Acute and recurrent pancreatitis in children: etiological factors

Sánchez-Ramírez, Carmen Alicia; Larrosa‐Haro, Alfredo; Flores-Martínez, Silvia Esperanza; Sánchez‐Corona, José; Villa-Gómez, Alejandra; Macías-Rosales, Rocío

doi:10.1111/j.1651-2227.2007.00225.x

Cited by 100 publications

(109 citation statements)

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(34 reference statements)

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“…Sánchez-Ramirez et al 18 observaram 36 crianças com diagnóstico de PA e 19 com pancreatite recorrente, concluindo que em cerca de 35% dos casos a causa era idiopática, mesmo após investigação completa, conforme já apontado em estudos anteriores, que descrevem valores entre 10-20% de PA idiopática em crianças 19,20 . Ainda, evidências recentes apontam que parte significativa dos casos de pancreatite idiopática em crianças está relacionada a mutações genéticas diversas 18,21 , responsáveis pela ocorrência da doença diretamente ou predisponentes desta, muitas das quais localizadas no braço longo do cromossomo 7 (7q35), onde muitos genes envolvidos com a transcrição e regulação do tripsinogênio estão localizados 22 .…”

Section: Pancreatite Aguda Recorrente Hereditária: Aspectos Genéticosunclassified

“…Mais de 1.000 mutações do gene regulador da condutância transmembrana da fibrose cística (CFTR) foram descritas 15,18,23 como causadoras da doença de caráter autossômico recessivo, à medida que tornam deficitária a função dos canais de cloreto regulados por monofosfato cíclico de adenosinae, ainda, a secreção de bicarbonato de sódio, que, somadas, alteram o equilíbrio na diluição e alcalinização da secreção pancreática, permitindo a formação de plugs proteicos intraductais por acúmulo de líquido mais viscoso e predispondo à ativação de enzimas intrapancreáticas e consequente autodigestão do parênqui-ma. Estima-se que mesmo indivíduos heterozigotos para as mutações no gene CFTR tenham um risco aumentado em 40 vezes no desenvolvimento de pancreatite crôni-ca 22 .…”

Section: Pancreatite Aguda Recorrente Hereditária: Aspectos Genéticosunclassified

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Acute pancreatitis in pediatrics: a systematic review of the literature

2012

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Objective: To describe the main epidemiological, clinical, diagnostic and treatment aspects of children with acute pancreatitis.Sources: Systematic review of MEDLINE and SciELO databases in the last 5 years on acute pancreatitis in children, as well as consultation of relevant references on the texts obtained. Summary of the findings:Cases of acute pancreatitis in children have received growing attention in recent years, and an increase in the number of cases has been reported in several studies. The main etiologies in children involve biliary disease, drug-induced pancreatitis, recurrent hereditary pancreatitis and trauma, and up to 30% of cases have no defined etiology. The diagnosis is based on the combination of clinical and laboratory aspects with the increase of acinar enzymes and radiologic tests. Initial support treatment, with proper volume replacement and correction of the metabolic disturbances, besides specific nutritional therapy, are the fundamental points in the handling of acute conditions. Long term complications are unusual, and mortality rates are inferior to the rates for the adult population. Conclusions:The early diagnosis and the appropriate handling can contribute to a better outcome for the child with pancreatitis and to prevent the immediate and late complications related to the disease. More studies are required to better explain aspects related to the clinical and radiological diagnosis of pancreatitis in children, as well as aspects related to the nutritional therapy for this age group. J Pediatr (Rio J). 2012;88(2):101-14: Pancreatitis, pediatrics, nutritional support, morbidity, enteral nutrition. ResumoObjetivo: Descrever os principais aspectos epidemiológicos, clínicos, diagnósticos e do tratamento de crianças com pancreatite aguda. Fontes dos dados:Realizada revisão sistemática das bases de dados MEDLINE e SciELO nos últimos 5 anos sobre pancreatite aguda em crianças, bem como consultadas referências relevantes dos textos obtidos. Síntese dos dados:Os casos de pancreatite aguda em crianças recebem crescente atenção nos últimos anos, sendo verificado um aumento na incidência da doença em diversos estudos. As principais etiologias em crianças envolvem doença biliar, pancreatite secundária a medicamentos, pancreatite hereditária recorrente e trauma, sendo até 30% dos casos sem etiologia definida. O diagnóstico baseia-se na combinação de aspectos clínicos, laboratoriais com elevação das enzimas acinares e testes radiológicos. Tratamento de suporte inicial, com reposição volêmica adequada e correção dos distúrbios metabólicos, além de terapêutica nutricional específica, são os pontos fundamentais no manejo dos quadros agudos. Complicações a longo prazo são incomuns, e as taxas de mortalidade, inferiores às da população adulta. Conclusões:O diagnóstico precoce e o manejo apropriado podem contribuir para a melhor evolução da criança com pancreatite e prevenir as complicações imediatas e tardias relacionadas à doença. Mais estudos são necessários para melhor elucidar aspectos re...

