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Milano RV, Morneault-Gill K, Kamal HY, Barkin JA, Chadwick CB. Pancreatitis in cystic fibrosis: Presentation, medical and surgical management, and the impact of modulator therapies. Pediatr Pulmonol 2024; 59 Suppl 1:S53-S60. [PMID: 38501345 DOI: 10.1002/ppul.26958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
Patients with Cystic Fibrosis (CF) are at increased risk of acute (AP) and chronic (CP) pancreatitis, and their complications. The extent of remaining healthy pancreatic parenchyma determines the risk of developing future episodes of pancreatitis, as well as pancreatic exocrine or endocrine insufficiency. Pancreatitis may be the presenting symptom of CF, and genetic testing is especially important in pediatrics. AP and recurrent AP are managed with intravenous fluid hydration and pain control, in addition to early refeeding and treatment of complications. With the use of modulator therapy in CF, pancreatic function may be restored to some extent. CP related pain is managed with analgesics and neuromodulators, with surgery if indicated in specific situations including TPIAT as a possible type of surgical intervention. Long-term sequelae of CP in patients with CF include exocrine pancreatic insufficiency treated with pancreatic enzyme replacement therapy, fat-soluble vitamin deficiencies and associated metabolic complications such as bone disease/osteoporosis, pancreatogenic diabetes, and less commonly, pancreatic cancer. We review the presentation and etiologies of pancreatitis in CF patients as well as the management of AP and CP primarily in children.
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Affiliation(s)
- Reza V Milano
- Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Kayla Morneault-Gill
- Department of Pediatrics, Division of Gastroenterology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Hebat Y Kamal
- Department of Pediatrics, Division of Gastroenterology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Jodie A Barkin
- Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Christina Baldwin Chadwick
- Department of Pediatrics, Division of Gastroenterology, University of Florida, College of Medicine, Gainesville, Florida, USA
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Dike CR, DadeMatthews A, DadeMatthews O, Abu-El-Haija M, Lebensburger J, Smith A, Imdad A. Acute Pancreatitis in Individuals with Sickle Cell Disease: A Systematic Review. J Clin Med 2024; 13:4712. [PMID: 39200854 PMCID: PMC11355684 DOI: 10.3390/jcm13164712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/04/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Sickle cell disease (SCD) impacts about 100,000 people in the US. SCD increases the risk of cholelithiasis and microvascular ischemia, which could increase the risk of acute pancreatitis (AP). Abdominal pain is a common presenting symptom of AP and sickle cell vaso-occlusive crisis. The purpose of our systematic review is to estimate the prevalence and determine the severity of AP in individuals with SCD compared to the general population. Methods: Multiple electronic databases were searched. We included studies that included children and adults (population) and addressed the association of SCD (exposure) with AP (outcome) compared to the same population without SCD (control). Two authors screened titles and abstracts independently, and data were abstracted in duplication from included studies. We registered this protocol in PROSPERO-CRD42023422397. Results: Out of 296 studies screened from multiple electronic databases, we identified 33 studies. These studies included 17 case reports, one case series, and 15 retrospective cohort studies, and 18 studies included children. Eight of the AP case reports were in patients with HbSS genotype, two with sickle beta thalassemia, and one with HbSoArab, and in six case reports, a genotype was not specified. Complications were reported in 11 cases-respiratory complication (in at least four cases), splenic complications (three cases), pancreatic pseudocyst (two cases) and death from AP (one case). Of the four AP cases in the case series, three had HbSS genotype, and two cases had complications and severe pancreatitis. AP prevalence in SCD was estimated to be 2% and 7% in two retrospective studies, but they lacked a comparison group. In retrospective studies that evaluated the etiology of AP in children, biliary disease caused mostly by SCD was present in approximately 12% and 34%, respectively. Conclusions: Data on the prevalence of AP in individuals with SCD are limited. Prospectively designed studies aiming to proactively evaluate AP in individuals with SCD who present with abdominal pain are needed to improve timely diagnosis of AP in SCD and outcomes.
