Chronic Pancreatitis In Children Research Articles

Surgical treatment of chronic pancreatitis in children

Chronic pancreatitis in children is a continuous or recurrent disease characterized by irreversible inflammatory and destructive changes in the pancreas (PG), progressive fibrosis, accompanied by a gradual decrease in its exocrine and endocrine functions. In recent decades, there has been a significant increase in patients with CP; the incidence in children is estimated at 2 cases per 100,000 people. According to the literature, pancreatic cancer in the outcome of chronic pancreatitis in childhood is 6.2%. Mortality rates for CP vary in different studies: 15-20% of children with CP die from complications and secondary disorders. The purpose of the study is to study current problems and determine the prospects for the treatment of chronic pancreatitis in children based on a review of modern literature. Materials and methods. As part of the preparation, a systematic review of the world and domestic literature on the surgical treatment of chronic pancreatitis in children was carried out. Results. A literature search confirmed the lack of consensus regarding the surgical treatment of CP in children. The small number of observations does not allow us to analyze the long-term results of surgical treatment of children with CP. Patients with hereditary pancreatitis pose a particular challenge; treatment algorithms for this group of patients are not described in the literature. Also in the literature there are isolated descriptions of complications with CP in children; there are no reliable results of the effectiveness of surgical intervention for endocrine and exocrine insufficiency in children. It is necessary to conduct scientific and practical research to develop indications for surgical treatment of children with CP and to verify specific complications.

Surgical and Endoscopic Intervention for Chronic Pancreatitis in Children: The Kings College Hospital Experience.

Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst.

Chronic Pancreatitis in Children

Chronic pancreatitis (CP) in children is a rare condition and its etiology varies; it is mainly associated with genetic abnormalities, autoimmune pancreatitis, and obstruction. Most cases of CP have a history of acute pancreatitis. The magnetic resonance cholangiopancreatography is a diagnostic technique that allows noninvasive multiplanar visualization of the biliary and pancreatic ducts, and does not require contrast administration. In children with CP, the step-up management includes a limited trial of endoscopic interventions, such as endoscopic retrograde cholangiopancreatography, followed by surgery.

Chronic pancreatitis in children - report of 484 cases

Chronic pancreatitis in children - report of 484 cases

P.16: Chronic Pancreatitis in children under 18 in New South Wales, Australia: establishing suitable candidates for total pancreatectomy and islet auto transplantation (TPIAT)

P.16: Chronic Pancreatitis in children under 18 in New South Wales, Australia: establishing suitable candidates for total pancreatectomy and islet auto transplantation (TPIAT)

Anomalous Pancreatobiliary Ductal Union Presenting as Recurrent Acute and Chronic Pancreatitis in Children and Adolescents With Response to Endotherapy.

Introduction Anomalous pancreaticobiliary duct union (APBDU) is defined by the abnormal position of the junctional union of the common bile duct and the pancreatic duct, outside the duodenal wall above the influence of sphincter of Oddi, associated with choledochal cysts and biliary malignancies. APBDU may rarely present as recurrent acute pancreatitis (RAP) or chronic pancreatitis (CP). We aimed to study the prevalence of patients with APBDU presenting as RAP or CP and their response to endotherapy. Methods A retrospective audit of the prospectively maintained endoscopy database at our institute between January 2018 and November 2020 was conducted to identify cases of APBDU presenting as RAP or CP. Details of investigations, endoscopic retrograde cholangiopancreatography (ERCP) findings, and follow-up till six months were noted. Results We identified 26 cases of APBDU, of which five (19.2%) cases presented as RAP or CP. Of these five patients, two had RAP, while three presented with CP (median: 11 years; range: 4-25 years). Magnetic resonance cholangiopancreatography (MRCP) showed APBDU in three patients. One patient with RAP had a Komi type IIIB anomaly. Another patient with RAP had a rare anomaly with absent ventral PD, with the bile duct communicating and draining through the dorsal duct. Two patients with CP had a long common channel with Komi IIA anomaly. One patient with CP had IIIC2 anomaly. Pancreas divisum was noted in three patients, all of whom underwent minor-papilla sphincterotomy. Successful pancreatic stent placement was performed in all patients. Over one year of follow-up, patients with CP had a significant decrease in pain as measured by the visual analog scale. Those with RAP had no further episodes of pancreatitis. Conclusion APBDU is a rare cause of RAP and CP in young patients, occasionally missed on MRCP. RAP and CP caused by APBDU show good response to endotherapy.

