Demographics and risk factors for pediatric recurrent acute pancreatitis

Abstract

Purpose of review Approximately 20–30% of children who experience one episode of acute pancreatitis will have at least one additional episode. For some children, pancreatitis recurs multiple times and in a few years is followed by the diagnosis of chronic pancreatitis. Identifying risk factors for recurrent episodes and disease progression is critical to developing therapeutic interventions. Recent findings Obesity is driving an increase in biliary stone disease and severe acute pancreatitis. Recurrent acute pancreatitis (RAP) may lead to the development of diabetes through autoimmune mechanisms. Cystic fibrosis or CFTR-related disorders may present as RAP and CFTR modulator therapy can increase or decrease the risk of acute pancreatitis in these populations. Children with Crohn disease have a three-fold risk of acute pancreatitis over the general population while children with ulcerative colitis are at increased risk for pediatric autoimmune pancreatitis, a disorder that may be distinct from autoimmune pancreatitis described in adults. Obstructive jaundice in the absence of identified mechanical factors may be a presenting sign of pediatric autoimmune pancreatitis. Summary Pediatric RAP is a painful condition that leads to gland destruction and functional insufficiency. Risk factors are being clarified but preventive treatments remain elusive.

Risk factors for the progression from acute recurrent to chronic pancreatitis among children in China

“…The number of drug-related risk factors in the etiological analysis of ARP in this study was higher than that in other studies ( 15 , 16 ), probably because SCMC is one of the largest cancer centers in China, with many hematopathy patients receiving treatment at the center, and because asparaginase is a commonly used chemotherapy drug for acute lymphoblastic leukemia, thus increasing the proportion of cases with drug-induced ARP. Similarly, the number of patients with ARP caused by tumor compression or infiltration increased in the etiology of this study.…”

“…The number of drug-related risk factors in the etiological analysis of ARP in this study was higher than that in other studies (15,16), probably because SCMC is one of the largest cancer centers in China, with many hematopathy patients receiving treatment at the center, and because asparaginase is a commonly used chemotherapy drug for acute lymphoblastic leukemia, thus increasing the proportion of cases with druginduced ARP. Similarly, the number of patients with ARP Frontiers in Pediatrics 05 frontiersin.org Comparison of the Kaplan-Meier curves of CP progression between those with (blue) and without (yellow) gene mutations showed a significantly faster rate of progression from ARP to CP (HR of progression was 1.607; 95% CI: 1.024, 2.522; P = 0.039).…”

Nutrition management and pancreatitis in children: new insights

“…The incidence of childhood obesity continues to rise both in the US and globally [15,16]. Obesity is associated with chronic inflammation, oxidative stress, and more severe AP [17]. Children with obesity are at increased risk of gallstone pancreatitis, and hence cholecystectomy [17].…”

“…Obesity is associated with chronic inflammation, oxidative stress, and more severe AP [17]. Children with obesity are at increased risk of gallstone pancreatitis, and hence cholecystectomy [17]. The International Study Group of Pediatric Pancreatitis in Search For A Cure (INSPPIRE) showed that in their cohort; children who were obese or overweight had their first AP episode and diagnosis of CP at a later age and were less likely to be diagnosed with CP than children who were underweight or normal weight [18].…”

Bicarbonate Transport in Cystic Fibrosis and Pancreatitis

“…Recent studies of ivacaftor with or without lumacaftor contradicted the assertion that exocrine pancreatic insufficiency is irreversible in CF children [ 143 , 144 , 145 ]. However, while pancreatic function improved, as evidenced by the increased fecal elastase-1 concentration and decreased immunoreactive trypsinogen levels, some studies reported an increase in pancreatitis episodes, resembling the phenotype of pancreatic-sufficient CF patients [ 143 , 144 ]. However, in pancreatic-sufficient CF adults, CFTR modulator therapy reduced the risk and frequency of RAP [ 146 , 147 ].…”