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Affiliation(s)
- Chinenye R. Dike
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Adefunke DadeMatthews
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL 36849, USA;
| | - Oluwagbemiga DadeMatthews
- School of Kinesiology, College of Human Sciences and Education, Louisiana State University, Baton Rouge, LA 70803, USA;
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jeffrey Lebensburger
- Department of Pediatrics, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Abigail Smith
- Health Science Library, Upstate Medical University, Syracuse, NY 13210, USA;
| | - Aamer Imdad
- Stead Family Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of Iowa, Iowa City, IA 52242, USA;
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Bukowski JS, Jamer T, Kowalska-Duplaga K, Marczuk M, Stelmaszczyk-Emmel A, Banasiuk M, Banaszkiewicz A. Very early and early nutrition in children with pancreatitis-A randomised trial. J Pediatr Gastroenterol Nutr 2024; 79:343-351. [PMID: 38938000 DOI: 10.1002/jpn3.12301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES The aim of our study was to assess the impact of the very early introduction of refeeding on the course of acute pancreatitis (AP) in children. Additionally, we evaluated the effect of nutrition on inflammatory markers, including cytokines. METHODS This prospective randomised study was conducted in three university hospitals in Poland. Patients, aged 1-18 years with AP, were randomised into two groups: A-refeeding within 24 h of hospital admission (very early), and B-refeeding at least 24 h after admission (early nutrition). The severity of AP was assessed after 48 h. The serum concentrations of four cytokines (tumour necrosis factor α [TNFα], interleukin-1β [IL-1β], interleukin-6 [IL-6] and interleukin-8 [IL-8]) and C-reactive protein, as well as the activity of amylase, lipase and aminotransferases, were measured during the first 3 days of hospitalisation. RESULTS A total of 94 children were recruited to participate in the study. The statistical analysis included 75 patients with mild pancreatitis: 42-group A and 33-group B. The two groups did not differ in the length of hospitalisation (p = 0.22), AP symptoms or results of laboratory tests. Analysis of cytokine levels was conducted for 64 children: 38-group A and 26-group B. We did not find a difference in concentrations of the measured cytokines, except for IL-1β on the third day of hospitalisation (p = 0.01). CONCLUSIONS The time of initiation of oral nutrition within 24 h (very early) or after 24 h (early) from the beginning of hospitalisation had no impact on the length of hospitalisation, concentrations of TNF-α, IL-1β, IL-6 and IL-8, activity of amylase and lipase or occurrence of symptoms in children with mild AP.
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Affiliation(s)
- Jan S Bukowski
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Tatiana Jamer
- Department of Paediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Kinga Kowalska-Duplaga
- Department of Paediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Cracow, Poland
| | - Martyna Marczuk
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Banasiuk
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Banaszkiewicz
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
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Orkin S, Holovach P, Thompson T, Farrell P, Nasr A, Vitale D, Ibrahim S, Kotha N, Estes J, Hornung L, Abu-El-Haija M. Nutritional parameters following first episode of pediatric acute pancreatitis. Clin Nutr ESPEN 2024; 63:409-416. [PMID: 38996062 DOI: 10.1016/j.clnesp.2024.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND AND OBJECTIVES Acute pancreatitis (AP) carries the risk of subsequent nutritional deficiencies. The prevalence of these deficiencies following a single episode of AP in children is unknown. We aimed to determine prevalence of anthropometric and laboratory-based measures of nutritional status in children following their first (index) admission for AP. METHODS Prospective observational cohort study of patients ≤21 years of age with first episode of confirmed AP. Anthropometric and laboratory values were obtained at time of AP onset and at follow up time points of 3 and 12 months (m) post AP. AP attack was classified as either: mild, moderately severe or severe (which were combined in one group (SAP)). RESULTS 181 patients met criteria and were followed prospectively with 52% male, a median age of 13.7 years (IQR 9.4-16.0) and median Body Mass Index (BMI) Z-score of 0.6 (IQR -0.5, 1.6). Most patients had mild AP (140, 77%), with 23% meeting criteria for moderate or severe (41/181). 6 (3%) had diabetes mellitus (DM) predating AP and were excluded from further analysis. BMI Z-score remained stable during the follow up period. 13% of patients developed pre-DM or DM at 3m or 12m. Nearly one third of patients had low ferritin at 3m (29%) or 12m (29%). At 12m, 8% of patients had Vitamin A deficiency. 6% of patients had low Vitamin E levels at 3m and 5% at 12m. Over half of patients at both 3m and 12m had 25 OH Vitamin D insufficiency or deficiency (56% and 56%). Prolonged International Normalized Ratio (INR) (>1.3) was seen in 9% of patients at 12m. Very low albumin (<3.5 g/dL) was found in 24% of patients at 3m and 18% at 12m (Table 1). Patients with very low albumin at 3m were younger (median 10.7 vs. 14.2 years, p = 0.04), however sex, BMI Z-score and AP severity were not associated with albumin level. Although BMI Z-score did not differ between the groups, those with SAP had a significant decrease in BMI Z-score from first attack compared to mild AP at 3m (-0.4 vs. 0.0, p = 0.0002, Figure 2). At 3m, Vitamin E deficiency in SAP versus mild AP was found in 20% vs 2% (p = 0.04) and SAP had a lower median hematocrit (35.8 vs. 37.6, p = 0.046). There were no other laboratory significant differences at 3m in mild versus SAP groups. At 12m, those with SAP were more likely to have pre-DM or DM compared to mild AP (31% vs. 7%, p = 0.002). No other significant laboratory differences occurred at 12m. CONCLUSIONS After the first AP attack patients experience nutritional deficiencies, including ferritin, all fat-soluble vitamins, and low albumin. SAP is associated with a decrease in BMI Z-score, increased prevalence of vitamin E deficiency at 3m, and an increase in pre-diabetes and diabetes at 12m. Serial monitoring of vitamin and mineral values post AP is warranted and further prospective studies are needed.
