Management Of Pancreatitis In Children Research Articles

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the Society for Pediatric Radiology Joint Position Paper on Noninvasive Imaging of Pediatric Pancreatitis: Literature Summary and Recommendations.

The reported incidence of pediatric pancreatitis is increasing. Noninvasive imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), play important roles in the diagnosis, staging, follow-up, and management of pancreatitis in children. In this position paper, generated by members of the Pancreas Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the Abdominal Imaging Committee of The Society for Pediatric Radiology (SPR), we review the roles of noninvasive imaging in pediatric acute, acute recurrent, and chronic pancreatitis. We discuss available evidence related to noninvasive imaging, highlighting evidence specific to pediatric populations, and we make joint recommendations for use of noninvasive imaging. Further, we highlight the need for research to define the performance and role of noninvasive imaging in pediatric pancreatitis.

Diagnosis and Management of Pancreatitis in Childhood: A Single-Centre Experience

Background: Pancreatitis can be seen at any age in childhood. Therefore, it is important for pediatricians to know the diagnosis and the management of pancreatitis. Objectives: The aim of this study was to evaluate the etiological factors, clinical features and management of pancreatitis in children. Methods: This study included hospitalized children who were diagnosed with pancreatitis. The clinical presentations, laboratory analyses, radiological features, etiologies and treatments were recorded. Results: A total of 59 pancreatic attacks were recorded in 41 patients. The most common symptoms were abdominal pain and vomiting, and the most common etiological cause was idiopathic. Approximately 22% of the patients had acute recurrent episodes. Somatostatin was used to treat 61% of the attacks; however, it did not reduce the time to recovery after an attack when compared to those patients who did not use somatostatin (P = 0.36). The white blood cell counts and urea and calcium levels were significantly different between those patients who did and did not use somatostatin. Seventeen (28.8%) of the pancreatitis attacks were determined to be severe. Moreover, a mutation in the cystic fibrosis transmembrane conductance regulator was detected in two patients with recurrent pancreatitis. Conclusions: Fever and irritability can be signs of pancreatitis in infants and toddlers. In our cases, the somatostatin treatment was not effective in terms of the time to recovery after an attack.

Diagnostic evaluation and management of chronic pancreatitis in children

Diagnostic evaluation and management of chronic pancreatitis in children

Pancreatitis in Children.

Pancreatic disease in children has a wide clinical spectrum and may present as Acute pancreatitis (AP), Acute recurrent pancreatitis (ARP), Chronic pancreatitis (CP) and Pancreatic disease without pancreatitis. This article highlights the etiopathogenesis and management of pancreatitis in children along with clinical data from five tertiary care hospitals in south India [Chennai (3), Cochin and Pune].

Therapeutic ERCP in the management of pancreatitis in children

Background: The use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is increasing in the management of pancreatobiliary diseases in children. Methods: Over a 32-month period, we performed 34 ERCP procedures for the treatment of pancreatitis in 22 children at two university hospitals. Demographics and clinical data and ERCP findings were documented. Clinical status was assessed 6 months before the first ERCP and 6 months after the last ERCP, according to general condition, severity and frequency of pain, and health care encounters (emergency department visits, clinic visits, and hospital admissions related to the pancreatitis). Results: Mean age of the patients was 10.7 years (range 1.5 to 17 years). Abdominal pain was the main presenting symptoms with hyperamylasemia and hyperlipasemia. Clinical diagnoses included acute pancreatitis (6), recurrent pancreatitis (5), and chronic pancreatitis (11). The mean follow-up was 16.4 months. Nine patients had sphincter manometry, with abnormal results leading to biliary sphincterotomy in 4. Fifteen patients underwent a total of 23 therapeutic ERCP procedures unrelated to sphincter dysfunction. There were 2 complications of 34 procedures (6%), both being mild pancreatitis after sphincter manometry. There were no deaths. There was a significant reduction in frequency ( p < 0.01) and severity of pain ( p < 0.01) after intervention. Patients without pancreatographic changes of chronic pancreatitis had the most marked clinical improvement ( p < 0.05). In those with ductal changes of chronic pancreatitis, clinical improvement was not predicted by the extent of ductal changes. There was a significant decrease in health care encounters ( p < 0.05) and improvement in general condition ( p < 0.01) after endoscopic therapy, especially in those with a normal pancreatogram. Conclusions: Therapeutic ERCP is safe in pediatric patients with pancreatitis. Significant clinical improvement is achieved in patients with biliary or pancreatic stone disease. Prospective studies with long-term follow-up are needed to determine the impact of endoscopic therapy in patients with chronic pancreatitis and sphincter of Oddi dysfunction. (Gastrointest Endosc 2000;51:396-400.)