI), acute pancreatitis (AP) was diagnosed in 77 children (43.8%), and HA or HL was observed in 88 children (50.0%). Only a few patients were diagnosed with autoimmune or chronic pancreatitis (6.2%). PI was observed at the time of the IBD diagnosis in 26.1% of the cases. A total of 54.5% of the patients had moderate to severe IBD, and 96% had colonic involvement at the time of diagnosis of PI. Idiopathic PI was the most common (57%), followed by drug-induced PI (37%) and azathioprine (AZA). In patients with AZA-induced AP, the successful introduction of 6-mercaptopurine (6-MP) to therapy was noted in 62.5% of the children. Our results suggest that routine monitoring of pancreatic enzymes in patients with IBD should be performed, especially after the initiation of the AZA treatment. The presence of transient HA/HL in IBD does not necessarily indicate pancreatic pathology.

One of the pathophysiological mechanisms of acute pancreatitis (AP) is the reduced integrity of the intestinal mucosa. Enteral nutrition supports the gut barrier, but its effect on intestinal permeability in pediatric AP has not yet been evaluated. The aim of this study was to assess how very early enteral nutrition (within 24hours of admission) and early enteral nutrition (after the first 24hours) affect plasma zonulin levels in children with mild-to-moderate AP. We conducted a prospective randomized study between January 2019 and September 2022 in three university hospitals. It included children aged 1 to 18 years with AP. Patients were randomly assigned to one of two groups: (A) refeeding within 24hours of admission (very early nutrition) or (B) refeeding at least 24hours after admission (early nutrition). Blood samples and clinical data were collected during the first 3 days of the hospital stay. Zonulin concentrations were measured in 61 children (37 in group A and 24 in group B). The groups did not differ significantly in age, weight, height, body mass index, AP diagnostics, or laboratory results. Zonulin levels were comparable in both groups throughout the first 3 days of hospitalization. In children with mild pancreatitis, very early enteral nutrition does not appear to affect intestinal barrier permeability, as assessed by plasma zonulin levels, compared to early nutrition.