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Affiliation(s)
- Sarah Orkin
- Department of Pediatrics, College of Medicine, University of Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA.
| | - Phillip Holovach
- Department of Pediatrics, College of Medicine, University of Cincinnati, USA
| | - Tyler Thompson
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA
| | - Peter Farrell
- Department of Pediatrics, College of Medicine, University of Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA
| | - Alexander Nasr
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA
| | - David Vitale
- Department of Pediatrics, College of Medicine, University of Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA
| | - Sherif Ibrahim
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA
| | - Nicole Kotha
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA
| | - James Estes
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA
| | - Lindsey Hornung
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, USA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA
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Abu-El-Haija M, Zhang W, Karns R, Ginzburg G, Vitale DS, Farrell P, Nasr A, Ibrahim S, Bellin MD, Thompson T, Garlapally V, Woo JG, Husain SZ, Denson LA. The Role of Pancreatitis Risk Genes in Endocrine Insufficiency Development After Acute Pancreatitis in Children. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00515-9. [PMID: 38871151 DOI: 10.1016/j.cgh.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND & AIMS Acute pancreatitis (AP) is increasingly recognized as a risk factor for diabetes mellitus (DM). We aimed to study the association of pancreatitis genes with pancreatic endocrine insufficiency (pre-DM and DM) development post-AP in children. METHODS This was an observational cohort study that enrolled subjects ≤21 years with their first episode of AP and followed them for 12 months for the development of pancreatic endocrine insufficiency. Pancreatitis risk genes (CASR, CEL, CFTR, CLDN2, CPA1, CTRC, PRSS1, SBDS, SPINK1, and UBR1) were sequenced. A genetic risk score was derived from all genes with univariable P < .15. RESULTS A total 120 subjects with AP were genotyped. Sixty-three subjects (52.5%) had at least 1 reportable variant identified. For modeling the development of pancreatic endocrine insufficiency at 1 year, 6 were excluded (2 with DM at baseline, 3 with total pancreatectomy, and 1 death). From this group of 114, 95 remained normoglycemic and 19 (17%) developed endocrine insufficiency (4 DM, 15 pre-DM). Severe AP (58% vs 20%; P = .001) and at least 1 gene affected (79% vs 47%; P = .01) were enriched among the endocrine-insufficient group. Those with versus without endocrine insufficiency were similar in age, sex, race, ethnicity, body mass index, and AP recurrence. A model for pre-DM/DM development included AP severity (odds ratio, 5.17 [1.66-16.15]; P = .005) and genetic risk score (odds ratio, 4.89 [1.83-13.08]; P = .002) and had an area under the curve of 0.74. CONCLUSIONS In this cohort of children with AP, pancreatitis risk genes and AP disease severity were associated with pre-DM or DM development post-AP.
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Affiliation(s)
- Maisam Abu-El-Haija
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Wenying Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rebekah Karns
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gila Ginzburg
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - David S Vitale
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Peter Farrell
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexander Nasr
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sherif Ibrahim
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Melena D Bellin
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; Department Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Tyler Thompson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Vineet Garlapally
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jessica G Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sohail Z Husain
- Department of Pediatrics (Gastroenterology), Stanford University and Stanford Medicine Children's Health, Stanford, California
| | - Lee A Denson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Pasqualetto AF, Boroni G, Moneghini D, Parolini F, Orizio P, Bulotta AL, Missale G, Alberti D. Single Center Experience of Eus-Guided Cystogastrostomy and Lumen-Apposing Metal Stent (LAMS) Positioning in Children with Pancreatic Fluid Collections: A Case Series. CHILDREN (BASEL, SWITZERLAND) 2024; 11:643. [PMID: 38929223 PMCID: PMC11202220 DOI: 10.3390/children11060643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/04/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
Pancreatic fluid collections (PFCs) are a well-known complication of pancreatitis. PFCs operative management includes percutaneous, endoscopic or surgical drainage. Even if in adult patients, endoscopic drainage is a well-established treatment, few data are available in pediatric setting. We report our single-center experience of EUS-guided cystogastrostomy and lumen-apposing metal stent (LAMS) positioning in children with PFCs; this, at the best of our knowledge, has never been reported before. All consecutive children with PFCs between April 2020 and November 2022 were enrolled in this retrospective study. PFCs were preoperatively evaluated with MRI or CT scan. All the procedures were performed under general anesthesia. A LAMS Hot-AxiosTM 10 × 15 mm was placed in all patients. We evaluated technical feasibility and clinical outcomes, including complications and recurrence rates. Follow-up included clinical observation, blood tests and US. EUS-guided cystogastrostomy was performed in 3 children (2 males; median age 13.2 years). Median maximum cyst diameter was 14.7 cm (range 10-22 cm). Technical and clinical success rates were 100%. No intra or post-operative complications occurred. Our experience suggests that this can be considered a safe and feasible treatment of PCFs even in the pediatric population, as long as the procedure is performed by an expert Endoscopist in a pediatric tertiary-level Center.