Клиническое наблюдение наследственного панкреатита у 4 сибсов вследствие мутации в гене PRSS1

Hereditary pancreatitis in children remains a challenging problem in clinical genetics, gastroenterology, and surgery. Genetic causes account for more than 50% of all cases of acute recurrent pancreatitis and 75% of chronic pancreatitis in children. The development of chronic pancreatitis is commonly caused by mutations in the CFTR, PRSS1, SPINK1, CTRC, and CPA1 genes. This article presents a clinical case of hereditary pancreatitis with an autosomal dominant inheritance in 4 siblings, in whom a pathogenic variant in the PRSS1 gene was detected during molecular genetic testing. Key words: hereditary pancreatitis, pathogenic variant, PRSS1 gene, children, siblings

Pancreatic Stones in Children with Chronic Pancreatitis: A Case Report

Background: Chronic pancreatitis is a continuous progressive inflammation of the pancreas that can cause recurrent abdominal pain. The incidence of chronic pancreatitis in children is on an upward trend in recent years. The purpose of this case report is to enhance clinician's insight in considering chronic pancreatitis as a differential diagnosis in cases of recurrent abdominal pain in children. Case: We reported a case of chronic pancreatitis with pancreatic stones in a 12-year-old child. The patient came with complaints of recurrent upper left abdominal and heartburn accompanied by nausea and vomiting. Epigastric and left hypochondriac tenderness were found. Laboratory examination showed an increase in pancreatic enzymes up to 6x the normal value. The results of abdominal CT-scan and MRCP showed multiple pancreatic stones with pseudocysts. The patient then underwent the Puestow procedure. Postoperatively, the complaints of abdominal pain resolved and the pancreatic enzymes improved significantly. Discussion: The diagnosis of pancreatitis must meet 2 out of the 3 criteria that have been determined. Primary management includes fluids, analgesics, early nutrition, and surgery in cases of chronic pancreatitis accompanied by complications such as pseudocysts or pancreatic stones. Conclusion: This case teaches the need for a careful clinical approach and consideration of chronic pancreatitis as a differential diagnosis in a child with recurrent abdominal pain.

Interobserver Agreement for CT and MRI Findings of Chronic Pancreatitis in Children: A Multicenter Ancillary Study Under the INSPPIRE Consortium.

BACKGROUND. Imaging findings represent key criteria for diagnosing chronic pancreatitis in children. Understanding radiologists' agreement for imaging findings is critical to standardizing and optimizing diagnostic criteria. OBJECTIVE. The purpose of this study is to evaluate the interobserver agreement among experienced pediatric radiologists for subjective, quantitative, and semiquantitative imaging findings of chronic pancreatitis in children. METHODS. In this retrospective study, CT or MRI examinations performed in children with chronic pancreatitis were submitted by six sites participating in the INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a Cure) Consortium. One pediatric radiologist from each of the six sites reviewed examinations; three of the radiologists independently reviewed all CT examinations, and the other three radiologists independently reviewed all MRI examinations. Reviewers recorded 13 categoric imaging findings of chronic pancreatitis and measured pancreas thickness and pancreatic duct diameter. Agreement was assessed using kappa coefficients for the categoric variables and intraclass correlation coefficients (ICCs) for the continuous variables. RESULTS. A total of 76 CT and 80 MRI examinations performed in 110 children (65 girls and 45 boys; mean age, 11.3 ± 4.6 [SD] years) were reviewed. For CT, kappa coefficients for categoric findings ranged from -0.01 to 0.81, with relatively high kappa coefficients noted for parenchymal calcifications (κ = 0.81), main pancreatic duct dilatation (κ = 0.63), and atrophy (κ = 0.52). ICCs for parenchymal thickness measurements ranged from 0.57 in the pancreas head to 0.80 in the body and tail. The ICC for duct diameter was 0.85. For MRI, kappa coefficients for categoric findings ranged from -0.01 to 0.74, with relatively high kappa coefficients noted for main duct irregularity (κ = 0.74), side branch dilatation (κ = 0.70), number of dilated side branches (κ = 0.65), and main duct dilatation (κ = 0.64); kappa coefficient for atrophy was 0.52. ICCs for parenchymal thickness measurements ranged from 0.53 for the neck and body individually to 0.68 in the tail. ICC for duct diameter was 0.77. CONCLUSION. Interobserver agreement was fair to moderate for most CT and MRI findings of chronic pancreatitis in children. CLINICAL IMPACT. This study highlights challenges for the imaging diagnosis of pediatric chronic pancreatitis. Standardized and/or objective criteria are needed given the importance of imaging in diagnosis.

