Etiology and outcome of acute recurrent pancreatitis and chronic pancreatitis

Abstract

Background Owing to the lack of data, we aimed to determine the etiology and outcome of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in children in Southeast Asia. Methods This retrospective study was conducted at a university hospital in Bangkok, Thailand. We included patients aged <18 years who were diagnosed with pancreatitis from 2000 to 2021. Results Among 155 patients with pancreatitis, 21 (13.5%) were diagnosed with either ARP (n = 7) or CP (n = 14). Clinical manifestations of CP included chronic abdominal pain (n = 10, 71.4%), steatorrhea (n = 8, 57.1%), and diabetes mellitus (n = 1, 7.1%). Positive radiological findings compatible with CP were detected from an abdominal ultrasound, computed tomography, magnetic resonance cholangiopancreatography in 70%, 90.9%, and 92.9% of patients, respectively. Genetic, metabolic, and pancreaticobiliary causes were the major causes of ARP/CP (23.8% each) and the etiologies were unidentified in one‐fifth of the patients. Patients with metabolic diseases who had AP were at‐risk of developing ARP (hazards ratio [HR], 4.7, 95% confidence interval [CI]: 1.5–13.9). Children with ARP or CP were younger than those with AP (P = 0.04). Approximately two‐thirds of patients with CP had growth faltering and they had more episodes of hospitalization due to acute attacks when compared to patients with ARP ( 4 [interquartile range [IQR], 3–6] vs. 3 [IQR, 2–3]; P = 0.02). Conclusion Genetic, metabolic, and pancreaticobiliary diseases were the common etiologies of ARP and CP among children living in a developing country in Southeast Asia. The burden of CP included malnutrition and frequent hospitalization. The findings emphasize the importance of an early etiological diagnosis and monitoring for pancreatic insufficiency in ARP/CP.

Pancreas‐related persisting sequelae in ALL survivors with a history of asparaginase‐associated pancreatitis: A part of the ALL‐STAR study

“…Several studies have described the AAP phenotype and suggested underlying risk factors, which include older age at ALL diagnosis, higher cumulative dose of asparaginase, and certain host genome variants 12–16 . Potential long‐term sequelae (e.g., organ‐related symptoms, exocrine deficiency, and diabetes mellitus [DM]) could have a negative impact on growth, overall health, and quality of life, 17–21 however, this has not previously been systematically explored. Symptoms of pancreatic dysfunction may be unspecific and thus misinterpreted unless targeted screening is performed.…”

Long‐term effects of asparaginase‐associated pancreatitis

“…The increased overall survival of ALL, combined with an intensified use of ASNase in the treatment of ALL, has resulted in a growing number of long‐term AAP survivors, and calls for a focus on potential long‐term effects. Such potential late effects of ASNase treatment include morphological changes in the pancreas accompanied with recurring painful pancreatitis episodes, gastrointestinal symptoms, and endocrine and exocrine deficiency 2,9,10 that may affect growth, puberty, daily function, and health‐related quality of life 11–14 . As completion of ASNase treatment is associated with superior overall survival, 15,16 patients are commonly re‐exposed to ASNase after resolution of ASNase‐related toxicities, including AAP, depending on the anticipated risk of leukemic relapse and the severity of the toxicity 3,17 .…”

“…Such potential late effects of ASNase treatment include morphological changes in the pancreas accompanied with recurring painful pancreatitis episodes, gastrointestinal symptoms, and endocrine and exocrine deficiency 2,9,10 that may affect growth, puberty, daily function, and health-related quality of life. [11][12][13][14] As completion of ASNase treatment is associated with superior overall survival, 15,16 patients are commonly re-exposed to ASNase after resolution of ASNase-related toxicities, including AAP, depending on the anticipated risk of leukemic relapse and the severity of the toxicity. 3,17 ASNase re-exposure is associated with a 40%-50% risk of developing a second AAP episode, 18 with potential aggravation of long-term sequelae; however, detailed information on the risk of sequalae after a second AAP is not yet available.…”