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Affiliation(s)
- Annalisa Fiammetta Pasqualetto
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
| | - Giovanni Boroni
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
- European Reference Network for Hepatological Diseases (ERN RARE-LIVER)
| | - Dario Moneghini
- Department of Digestive and Interventional Endoscopy, ASST Spedali Civili, 25123 Brescia, Italy; (D.M.); (G.M.)
| | - Filippo Parolini
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
- European Reference Network for Hepatological Diseases (ERN RARE-LIVER)
| | - Paolo Orizio
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
| | - Anna Lavinia Bulotta
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
| | - Guido Missale
- Department of Digestive and Interventional Endoscopy, ASST Spedali Civili, 25123 Brescia, Italy; (D.M.); (G.M.)
| | - Daniele Alberti
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
- European Reference Network for Hepatological Diseases (ERN RARE-LIVER)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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Akshintala VS, Moore MG, Cruz-Monserrate Z, Nathan JD, Searle BC, Abu-El-Haija M. Urine Proteomics Profiling Identifies Novel Acute Pancreatitis Diagnostic Biomarkers in a Pediatric Population. Gastroenterology 2024:S0016-5085(24)04937-0. [PMID: 38797238 DOI: 10.1053/j.gastro.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/12/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Venkata S Akshintala
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Madalyn G Moore
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology and Nutrition and, The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jaimie D Nathan
- Department of Pediatric Abdominal Transplant and Hepatopancreatobiliary Surgery, Nationwide Children's Hospital, Columbus, Ohio; Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Brian C Searle
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio; Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Fathema K, Karim B, Al-Azad S, Rukunuzzaman M, Ahmed M, Rifah TJ, Saha D, Benzamin M. Computed Tomography Assessment of Severity of Acute Pancreatitis in Bangladeshi Children. Pediatr Gastroenterol Hepatol Nutr 2024; 27:176-185. [PMID: 38818279 PMCID: PMC11134178 DOI: 10.5223/pghn.2024.27.3.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/10/2023] [Accepted: 10/30/2023] [Indexed: 06/01/2024] Open
Abstract
Purpose Acute pancreatitis (AP) is common among children in Bangladesh. Its management depends mainly on risk stratification. This study aimed to assess the severity of pediatric AP using computed tomography (CT). Methods This cross-sectional, descriptive study was conducted in pediatric patients with AP at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh. Results Altogether, 25 patients with AP were included, of whom 18 (mean age, 10.27±4.0 years) were diagnosed with mild AP, and 7 (mean age, 10.54±4.0 years) with severe AP. Abdominal pain was present in all the patients, and vomiting was present in 88% of the patients. Etiology was not determined. No significant differences in serum lipase, serum amylase, BUN, and CRP levels were observed between the mild and severe AP groups. Total and platelet counts as well as hemoglobin, hematocrit, serum creatinine, random blood sugar, and serum alanine aminotransferase levels (p>0.05) were significantly higher in the mild AP group than in the severe AP group (p=0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of CT severity index (CTSI) were 71.4%, 72.2%, 50%, and 86.7%, respectively. In addition, significant differences in pancreatic appearance and necrosis were observed between the two groups on CT. Conclusion CT can be used to assess the severity of AP. In the present study, the CTSI effectively assessed the severity of AP in pediatric patients.
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Affiliation(s)
- Kaniz Fathema
- Department of Pediatric Gastroenterology and Nutrition, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
| | - Bazlul Karim
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Salahuddin Al-Azad
- Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md. Rukunuzzaman
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mizu Ahmed
- Department of Dermatology, Shahid Syed Nazrul Islam Medical College Hospital, Kishoregonj, Bangladesh
| | - Tasfia Jannat Rifah
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Dipanwita Saha
- Department of Pediatric Gastroenterology and Nutrition, Comilla Medical College, Comilla, Bangladesh
| | - Md. Benzamin
- Department of Pediatric Gastroenterology and Nutrition, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh
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9
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Kim HJ. Potential Predictors of Severe and Recurrent Pancreatitis in Children: A Single-Center Experience. Pediatr Emerg Care 2024; 40:302-306. [PMID: 37643350 DOI: 10.1097/pec.0000000000003036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Severe pancreatitis often requires intensive care; therefore, early detection is important. This study aimed to evaluate the possible predictors of pancreatitis severity in children. Furthermore, we evaluated the prevalence of pancreatitis recurrence and related factors. METHODS We retrospectively analyzed the medical records of patients aged younger than 18 years who were diagnosed with acute pancreatitis between January 2017 and June 2022. Acute pancreatitis was diagnosed and classified based on the revised Atlanta criteria. RESULTS A total of 64 patients were enrolled, and severe pancreatitis was observed in 10 (15.6%) patients. Patients with severe pancreatitis were younger and had higher C-reactive protein levels than those with mild pancreatitis. The areas under the receiver operating characteristic curves of C-reactive protein levels at admission and 48 hours after diagnosis were 0.612 (95% confidence interval, 0.379-0.844) and 0.873 (95% confidence interval, 0.537-0.983), respectively. Fourteen patients (21.9%) experienced further episodes of recurrent pancreatitis. Patients with recurrent pancreatitis were older (13.7 vs 11.4 years, P = 0.022) and prominently boys (85.7 vs 52%, P = 0.022) compared with those without recurrence. Obesity was observed in 4 (0.6%) patients, which was confirmed in all recurrence groups and was statistically significant. CONCLUSIONS This study demonstrated the feasibility of C-reactive protein in the early risk assessment of patients with acute pancreatitis and highlighted the potential risk of recurrence in patients with obesity.