The Role of Surgical Management in Chronic Pancreatitis in Children: A Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee.

Chronic pancreatitis (CP) is rare in childhood but impactful because of its high disease burden. There is limited literature regarding the management of CP in children, specifically about the various surgical approaches. Herein, we summarize the current pediatric and adult literature and provide recommendations for the surgical management of CP in children. The literature review was performed to include the scope of the problem, indications for operation, conventional surgical options as well as total pancreatectomy with islet autotransplantation, and outcomes following operations for CP. Surgery is indicated for children with debilitating CP who have failed maximal medical and endoscopic interventions. Surgical management must be tailored to the patient's unique needs, considering the anatomy and morphology of their disease. A conventional surgical approach (eg, drainage operation, partial resection, combination drainage-resection) may be considered in the presence of significant and uniform pancreatic duct dilation or an inflammatory head mass. Total pancreatectomy with islet autotransplantation is the best surgical option in patients with small duct disease. The presence of genetic risk factors often portends a suboptimal outcome following a conventional operation. The morphology of disease and the presence of genetic risk factors must be considered while determining the optimal surgical approach for children with CP. Surgical outcomes for CP are variable and depend on the type of intervention. A multidisciplinary team approach is needed to assure that the best possible operation is selected for each patient, their recovery is optimized, and their immediate and long-term postoperative needs are well-met.

Modern aspects of diagnosis and treatment of chronic pancreatitis in children: experience of the center Center for the treatment of developmental anomalies and diseases of the hepatopancreatobiliary system in children

Chronic pancreatitis is one of the most pressing problems of pediatric gastroenterology and surgery of hepatopancreatobiliary organs. Diagnosis and treatment of this category of patients requires a comprehensive examination using modern highly sensitive research methods and the collegial participation of a surgeon, gastroenterologist and endocrinologist. Due to the fact that the algorithm for managing these patients is not regulated, patients often receive enzyme replacement therapy for a long time, with indications for surgical treatment. In addition, the non-specificity of complaints and clinical manifestations of chronic pancreatitis, the asymptomatic course and the initial detection of exo- and endocrine insufficiency lead to a later choice of the optimal treatment method and increase the risk of complications. The key to effective care for children with chronic pancreatitis is the staging and continuity in research and treatment. At the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the Filatov Hospital, highly effective interventions are carried out for chronic pancreatitis in children, the purpose of which is to ensure an adequate outflow of pancreatic juice using longitudinal pancreaticojejunostomy, which, in addition to draining the pancreas, allows to achieve clinical remission and stop the progression pathological process, including diabetes mellitus. The article reflects the experience of diagnosis and treatment of chronic pancreatitis in children.

The Epidemiology and Burden of Childhood Chronic Pancreatitis in South Australia

To assess longitudinal, population-based data on the prevalence and impact of chronic pancreatitis in children. Administrative data linkage was used to ascertain an index cohort consisting of all individuals who had an initial diagnosis of chronic pancreatitis before age 19years in the South Australian public hospital system between June 2000 and June 2019. Age- and sex-matched controls were drawn from the general population of South Australia, children with type 1 diabetes, and children with type 2 diabetes. Main outcomes and measures included hospital visits, days in hospital, emergency department (ED) visits, intensive care unit (ICU) admissions, education comparators, and incidence and prevalence estimates. A total of 73 incident cases were identified. The crude prevalence and incidence of pediatric chronic pancreatitis were estimated at 6.8/100 000 and 0.98/100 000 per year, respectively. Of the index cohort, 24 cases (32.8%) of pediatric chronic pancreatitis were identified as occurring in children of Aboriginal and/or Torres Strait Islander descent. Compared with matched general population controls, children with chronic pancreatitis averaged 11-fold more hospital visits, 5-fold more ED visits, and 9-fold more ICU admissions; spent 10-fold more days in the hospital; and had a 2-fold higher rate of absence from school (P<.001 for all). Similarly, children with chronic pancreatitis used substantially more health resources than children with type 1 or 2 diabetes. Pediatric patients with chronic pancreatitis consume a high volume of public health services and are significantly impacted in their ability to engage in education.

