Chronic pancreatitis in children:Current knowledge in diagnosis and treatment

Abstract

Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas characterized by irreversible morphological changes and fibrosis, leading to exocrine and endocrine pancreatic insufficiency. The prevalence of chronic pancreatitis in childhood is unknown. Most likely, idiopathic causes comprise a large percentage of children with CP. CP should be considered in children presenting with recurrent abdominal pain. Pain may be disabling, exocrine pancreatic insufficiency and diabetes may develop over time. Diagnostic tests include abdominal ultrasound, contrast-enhanced CT, MRCP, ERCP, EUS. Genetic etiologies should be investigated in children with CP of unknown cause. Medical treatment includes control of the pain, replacement therapy with pancreatic enzymes, antioxidants, insulin. Endoscopic interventions (sphincterotomy/stent placement) can be used to decompress the pancreatic duct. Surgical approaches (lateral pancreaticojejunostomy, total pancreatectomy and islet autotransplantation) are rarely used in pediatrics. Although significant advances have been made in our understanding of CP in childhood within the last decade, challenge remains to develop better diagnostic techniques, treatment modalities and improved outcomes.