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Affiliation(s)
- Hyun Jin Kim
- From the Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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10
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Dike CR, Ollberding NJ, Thompson T, Kotha N, Minar P, Vitale DS, Lin TK, Nasr A, Denson LA, Haslam DB, Abu-El-Haija M. Acute pancreatitis is associated with gut dysbiosis in children. Dig Liver Dis 2024; 56:444-450. [PMID: 37932168 PMCID: PMC10921998 DOI: 10.1016/j.dld.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Pediatric acute pancreatitis (AP) is associated with significant morbidity. Therefore, improved understanding of children who will develop severe AP is critical. Adult studies have reported AP associated gut dysbiosis, but pediatric studies are lacking. AIMS Assess stool microbial taxonomic and functional profiles of children with first attack of AP compared to those of healthy controls (HC), and between mild and severe AP METHODS: Children under 21 years hospitalized at a tertiary center (n = 30) with first AP attack were recruited including HC (n = 34) from same region. Shotgun metagenomic sequencing was performed on extracted DNA. RESULTS Demographics were similar between AP and HC. Alpha diversity (-0.68 ± 0.13, p-value < 0.001), and beta-diversity (R2=0.13, p-value < 0.001) differed, in children with AP compared to HC. Species including R.gnavus, V.parvula, E.faecalis, C.innocuum were enriched in AP. MetaCyc pathways involved in amino acid metabolism and fatty acid beta-oxidation were enriched in AP. Beta-diversity (R2=0.06, p-value = 0.02) differed for severe AP compared to mild AP with enrichment in E.faecalis and C.citroniae. CONCLUSIONS Gut dysbiosis occurs in pediatric AP and is associated with AP severity. A multicenter study confirming these findings could pave way for interventional trials manipulating the gut microbiome to mitigate AP severity.
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Affiliation(s)
- Chinenye R Dike
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Nebraska Medical Center and Children's Hospital & Medical Center, Omaha, NE USA; Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Alabama at Birmingham, Birmingham, AL USA.
| | - Nicholas J Ollberding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tyler Thompson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA
| | - Nicole Kotha
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA
| | - Phillip Minar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David S Vitale
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tom K Lin
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander Nasr
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA
| | - Lee A Denson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David B Haslam
- Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maisam Abu-El-Haija
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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11
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Farrell PR, DesPain AW, Farmer P, Farrell LM, Greenfield B, Rogers ME, Hornung L, Kim E, Pearman R, Neway B, Thompson T, Heubi JE, Sehgal S, Amoury R, Abu-El-Haija M. Faster discharge with lactated ringers than normal saline in first 72 h of acute pancreatitis: A multicenter randomized trial. J Pediatr Gastroenterol Nutr 2024; 78:360-368. [PMID: 38374568 PMCID: PMC10883603 DOI: 10.1002/jpn3.12082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 11/02/2023] [Accepted: 11/21/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Data driven strategies for acute pancreatitis (AP) in pediatrics are limited; adult data suggests lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes, but has not been studied in pediatrics. Our objective was to evaluate the efficacy of LR during the first 48 h of an AP episode compared with NS. STUDY DESIGN A multisite randomized controlled clinical trial, from 2015 to 2020 (Clinical Trials.gov NCT03242473). Patients were randomized to exclusively LR or NS for the first 48 h. Primary outcomes were serial C-reactive protein (CRP) values. Secondary outcomes included other lab values, time to feeds, length of stay (LOS), systemic inflammatory response syndrome (SIRS) development, and progression to severe AP (SAP). RESULTS We studied 76 patients (38 LR, 38 NS). CRP at 24 and 48 h were not significantly different between LR or NS group. Additionally, there were no differences in trends of BUN, amylase, lipase, SIRS status, or SAP development between the LR and NS group at 24 and 48 h. A higher proportion of LR patients (32%, 12/38) were discharged before 48 h compared to NS (13%, 5/38). The LR group had a significantly higher rate of discharge within the first 72 h compared to the NS group (p = 0.02). CONCLUSION The use of LR was associated with a faster rate of discharge during the intervention period and in the first 72 h, but no other differences compared to NS. This reduction in length of hospitalization has significant implications for patients and healthcare costs.
