What Have We Learned About Acute Pancreatitis in Children?

Abstract

Pediatric pancreatitis has received much attention during the past few years. Numerous reports have identified an increasing trend in the diagnosis of acute pancreatitis in children and key differences in disease presentation and management between infants and older children. The present review provides a brief, evidence-based focus on the latest progress in the clinical field. It also poses important questions for emerging multicenter registries to answer about the natural history and management of affected children with pancreatitis.

Acute pancreatitis in children: a tertiary hospital report

“…The definition of AP diagnosis required at least two of three criteria: abdominal pain, especially in the epigastric region, serum amylase, or lipase activity at least three times greater than the upper limit of normal and imaging findings compatible with AP [1,2,12,13]. ARP was considered as two or more episodes of AP per year or more than three episodes over a lifetime with intervening return to baseline: complete resolution of pain ( ‡1 month pain-free interval) or complete normalization of pancreatic enzymes levels along with resolution of pain (can be shorter interval than 1 month) [1,12].…”

“…The current incidence seems to be around 3.6-13.2 cases per 100,000 individuals per year, according to some studies from Australia and United States [1,2,[7][8][9]. The reasons for this increase are not entirely clear and could represent more a geographic than a worldwide phenomenon.…”

“…A small number of patients have recurrent episodes of AP and are at risk of developing chronic pancreatitis (CP). Fibrosis and chronic inflammation can lead to exocrine failure and in a later stage endocrine compromise with the development of diabetes [1][2][3][4][5].…”

Alta frecuencia de pancreatitis aguda asociada a patología biliar en niños chilenos

“…También es notoria la alta incidencia de quistes del colédoco, llegando a un 11,1% del total de pacientes, lo que podría explicarse en el contexto de un sesgo de derivación de patología de nivel terciario a nuestra institución. En series modernas se reporta una incidencia de patología biliar de 9-30% [4][5][6]12 . Ziegler sin embargo, señala a la patología biliar litiásica (litiasis pigmentada) como la principal etiología de PA en niños, pero en su serie encontramos una alta incidencia de pacientes con enfermedades hematoló-gicas, como anemia de células falciformes 13 , lo que no es extrapolable a la realidad de nuestro país.…”

“…Artículos recientes señalan que la incidencia de la PA en niños ha aumentado en los últimos años 2,4 . Las causas más frecuentes de PA en pediatría son el trauma, las enfermedades sistémicas, el uso de drogas, la PA idiopática y la patología biliar, incluyendo alteraciones anatómicas de la vía biliar y litiasis 2,5,6 . Existe consenso en que la PA idiopática ocupa un lugar relevante en la lista de causas (en ocasiones, primer lugar), postulándose mutaciones en genes involucrados en la secreción pancreática como una explicación plausible 7 .…”