Особливості перебігу патології підшлункової залози в дітей

Актуальність. Поширеність панкреатиту в дітей становить 5–25 %. Мета: визначити особливості патології підшлункової залози в дітей. Матеріал та методи. Дослідження проведено на базі гастроентерологічного відділення Чернівецької обласної клінічної дитячої лікарні впродовж 2013–2015 рр. Результати. Частота хронічного панкреатиту серед дітей Чернівецької області загалом становить 1,8 %. У 66 % дітей із хронічним гастродуоденітом і в 100 % дітей із виразковою хворобою цибулини дванадцятипалої кишки були виявлені ультразвукові зміни підшлункової залози. Ознаки хронічного панкреатиту відмічені в 1 дитини з целіакією і 4 дітей із лактазною недостатністю. У 17 дітей спостерігались ультразвукові ознаки фіброзу залози та зниження рівня еластази‑1 в калі, що можуть розглядатися як ознаки хронічного панкреатиту, у 9 дітей встановлено ультразвукові ознаки структурних змін підшлункової залози, але рівень еластази‑1 був нормальним (хворі з рецидивуючим панкреатитом), у 18 дітей не було ультразвукових змін структури залози та рівень еластази‑1 в калі не змінювався. Висновок. Хронічні панкреатити в дітей перебігають на фоні больового (нападоподібний біль із локалізацією в епігастрії або часта зміна локалізації болю), диспептичного (найчастіше проявляється нудотою та блюванням) і астеновегетативного синдромів та супроводжуються дисгармонійним фізичним розвитком. У всіх хворих із хронічним панкреатитом виявлено вогнищеві або лінійні фіброзні зміни паренхіми підшлункової залози, неспецифічні зміни в копрограмі та значне зниження рівня еластази‑1 у крові.

Complications of chronic pancreatitis in children.

In children, chronic pancreatitis is infrequent but may be associated with serious complications, including severe pain that limits activities, exocrine and endocrine pancreatic insufficiency and malnutrition. Investigation into pediatric chronic pancreatitis has transitioned from single center reports to multicenter, protocol-driven studies. As a result, we now have information on much larger numbers of children with chronic pancreatitis, allowing a more reliable understanding of the complications of chronic pancreatitis. A high percentage of children with chronic pancreatitis use opioids frequently to control pain. About a quarter of children with chronic pancreatitis have exocrine pancreatic insufficiency, and about 6% have pancreatogenic diabetes. Mild malnutrition and low bone density are both common in children with chronic pancreatitis. Large multicenter and single-center observational studies have allowed us to more accurately assess complications of chronic pancreatitis in children. These studies demonstrate the need for examination of therapies for these complications in children.

Medical Management of Chronic Pancreatitis in Children: A Position Paper by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee.

This position paper summarizes the current understanding of the medical management of chronic pancreatitis (CP) in children in light of the existing medical literature, incorporating recent advances in understanding of nutrition, pain, lifestyle considerations, and sequelae of CP. This article complements and is intended to integrate with parallel position papers on endoscopic and surgical aspects of CP in children. Concepts and controversies related to pancreatic enzyme replacement therapy (PERT), the use of antioxidants and other CP medical therapies are also reviewed. Highlights include inclusion of tools for medical decision-making for PERT, CP-related diabetes, and multimodal pain management (including an analgesia ladder). Gaps in our understanding of CP in children and avenues for further investigations are also reviewed.

Acute recurrent and chronic pancreatitis in children.

Acute recurrent pancreatitis (ARP) is defined as two distinct episodes of acute pancreatitis (AP), whereas chronic pancreatitis (CP) is caused by persistent inflammation of the pancreas. In children they are caused by genetic mutations, autoimmune pancreatitis, congenital pancreatic abnormalities, and other conditions. Acute recurrent pancreatitis is frequently a precursor to CP, and both are thought to be on the same disease continuum. In particular, genetic factors are associated with early progression of ARP to CP. The diagnosis of CP, as in AP, is based on clinical findings, biochemical tests, and imaging studies. Findings of exocrine pancreatic dysfunction are also important in the diagnosis of CP. A step-up strategy has become increasingly standard for the treatment of patients with CP. This strategy starts with endoscopic treatment, such as pancreatic sphincterotomy and stenting, and progresses to surgery should endoscopic therapy fail or prove technically impossible. Non-opioid (e.g. ibuprofen / naproxen) and opioid (e.g. oxycodone) forms of analgesia are widely used in pediatric patients with AP or CP, whereas pancreatic enzyme replacement therapy may be beneficial for patients with abdominal pain, steatorrhea, and malnutrition. Despite the disparity in the age of onset, pediatric CP patients display some similarities to adults in terms of disease progress. To reduce the risk of developing pancreatic exocrine inefficiency, diabetes and pancreatic cancer in the future, clinicians need to be aware of the current diagnostic approach and treatment methods for ARP and CP and refer them to a pediatric gastroenterologist in a timely manner.