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Affiliation(s)
- Peter R Farrell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Angelica W DesPain
- Division of Emergency Medicine, The Children's Hospital of San Antonio, San Antonio, Texas, USA
| | - Peter Farmer
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leslie M Farrell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bryan Greenfield
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Division of Emergency Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Michael E Rogers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lindsey Hornung
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Esther Kim
- Division of Critical Care Medicine, Children's National Health System, Washington, District of Columbia, USA
| | - Ryan Pearman
- Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Beemnet Neway
- Department of Pediatrics, NewYork Presbyterian-Weill Cornell Medical Center, New York City, New York, USA
| | - Tyler Thompson
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James E Heubi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sona Sehgal
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Health System, Washington, District of Columbia, USA
| | - Rana Amoury
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of the King's Daughters, Children's Specialty Group, Norfolk, Virginia, USA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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12
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Salim A, Boonthai A, Tanpowpong P, Losty PD. Acute pancreatitis in childhood - a comparative international study and tale of two cities. ANZ J Surg 2024; 94:215-221. [PMID: 38115552 DOI: 10.1111/ans.18840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUNDS To compare factor(s) contributing to aetiology, management and clinical outcome(s) of paediatric patients acquiring acute pancreatitis (AP) at two major university paediatric surgical centres in Liverpool and Bangkok. METHODS All patients (<18 years) with an index diagnosis of AP (ICD 10 coding) during 2006-2016 were studied. RESULTS 121 patients included n = 79 (65.3%) in Thailand versus n = 42 (34.7%) in the UK centre with no difference(s) in age at diagnosis at 10.4 ± 4.5 and 11.7 ± 6 years. (P = 0.12). Major AP aetiology(s) in Thailand were medications (39.2%) and choledochal cysts (8.9%). In the UK-gallstone disease (21.4%), and medications (16.7%) were leading factors (P < 0.01). Ultrasonography was deployed more frequently in the UK versus Thai centre (74.3% vs. 49.1%; P < 0.01). Pancreatitis was confirmed by imaging in 67.9% (Thai) and 62.9% (UK) patients (P = 0.47). Most patients at both centres had a mild-grade pancreatitis illness (95% Thai vs. 90.5% UK; P = 0.28) while 12.7% of Thai and 19% of UK children developed pancreatitis-related complication (P = 0.37). Overall mortality rate (%) was significantly higher in the Thai versus UK centre (27.8% vs. 9.5%; P = 0.02). CONCLUSIONS Aetiology of acute pancreatitis appears to vary between UK and Thailand children. Timely early diagnosis and healthcare pathways may be driven by local patient-related factor(s). The higher mortality (%) observed in Thailand versus UK in this comparative study was linked to underlying co-existent chronic medical condition(s) in vulnerable patient cohorts.
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Affiliation(s)
- Adeline Salim
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Ampaipan Boonthai
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pornthep Tanpowpong
- Division of Gastroenterology, Department of Paediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paul D Losty
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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13
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Devecí U, Ünsal SK, Dogan Y. A Retrospective Review of Children followed up with the Diagnosis of Acute Pancreatitis. Niger J Clin Pract 2023; 26:1876-1885. [PMID: 38158356 DOI: 10.4103/njcp.njcp_441_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Acute pancreatitis (AP) is an inflammatory disease of the pancreas, the frequency of which increases in childhood. AIM To investigate the demographic, etiological, clinical, laboratory, and radiological characteristics of children followed up with the diagnosis of AP. The study also included genetic studies of recurrent cases. MATERIALS AND METHODS This retrospective cohort study included pediatric patients <18 years of age with AP who were followed up with recurrent pancreatitis in the Pediatrics Department of a University Hospital between January 2010 and April 2021. Patients who met at least 2 of the 3 criteria defined by the International Pediatric Pancreatitis Study Group (INSPPIRE) were accepted as AP. Demographic, etiological, and clinical data of the patients, developing complications, pathological evaluation of the samples, and genetic analysis results were obtained from the patient files. The obtained data were statistically analyzed using the SPSS version 26.0 program. Descriptive statistics of the data were expressed as mean ± standard deviation, median, minimum and maximum values, number (n), and percentage (%). Kolmogorov-Smirnov test, Mann Whitney U test, Chi-square test and Fischer test were used. RESULTS Fifty-four (50%) female and 54 (50%) male patients with a mean age of 9.96 ± 4.8 years who met the study criteria were included in the study. In the follow-up, it was reported that acute recurrent pancreatitis developed in 23 (21%) patients and chronic pancreatitis developed in 8 (7%) patients. The most common complaints were abdominal pain (94.4%), and vomiting (60.2%), followed by malnutrition (36.1%), nausea (17.6%), diarrhea (13%), and fever (13%). Etiology could not be determined in 19.4% of the patients. It was noted that the genetic predisposition of the patients played a role in the development of recurrent and chronic pancreatitis. Amylase, lipase, and CRP values, which are among the laboratory parameters showing the severity and prognosis of AP, were found to be significant. CONCLUSIONS Sociocultural and demographic data of the patients should also be taken into account. Gene sequences that cause to genetic predisposition should be determined in recurrent and chronic pancreatitis cases. Acute pancreatitis should be considered in the differential diagnosis of patients with frequent abdominal pain and vomiting.
