Analysis of INSPPIRE‐2 Cohort

Abstract

Objectives: The objective of this study is to investigate risk factors and disease burden in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Methods: Data were obtained from INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2), the largest multi-center prospective cohort study in pediatric patients with ARP or CP. Results: Of 689 children, 365 had ARP (53%), 324 had CP (47%). CP was more commonly associated with female sex, younger age at first acute pancreatitis (AP) attack, Asian race, family history of CP, lower BMI%, genetic and obstructive factors, PRSS1 mutations and pancreas divisum. CFTR mutations, toxic-metabolic factors, medication use, hypertriglyceridemia, Crohn disease were more common in children with ARP. Constant or frequent abdominal pain, emergency room (ER) visits, hospitalizations, medical, endoscopic or surgical therapies were significantly more common in CP, episodic pain in ARP. A total of 33.1% of children with CP had exocrine pancreatic insufficiency (EPI), 8.7% had diabetes mellitus. Compared to boys, girls were more likely to report pain impacting socialization and school, medical therapies, cholecystectomy, but no increased opioid use. There was no difference in race, ethnicity, age at first AP episode, age at CP diagnosis, duration of disease, risk factors, prevalence of EPI or diabetes between boys and girls. Multivariate analysis revealed that family history of CP, constant pain, obstructive risk factors were predictors of CP. Conclusions: Children with family history of CP, constant pain, or obstructive risk factors should raise suspicion for CP.

Endotherapy in pediatric pancreatitis

“…Children with chronic pain from obstructive ductal disease stand the most to benefit from ERCP, either by removing pancreatic duct stones or addressing ductal strictures with balloon/catheter dilation or stent placement [11]. Children with CP in the INSPPIRE cohort undergo ERCP far more frequently than those with ARP, with 72% of CP patients having at least one ERCP compared to 11% with ARP [1 ▪ ].…”

“…Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are rare but often debilitating diseases in the pediatric population with an incidence of approximately 2 in 100 000 children [1 ▪ ,2]. Quality of life for these children can be negatively impacted, particularly secondary to chronic pain and endocrine or exocrine pancreatic dysfunction.…”

“…Quality of life for these children can be negatively impacted, particularly secondary to chronic pain and endocrine or exocrine pancreatic dysfunction. The reported healthcare burden is also high for both ARP and CP with frequent emergency department visits and a median hospitalization rate of two admissions per year [1 ▪ ].…”

“…The largest longitudinal cohort of pediatric ARP and CP (INSPPIRE-2 [INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE]) has provided much needed information on the utilization and potential benefit of endotherapy for children with ARP and CP. Those with CP are more likely to receive endoscopic therapy than those with ARP, with the most common interventions reported in the INSPPIRE-2 cohort being pancreatic sphincterotomy and pancreatic duct stent placement [1 ▪ ].…”