Chronic pancreatitis in children: between gastroenterologist and surgeon

The pancreas is an organ that plays a key role in the digestive process, preparing food ingredients such as proteins, fats and carbohydrates for adequate absorption in the small intestine. Today, a wide range of pathological conditions is known in which the tissue of the pancreas is affected and its functions are lost. The literature review examined various diseases that phenotypically manifest as pancreatitis, as well as various diagnostic and therapeutic strategies.

Spectrum of acute, recurrent and chronic pancreatitis in children.

To determine the clinical presentation, aetiology and outcome of pancreatitis in paediatric population. The retrospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of children with pancreatitis presenting between 2013 and 2018. Medical records were reviewed and findings of clinical, laboratory workup and management were noted on a specifically developed proforma. Data was analysed using SPSS 23. Of the 51 subjects, 28(54.9%) were boys. The overall mean age was 10.6±4.9 years. The most frequent clinical symptom was epigastric pain 39(76.5%). The most common aetiology was gallstones/pancreatic stones 19(37.25%). Mean hospital stay was 5.1±1.8 days, and it was longer in children aged up to 5 years compared to older children (p<0.05). Acute pancreatitis was seen in 23(45.09%) patients, followed by recurrent 19(37.25%) and chronic 9(17.64%). There was no mortality. Timely diagnosis and prompt management of haemodynamic status could lead to successful recovery without any serious complications in paediatric pancreatitis.

Progress in individualizing autologous islet isolation techniques for pediatric islet autotransplantation after total pancreatectomy in children for chronic pancreatitis.

Total pancreatectomy with islet autotransplantation is performed to treat chronic pancreatitis in children. Successful islet isolation must address the challenges of severe pancreatic fibrosis and young donor age. We have progressively introduced modifications to optimize enzymatic and mechanical dissociation of the pancreas during islet isolation. We evaluated 2 islet isolation metrics in 138 children-digest islet equivalents per gram pancreas tissue (IEQ/g) and digest IEQ per kilogram body weight (IEQ/kg), using multiple regression to adjust for key disease and patient features. Islet yield at digest had an average 4569 (standard deviation 2949) islet equivalent (IEQ)/g and 4946 (4009) IEQ/kg, with 59.1% embedded in exocrine tissue. Cases with very low yield (<2000 IEQ/g or IEQ/kg) have decreased substantially over time, 6.8% and 9.1%, respectively, in the most recent tertile of time compared to 19.2% and 23.4% in the middle and 34.1% and 36.4% in the oldest tertile. IEQ/g and IEQ/kg adjusted for patient and disease factors improved in consistency and yield in the modern era. Minimal mechanical disruption during digestion, warm enzymatic digestion using enzyme collagenase:NP activity ratio<10:1, coupled with extended distension and trimming time during islet isolation of younger and fibrotic pediatric pancreases, gave increased islet yield with improved patient outcomes.

Validation of threshold values for pancreas thickness and T1-weighted signal intensity ratio in the pediatric pancreas.

Pancreas atrophy and the loss of T1-weighted signal intensity by magnetic resonance imaging (MRI) are findings of chronic pancreatitis. The purpose of this study was to test published normal values and cutoffs for pancreas thickness and the pancreas:spleen T1-weighted signal intensity ratio in children without pancreatic disease. This was a secondary analysis of prospectively collected MRI data for 50 children (range: 6.3-15.9years; 27 female) with no history of pancreatic disease. Two observers (R1, R2) measured linear pancreas thickness on axial T1-weighted, fat-saturated gradient recalled echo images and placed regions of interest in the pancreas and spleen to calculate the T1-weighted signal intensity ratio. Measurements were compared to published pediatric normal values (computed tomography [CT], ultrasound [US]) and adult cutoffs (CT, MRI). Compared to published pediatric values for CT, 68% (R1: 34/50) or 40% (R2: 22/50) of participants had ≥1 pancreas segment with thickness below the normal range. No participant had a thickness value below the normal range published for US. Compared to cutoff values in adults, 84% (R1: 42/50) or 80% (R2: 40/50) of participants met the criteria for pancreas atrophy. Mean T1-weighted signal intensity ratio was 1.33±0.15 (R1) and 1.32±0.16 (R2). Twelve (R1: 24.5% of 49) or 11/49 (R2: 22.4%) participants had a T1-weighted signal intensity ratio below the threshold associated with exocrine insufficiency in adults. Previously defined thresholds for pancreas thickness and pancreas:spleen T1-weighted signal intensity ratio appear too restrictive for a pediatric population. Further study is needed to define optimal quantitative metrics for findings of chronic pancreatitis in children.