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Affiliation(s)
- U Devecí
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Elazig/Türkiye
| | - S K Ünsal
- Pediatrics, Firat University School of Medicine, Elazig/Türkiye
| | - Y Dogan
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Elazig/Türkiye
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14
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Zhang KY, Siddiqi I, Saad M, Balabanis T, Dehghan MS, Nasr A, Tolj V, Habtezion A, Park K, Abu-El-Haija M, Sellers ZM. Temporal Analysis of Inflammatory Bowel Disease and Pancreatitis Co-Occurrence in Children and Adults in the United States. Clin Transl Gastroenterol 2023; 14:e00628. [PMID: 37556391 PMCID: PMC10684167 DOI: 10.14309/ctg.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Pancreatitis in inflammatory bowel disease has been attributed to peripancreatic intestinal disease and/or drug-induced pancreatic toxicity. We used large cohort analyses to define inflammatory bowel disease and pancreatitis temporal co-occurrence with a detailed descriptive analysis to gain greater insight into the pathophysiological relationship between these 2 diseases. METHODS Truven Health MarketScan private insurance claims from 141,017,841 patients (younger than 65 years) and 7,457,709 patients from 4 academic hospitals were analyzed. We calculated the prevalence of Crohn's disease or ulcerative colitis (UC) with acute pancreatitis or chronic pancreatitis (CP) and performed temporal and descriptive analyses. RESULTS Of 516,724 patients with inflammatory bowel disease, 12,109 individuals (2.3%) had pancreatitis. Acute pancreatitis (AP) was 2-6x more prevalent than CP. In adults, AP occurred equally among Crohn's disease and UC (1.8%-2.2% vs 1.6%-2.1%, respectively), whereas in children, AP was more frequent in UC (2.3%-3.4% vs 1.5%-1.8%, respectively). The highest proportion of pancreatitis (21.7%-44.7%) was at/near the time of inflammatory bowel disease diagnosis. Of them, 22.1%-39.3% were on steroids during pancreatitis. Individuals with CP or recurrent pancreatitis hospitalizations had increased risk of a future inflammatory bowel disease diagnosis (odds ratio = 1.52 or 1.72, respectively). DISCUSSION Pancreatitis in inflammatory bowel disease may not simply be a drug adverse event but may also involve local and/or systemic processes that negatively affect the pancreas. Our analysis of pancreatitis before, during, and after inflammatory bowel disease diagnosis suggests a bidirectional pathophysiologic relationship between inflammatory bowel disease and pancreatitis, with potentially more complexity than previously appreciated.
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Affiliation(s)
- Ke-You Zhang
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| | - Ismaeel Siddiqi
- Department of Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michelle Saad
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Tatiana Balabanis
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| | - Melody S. Dehghan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| | - Alexander Nasr
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Vania Tolj
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Aida Habtezion
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
| | - K.T. Park
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Zachary M. Sellers
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
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15
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Mehta MS. Acute pancreatitis in children: risk factors, management, and outcomes. Curr Opin Pediatr 2023; 35:590-595. [PMID: 37594373 DOI: 10.1097/mop.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW Pediatric acute pancreatitis is an infrequent but potentially serious condition in children. Most have mild cases with spontaneous resolution, but up to one-third of patients can have moderate or severe disease or progress to recurrent or chronic pancreatitis. RECENT FINDINGS Significant advances have been made in the field of pediatric pancreatology with a recognition that pediatric acute pancreatitis can vary significantly from adult disease with different risk factors and outcomes. There is better understanding of appropriate management for pediatric pancreatitis as well as growing literature in complications of pancreatitis. SUMMARY The most common risk factors for pediatric acute pancreatitis include biliary disease, drug/toxin and idiopathic. Management involves adequate fluid resuscitation, early enteral nutrition and appropriate pain control. Systemic and local complications, including SIRS, necrosis and fluid collections, can occur in up to one-third of patients and care is largely supportive with a careful step-up approach to fluid collections and necrosis.
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Affiliation(s)
- Megha S Mehta
- Division of Pediatric Gastroenterology, UT Southwestern Medical Center, Dallas, Texas, USA
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16
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Vázquez-Frias R, Rivera-Suazo Y, Aguayo-Elorriaga AK, Alfaro-Bolaños JE, Argüello-Arévalo GA, Cadena-León JF, Chávez-Sáenz JA, Consuelo-Sánchez A, Cruz-Romero EV, Espinosa-Saavedra D, Espriu-Ramírez MX, Flores-Calderón J, González-Ortiz B, Hernández-Rosiles V, Ignorosa-Arellano KR, Jaramillo-Esparza CM, Lozano-Hernández FR, Larrosa-Haro A, Leal-Quiroga U, Macias-Flores JA, Martínez-Leo BA, Martínez-Vázquez A, Mendoza-Tavera NMJ, Pacheco-Sotelo S, Reyes-Apodaca M, Sánchez-Ramírez CA, Sifuentes-Vela CA, Sosa-Arce M, Zárate-Mondragón FE. The Asociación Mexicana de Gastroenterología consensus on the diagnosis and treatment of acute pancreatitis in children and adolescents. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:267-281. [PMID: 37336694 DOI: 10.1016/j.rgmxen.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 06/21/2023]
Abstract
Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.
