Definitions of Pediatric Pancreatitis and Survey of Present Clinical Practices

Abstract

Objectives There is limited literature on acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in children. The INSPPIRE (International Study group of Pediatric Pancreatitis: In search for a cure) consortium was formed to standardize definitions, develop diagnostic algorithms, investigate disease pathophysiology and design prospective multicenter studies in pediatric pancreatitis. Methods Subcommittees were formed to delineate definitions of pancreatitis and a survey was conducted to analyze current practice. Results Acute pancreatitis (AP) was defined as requiring 2 of: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings of AP. ARP was defined as: ≥2 distinct episodes of AP with intervening return to baseline. CP was diagnosed in the presence of: (1) typical abdominal pain plus characteristic imaging findings or; (2) exocrine insufficiency plus imaging findings or; (3) endocrine insufficiency plus imaging findings. We found that children with pancreatitis were primarily managed by pediatric gastroenterologists. Unless the etiology was known, initial investigations included serum liver enzymes, triglycerides, calcium, and abdominal ultrasound. Further investigations (usually for ARP and CP) included magnetic resonance or other imaging, sweat chloride, and genetic testing. Respondents’ future goals for INSPPIRE included: (1) determining natural history of pancreatitis; (2) eveloping algorithms to evaluate and manage pancreatitis; and (3) validating diagnostic criteria. Conclusions INSPPIRE represents the first initiative to create a multicenter approach to systematically characterize pancreatitis in children. Future aims include creation of patient database and biologic sample repository.

Extensive Molecular Analysis Suggested the Strong Genetic Heterogeneity of Idiopathic Chronic Pancreatitis

“…The annual incidence of CP in adults is estimated to be 5-12 per 100,000 inhabitants each year in Japan, Europe and the United States (2). Data on the incidence in children are not available (3). In adults, CP is frequently secondary to alcohol…”

Pancreatitis in Children

“…10 TN met all 3 of these criteria. Although diagnosis of acute pancreatitis could have been made simply on the basis of pain and altered serum levels of pancreatic enzymes, sonography is often used to rule out obstructive causes such as cysts or tumors, trauma, or stones.…”

“…Although diagnosis of acute pancreatitis could have been made simply on the basis of pain and altered serum levels of pancreatic enzymes, sonography is often used to rule out obstructive causes such as cysts or tumors, trauma, or stones. 10 Acute pancreatitis in children most commonly is manifested as abdominal pain or irritability (either occurs in as many as 91% of cases), epigastric tenderness (86% of cases), and nausea or vomiting (74% of cases). 6,11 For patients who are nonverbal because of developmental age (such as TN), irritability is more common.…”

Pancreatitis necrohemorrágica en un niño de 11 años. Caso clínico

“…La PA es un problema emergente, 1,2,3 con una incidencia de 3,6-13,2 casos/100 000 niños. 4 La etiología en niños es variable; las causas más frecuentes son las infecciones víricas, enfermedades sistémicas, traumatológicas, idiopáticas y litiásicas. 5 Sin embargo, la pancreatitis necrotizante (necrosis mayor del 30% del páncreas y/o mayor de 3 cm de un área del páncreas) es un proceso poco frecuente (< 1% de las PA).…”