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Nutrition Interventions in Pediatric Pancreatitis: Guidelines We Can Trust
Xenophon Theodoridis1,2, Maria G Grammatikopoulou1,3,4, Arianna Petalidou1
1Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa.
Insights
This study reviewed pediatric pancreatitis nutritional guidelines, finding significant variability in quality. The ESPGHAN/NASPGHAN guidelines scored highest, highlighting the need for improved, transparent clinical practice guidelines for pediatric pancreatitis management.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Evidence-Based Medicine
Background:
- Pediatric pancreatitis, though uncommon, shows increasing prevalence.
- Lack of specific nutritional guidelines for pediatric pancreatitis necessitated adult CPGs.
- This study critically appraises existing guidelines for pediatric pancreatitis medical nutrition therapy (MNT).
Purpose of the Study:
- To review and critically appraise clinical practice guidelines (CPGs) for medical nutrition therapy (MNT) in pediatric pancreatitis.
- Identify the highest-scoring guidelines for pediatric pancreatitis MNT.
- Highlight gaps and areas for improvement in current pediatric pancreatitis CPGs.
Main Methods:
- Comprehensive search of electronic databases and guideline repositories.
- Appraisal of identified CPGs using the validated AGREE II tool.
- Independent review by a multidisciplinary team of 3 reviewers.
Main Results:
- Four CPGs containing pediatric pancreatitis MNT information were identified.
- The ESPGHAN/NASPGHAN joint society paper achieved the highest appraisal score.
- The Belgian consensus received the lowest score and was not recommended by most reviewers.
Conclusions:
- Significant heterogeneity exists in the quality, rigor, and transparency of pediatric pancreatitis guidelines.
- Existing CPGs for pediatric pancreatitis MNT exhibit gaps and biases.
- There is a clear need to enhance and improve specific domains within these guidelines.
Objective:
Despite the fact that pediatric pancreatitis is an uncommon disease, its prevalence has increased in recent years. Nevertheless, until 4 years ago, the lack of nutritional guidelines for pediatric pancreatitis was evident, with all recommendations being based on clinical practice guidelines (CPGs) for adults. The aim of the present study was to review and critically appraise guidelines for the medical nutrition therapy (MNT) of pediatric pancreatitis.
Methods:
A comprehensive search was performed in electronic databases (PubMed, Scopus, National Institute for Health and Care Excellence), the International Guidelines Network, BMJ best practice, and the Scottish Intercollegiate Guidelines Network to identify CPGs on the MNT of pediatric pancreatitis. The validated AGREE II tool was used for guidelines appraisal by a team of 3 independent multidisciplinary reviewers.
Results:
A total of 4 CPGs were retrieved with pediatric pancreatitis MNT information. Out of the 4 advising bodies in total, the joint society paper published by the ESPGHAN/NASPGHAN received the highest score in almost all domains, whereas the Belgian consensus obtained the lowest score in all domains but stakeholder involvement, and was not recommended by 2 out of 3 reviewers.
Conclusions:
Pediatric pancreatitis guidelines appear heterogenous in quality, rigour, and transparency. Our study points out existing gaps and biases in the CPGs, and delineates the need for improving the domains identified as being of low-quality.
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