Transient Exocrine Pancreatic Insufficiency in Children

Abstract

Objectives: Pancreatic insufficiency in children is usually associated with diseases such as cystic fibrosis, Shwachman-Diamond syndrome, or chronic pancreatitis. Fecal elastase-1 is a reliable laboratory test for the diagnosis of exocrine pancreatic insufficiency (EPI). Transient pancreatic insufficiency has been rarely described and data on this entity are lacking in the medical literature. In this retrospective study we report 17 cases of transient pancreatic insufficiency presented mainly with failure to thrive and/or diarrhea. Methods: We followed 43 children (age range 1 month–18 years) with low fecal elastase-1 in our institution between the years 2009 and 2017. We followed growth and laboratory results (particularly, complete blood count, albumin, transaminases, celiac serology, sweat test, and fat-soluble vitamins). Elastase levels <200 mg/g were considered as pancreatic insufficiency. Results: Twenty-six were excluded due to missing data, a comorbidity or being syndromatic. Enrolled children (17) were all otherwise healthy. The median age at diagnosis was 3 years (range 0.2–15 years), 11 girls and 6 boys. Their main presenting symptoms were failure to thrive and/or diarrhea. Median fecal elastase-1 levels were 71 mg/g (range 18–160). Median time for normalization was 6 months (range 1–48 months). Abdominal sonography, celiac serology, and sweat test were normal for all patients. Most patients were treated with pancreatic enzymes until resolution. Conclusions: Transient EPI without clear etiology should be in the differential diagnosis of EPI after ruling out known etiologies. The resolving course pattern may be attributed to an unidentified infectious agent. Further studies to assess the etiology are mandated.

Diagnosis dan Tata Laksana Pankreatitis pada Anak

“…Sementara di Amerika, pemberian terapi enzim pengganti dibedakan berdasarkan berat badan, komposisi lemak dalam makanan, atau berdasarkan volume makanan. 24 27 Pankreatitis kronik dapat menyebabkan diabetes melitus (DM) pankreatogenik yang juga disebut sebagai DM tipe 3c dengan prevalensi 4-9% pada anak. 28 Oleh karena ada risiko terkena diabetes, perlu dilakukan skrining DM setahun sekali dengan pemeriksaan gula darah puasa (GDP) dan hemoglobin A1c (HbA1c).…”

Medical Management of Chronic Pancreatitis in Children

“…Reference laboratories, however, usually cite <100 mg/g stool as abnormal, 100 to 200 mg/g as indeterminate or with moderate EPI, with >200 mg/g as normal, with the same reference ranges utilized for CP in children (20,21). Fecal elastase is a spot test that varies with age or may be transiently decreased and may require multiple measurements over time during clinical decision making to account for progression to EPI and account for the multiple variables, which may impact results (22,23). Additionally, transient EPI can occur after pancreatic injury, viral infection or for unclear reasons.…”

“…Additionally, transient EPI can occur after pancreatic injury, viral infection or for unclear reasons. As such, repeat testing of fecal elastase may be influenced by clinical symptoms (22). Fecal elastase tends to perform best at the ends of the reference ranges (24), with intermediate values often requiring more investigation to correlate with EPI; this may be in particularly true in patients with chronic pancreatitis.…”