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Section: Pancreatite Aguda Recorrente Hereditária: Aspectos Genéticosunclassified

Acute pancreatitis in pediatrics: a systematic review of the literature

2012

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“…In contrast with adults, in whom alcohol and gallstones are the most common causes of CP, etiology in children is diverse [1,3,13]. The most common cases seen in our department resulted from gene mutations, anatomic anomalies of the pancreatic duct, biliary tract diseases and lipid disturbances [4].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years an increase in the number of children with CP has been observed in our hospital as well as in other pediatric centers worldwide [1,3,4,13]. In contrast with adults, in whom alcohol and gallstones are the most common causes of CP, etiology in children is diverse [1,3,13].…”

Section: Discussionmentioning

confidence: 99%

The clinical course of chronic pancreatitis associated with lipid disturbances in children

Oracz¹,

Kierkuś²,

Socha³

et al. 2012

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K Ke ey y w wo or rd ds s: : chronic pancreatitis, lipid disturbances, hypertriglyceridemia, children. S Sł ło ow wa a k kl lu uc cz zo ow we e: : przewlekłe zapalenie trzustki, zaburzenia lipidowe, hipertriglicerydemia, dzieci.A Ad dd dr re es ss s f fo or r c co or rr re es sp po on nd de en nc ce e: : Grzegorz Oracz MD, PhD Medical records of these patients were reviewed for clinical presentation and diagnostic findings. R Re es su ul lt ts s: : Lipid disturbances were found in 25 patients (13.8%). Hypertriglyceridemia was detected in 15 patients, hypercholesterolemia in 14 patients. In 10 patients with CP and lipid disturbances other factors causing CP were present (gene mutations in 6 patients and anatomic anomalies in 6 patients). There was no statistically significant difference in the clinical course between the hyperlipidemic (HA group) and non-hyperlipidemic group (NHA group). C Co on nc cl lu us si io on ns s: : Chronic pancreatitis associated with lipid disturbances is common in children and has a similar clinical course as chronic pancreatitis without lipid disturbances. We should be aware of coexistence of hyperlipidemia and other factors causing pancreatitis, such as gene mutations.

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“…Recently, an increase in the number of paediatric AP cases in single institutions has been reported by centres in the USA, [2][3][4][5] Australia, 6 and Mexico. 7 However, these studies are retrospective reviews and the incidence of AP is usually reported as an absolute number of cases per centre per year at individual referral institutions.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Clinical Associations of Childhood Acute Pancreatitis

et al. 2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflict of Interest:The authors have no conflicts of interest relevant to this article to disclose. What's Known on This Subject: Acute pancreatitis in childhood is a relatively rare but potentially serious condition. In the past, trauma and mumps have been the commonest associations. No study has ever estimated incidence within a childhood population on a prospective basis. AbbreviationsWhat This Study Adds: Acute pancreatitis has a childhood incidence in the UK of 0.78 per 100,000/year (95%CI 0.62-0.96). Gallstones and drug therapy are now the most commonly identified associations whilst mumps and trauma are identified rarely. Children of Pakistani heritage are disproportionately affected. Contributors' Statements:Abdalmonem Majbar: Dr Majbar helped with designing the data collection instruments, collected the data, conducted all analyses, drafted the initial manuscript, and approved the final manuscript as submitted.Eleri Cusick and Paul Johnson: Ms Cusick and Professor Johnson contributed to study conceptualization and design, took part in data interpretation, critically reviewed the manuscript, and approved the final manuscript as submitted.Richard Lynn: Mr Lynn contributed to study conceptualization and design, critically reviewed the manuscript, and approved the final manuscript as submitted.Linda Hunt: Dr Hunt supported and contributed to the statistical analysis, critically reviewed the manuscript, and approved the final manuscript as submitted.Julian Shield: Professor Shield conceptualized and designed the study, supervised and assisted data collection and analyses, critically reviewed the manuscript, and approved the final manuscript as submitted.All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Results: 94 cases (48 boys) fulfilled the diagnostic criteria. The median age at diagnosis was 11.2 years (range 1.3-14.9). White children accounted for 61% of the cases compared to 28% from Asian and 5% from African ethnicities. Pakistani children accounted for 18 of 26 (69%) Asian patients and 19% of the total cohort. The incidence of AP in children in the UK was 0.78 per 100,000/year (95%CI 0.62-0.96). The incidence in Pakistani children (4.55; 95%CI 2.60-7.39) was 7-fold greater than White children (0.63; 95%CI 0.47-0.83). Of the 94 cases: 35 (37%) were idiopathic or associated with drugs 18 (19%), gallstones 12 (13%), hereditary 7 (7%), organic acidaemias 7 (7%), anatomical anomalies 5 (5%), viral infections 3 (3%), systemic diseases 2 (2%) and trauma 1 (1%). The most common drug associations were asparaginase (28%), azathioprine (17%) and sodium valproate (17%). Conclusions:Whilst still relatively uncommon in the U...

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Acute and recurrent pancreatitis in children: etiological factors

Cited by 100 publications

References 20 publications

Acute pancreatitis in pediatrics: a systematic review of the literature

Acute pancreatitis in pediatrics: a systematic review of the literature

The clinical course of chronic pancreatitis associated with lipid disturbances in children

Incidence and Clinical Associations of Childhood Acute Pancreatitis

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