Pancreatitis in Children

Uç, Aliye; Husain, Sohail Z.

doi:10.1053/j.gastro.2018.12.043

Cited by 112 publications

(141 citation statements)

References 109 publications

(122 reference statements)

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“…Genetic and structural defects represented a significant percentage of patients with recurrent and chronic pancreatitis. This high frequency is similar to that seen in other studies of pediatric pancreatitis [19, 27, 33, 35]. This highlights the importance of pursuing an investigation for an underlying genetic or structural etiology, especially in those presenting with a recurrent episode of pancreatitis or evidence of chronic pancreatitis.…”

Section: Discussionsupporting

confidence: 85%

“…Other categories were determined in a post hoc manner. We assumed that alcohol would not be a significant etiology in this age group due to previous research showing that alcohol use disorder is nonexistent to extremely rare in the preadolescent age range, use of alcohol among children has declined significantly over the last 10 years, and that alcohol has been found to be nearly negligible as an etiology for pediatric pancreatitis [19–25]. Patients with traumatic pancreatitis were identified and excluded as this group has been studied extensively.…”

Section: Methodsmentioning

confidence: 99%

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Pancreatitis in pre-adolescent children: a 10 year experience in the pediatric emergency department

et al. 2019

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BackgroundThe diagnosis of pediatric pancreatitis has been increasing over the last 15 years but the etiology of this is uncertain. The population of pre-adolescent patients with pancreatitis in the emergency department has not been specifically described. Our objective was to determine the characteristics of these patients to illuminate this population and disease in order to better identify them and avoid a delay in diagnosis and treatment.MethodsThis was a retrospective descriptive study of consecutive pediatric patients under the age of 13 years between 2006 and 2016 who presented to our pediatric emergency department with a diagnosis of atraumatic pancreatitis. Patient characteristics, lab and imaging results, identified etiology of pancreatitis, and recurrence rates were recorded and evaluated.ResultsThere were 139 visits, of which 85 were for a first episode of acute pancreatitis, and 54 were patients with an episode of recurrent pancreatitis. The median age for all visits was 8 years (IQ range 5–11). Of the acute cases, 26% had uncertain or undetermined etiologies of which half were thought to likely be viral related; 20% had systemic inflammatory or autoimmune diseases; 19% were associated with medications, with the most common being valproic acid; 16% were cholelithiasis-related; and 15% were found to have a genetic, congenital or structural etiology. No patients had elevated triglycerides. Those with cholelithiasis and genetic or structural defects were found to have a higher recurrence rate than those with other etiologies. There were only four patients diagnosed with chronic pancreatitis.ConclusionsThe etiology of pancreatitis in pre-adolescent children has a different distribution than in adolescents and adults, with gallstone disease less frequent and concurrent contributing illness more common. Patients on pancreatitis-causing medications or with known genetic risk or structural pancreatic problems should be tested for pancreatitis if presenting with concerning symptoms. Hypertriglyceridemia and chronic pancreatitis with evidence of pancreatic exocrine insufficiency is uncommon in this population.

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Section: Discussionsupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Pancreatitis in pre-adolescent children: a 10 year experience in the pediatric emergency department

et al. 2019

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“…For AP with speci c causes, such as bile duct stones, anatomical abnormalities, bile duct dilatation, etc., it has been suggested that surgery should be performed as soon as possible after the condition is controlled and stable, to prevent recurrence [11,21]. In the literature [22], the mortality rate of pediatric AP is less than 5%, which is signi cantly lower than that of adult AP, possibly because: (1) Alcoholic pancreatitis is rare in pediatric cases, and alcoholic pancreatitis is a known cause of high mortality, with a mortality rate as high as 30.6% [23]. (2) With age, adults may lose some critical protective mechanism, which children retain [6].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China

Zhong

Tan

Yan

et al. 2020

Preprint

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Background: The diagnosis of pediatric pancreatitis has been increasing over the last 20 years. We aimed to compare the clinical characteristics for pediatric acute pancreatitis (AP) with adult AP, and investigate the risk factor for acute recurrent pancreatitis (ARP) in children. Method: From June 2013 to June 2019, a total of 130 pediatric patients with AP at the inpatient database were enrolled. Univariate analysis and multivariate Cox regression analysis were performed to identify the risk factors for ARP in children. Result: Major etiologic factors in 130 patients were biliary (31.5%), idiopathic (28.5%), trauma (16.2%). There was a significant difference in the constituent ratio of etiology between pediatric patients and adult patients (p<0.001). Compared with the adult patients, the pediatric patients had significantly lower severity (p=0.012) and occurrence rate of pancreatic necrosis (p=0.02). During the follow-up time (34.2±20.8 months), 19 children (14.6%) developed into ARP. Multivariate Cox regression analysis showed that female (p=0.025; OR=3.632; 95%confidence interval(CI) 1.179-11.188), hyperlipidemia (p=0.022; OR=3.480; 95%CI 1.201-10.085), pancreatic necrosis (p=0.001; OR=8.815; 95%CI 2.446-31.774) were the independent risk factors of ARP. The risk of recurrence was significantly different in each etiology group. Hyperlipidemic AP had the highest risk of recurrence over time, while viral and drug-induced AP had the lowest risk of recurrence (p=0.035).Conclusion: Biliary and idiopathic disease were the major etiologies of AP in children. Compared to adults, children tend to have milder disease conditions and a better prognosis. Female, hyperlipidemia, and first AP attack with pancreatic necrosis were associated with the increased risk of ARP.

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“…Moreover, the actuarial incidence of chronic pancreatitis in children is increasing and (2 cases:100,000 people/year, with overall prevalence of 6 cases:100,000 inhabitants). The most common genetic alterations are SPINK1, PRSS1, CEL-HYB, CFTR, CAP1, CTRC, CEL (18, 19). After the exclusion of more obvious and prevalent toxic causes such as smoking and alcohol, rarer metabolic toxic agents should be screened for, in the index visit.…”

Section: Risk Factors and Clinical Coursementioning

confidence: 99%

Conservative Treatment of Chronic Pancreatitis: A Practical Approach

et al. 2020

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Background: Chronic pancreatitis is a long-standing, inflammatory condition of the pancreas that leads to the progressive damage and loss of function of pancreatic parenchyma and to the development of possible locoregional and systemic medical complications. Materials and methods: In this review, we tried to summarize the current evidence on non-surgical treatment trying to suggest a practical approach to the management of chronic pancreatitis. Results: Besides the unclear pathophysiological mechanism and a poorly unknown epidemiology, chronic pancreatitis is a complex syndrome that displays different possible challenges for physicians. Despite being traditionally considered as a benign disease, chronic pancreatitis encompasses 10-year mortality rates which are superior to the ones reported for some of the most common cancers. Conclusions: Chronic pancreatitis encompasses the management of multiple and complex medical co-morbidities that needs to be understood and addressed in a multidisciplinary specialist context.

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Pancreatitis in Children

Cited by 112 publications

References 109 publications

Pancreatitis in pre-adolescent children: a 10 year experience in the pediatric emergency department

Pancreatitis in pre-adolescent children: a 10 year experience in the pediatric emergency department

Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China

Conservative Treatment of Chronic Pancreatitis: A Practical Approach

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