Nutritional management of chronic pancreatitis: A systematic review and meta‐analysis of randomized controlled trials

Abstract

Background and Aim Malnutrition is a frequent complication of chronic pancreatitis. Adequate nutritional support is imperative, but there is still uncertainty about the optimal nutritional treatment. This work systematically compiles evidence from randomized controlled trials investigating dietary interventions in chronic pancreatitis and, in a further step, contrasts those findings with existing dietary recommendations. Methods The literature search (PubMed and Cochrane Central Register of Controlled Trials) included English and German full‐text articles, which had been published in peer‐reviewed journals. Two independent reviewers identified and selected studies. For meta‐analysis, forest plots with 95% confidence intervals were generated using a random‐effects model. Results Eleven randomized controlled trials fulfilled all selection criteria. In these trials, the following dietary interventions were tested: antioxidant treatment (n = 6), vitamin D supplementation (n = 3), supplementation with oral nutritional supplements (n = 1), and symbiotics supplementation (n = 1). Studies were of good methodological quality (mean Jadad score of 3.6) but heterogeneous in terms of interventions and study populations. Only for vitamin D, there was convincing evidence for efficacy of supplementation. We found no effect for antioxidant treatment on pain relief (standardized mean difference = −0.12; 95% confidence interval −0.73 to 0.48) and limited generalizability for interventions with oral nutritional supplements and symbiotics. Conclusions Nutritional management in chronic pancreatitis remains challenging. As well‐designed randomized controlled trials are scarce, in large part, recommendations can only be based on low‐level evidence studies or expert opinion. For now, consumption of a balanced diet remains the cornerstone recommendation for prevention, whereas more goal‐directed interventions are indicated for specific nutrient deficiencies.

PACAP and PAC1 Receptor Expression in Human Insulinomas

“…Chronic pancreatitis is associated with repeated inflammations, causing tissue fibrosis, often pain and destruction of the pancreas. It affects both the endocrine and the exocrine parts of the organ, with need for specific nutrition and diet (Gress et al 1994a, b;Michalski et al 2008;Wiese et al 2020). Epidemiological data are difficult to estimate (incidence is varying from 4 to 13.4/100.000), because patients have often compliance problems as chronic alcoholism is one of the leading causes of this disease (Lévy et al 2014).…”

Malnutrition Is Highly Prevalent in Patients With Chronic Pancreatitis and Characterized by Loss of Skeletal Muscle Mass but Absence of Impaired Physical Function

“…We did not see any association of malnutrition with etiology, continued substance abuse, pain, endocrine or exocrine function. Although, for the most part, contribution of these factors is rather derived from pathophysiological considerations than evidence from clinical trials ( 22 ), these findings were unexpected. As almost half of all patients had received their diagnosis within the last year, it is possible that the aforementioned factors increase the risk of malnutrition only with longer disease duration or if treated inadequately.…”

S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003

“…Aktuelle Meta-Analysen berichten überwiegend geringe positive Effekte, sind teils aber auch negativ [452][453][454][455][456]. Eine nach Abschluss der Leitlinienerstellung veröffentlichte Meta-Analyse konnte keinen positiven Effekt für die Therapie mit Antioxidantien feststellen [457].…”