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Affiliation(s)
- R Vázquez-Frias
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico.
| | - Y Rivera-Suazo
- Hospital Star Médica Infantil Privado, Mexico City, Mexico
| | - A K Aguayo-Elorriaga
- Hospital Pediátrico Coyoacán, Secretaría de Salud de la Ciudad de México, Mexico City, Mexico
| | - J E Alfaro-Bolaños
- Servicio de Gastroenterología, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | | | - J F Cadena-León
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - A Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| | - E V Cruz-Romero
- Servicio de Cirugía, Centro Médico Naval, Mexico City, Mexico
| | - D Espinosa-Saavedra
- Departamento de Gastroenterología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - M X Espriu-Ramírez
- Servicio de Gastroenterología Pediátrica, Hospital General de Cancún Dr. Jesús Kumate Rodríguez, Cancún, Quintana Roo, Mexico
| | - J Flores-Calderón
- Departamento de Gastroenterología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - B González-Ortiz
- Departamento de Gastroenterología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - V Hernández-Rosiles
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| | - K R Ignorosa-Arellano
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - C M Jaramillo-Esparza
- Departamento de Gastroenterología y Endoscopia Pediátrica, Hospital Ángeles Universidad, Mexico City, Mexico
| | - F R Lozano-Hernández
- Servicio de Gastroenterología Pediátrica, Centro Médico Naval, Mexico City, Mexico
| | - A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Departamento de Reproducción Humana Crecimiento y Desarrollo Infantil, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - U Leal-Quiroga
- Servicio de Gastroenterología, Christus Muguerza Hospital Sur, Monterrey, Nuevo León, Mexico
| | - J A Macias-Flores
- Departamento de Gastroenterología, Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Chihuahua, Mexico
| | - B A Martínez-Leo
- Hospital Pediátrico Moctezuma, Secretaría de Salud de la Ciudad de México, Mexico City, Mexico
| | - A Martínez-Vázquez
- Departamento de Gastroenterología y Nutrición Pediátrica, Hospital para el Niño Poblano, Puebla, Puebla, Mexico
| | | | - S Pacheco-Sotelo
- Servicio de Gastroenterología y Nutrición Pediátrica, UMAE, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano de Seguro Social, Guadalajara, Jalisco, Mexico
| | - M Reyes-Apodaca
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | - M Sosa-Arce
- Departamento de Gastroenterología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - F E Zárate-Mondragón
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
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Daniluk U, Krawiec P, Pac-Kożuchowska E, Dembiński Ł, Bukowski JS, Banaszkiewicz A, Woźniuk-Kaźmierczak A, Czkwianianc E, Brylak J, Walkowiak J, Borys-Iwanicka A, Kofla-Dłubacz A, Pytrus T, Zdanowicz K, Lebensztejn DM. Pancreatic Involvement in the Course of Inflammatory Bowel Disease in Children-A Multi-Center Study. J Clin Med 2023; 12:4174. [PMID: 37445210 DOI: 10.3390/jcm12134174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The coexistence of inflammatory bowel disease (IBD) with pancreatic pathology is rare in children. A retrospective analysis of data from 1538 children diagnosed with IBD in 2014-2021 was conducted to determine the frequency and causes of pancreatitis and asymptomatic hyperlipasemia (HL) or hyperamylasemia (HA) in this group of patients. Among the 176 children (11.4%) with pancreatic involvement (PI), acute pancreatitis (AP) was diagnosed in 77 children (43.8%), and HA or HL was observed in 88 children (50.0%). Only a few patients were diagnosed with autoimmune or chronic pancreatitis (6.2%). PI was observed at the time of the IBD diagnosis in 26.1% of the cases. A total of 54.5% of the patients had moderate to severe IBD, and 96% had colonic involvement at the time of diagnosis of PI. Idiopathic PI was the most common (57%), followed by drug-induced PI (37%) and azathioprine (AZA). In patients with AZA-induced AP, the successful introduction of 6-mercaptopurine (6-MP) to therapy was noted in 62.5% of the children. Our results suggest that routine monitoring of pancreatic enzymes in patients with IBD should be performed, especially after the initiation of the AZA treatment. The presence of transient HA/HL in IBD does not necessarily indicate pancreatic pathology.
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Affiliation(s)
- Urszula Daniluk
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, 15-274 Bialystok, Poland
| | - Paulina Krawiec
- Department of Pediatrics and Gastroenterology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Elżbieta Pac-Kożuchowska
- Department of Pediatrics and Gastroenterology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Łukasz Dembiński
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Jan Stanisław Bukowski
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Aleksandra Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna Woźniuk-Kaźmierczak
- Department of Gastroenterology, Allergology and Pediatrics, Polish Mother's Memorial Hospital-Research Institute, 93-338 Lodz, Poland
| | - Elżbieta Czkwianianc
- Department of Gastroenterology, Allergology and Pediatrics, Polish Mother's Memorial Hospital-Research Institute, 93-338 Lodz, Poland
| | - Jan Brylak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Agnieszka Borys-Iwanicka
- 2nd Clinical Department of Pediatrics, Gastroenterology and Nutrition, Medical University of Wroclaw, 50-369 Wroclaw, Poland
| | - Anna Kofla-Dłubacz
- 2nd Clinical Department of Pediatrics, Gastroenterology and Nutrition, Medical University of Wroclaw, 50-369 Wroclaw, Poland
| | - Tomasz Pytrus
- 2nd Clinical Department of Pediatrics, Gastroenterology and Nutrition, Medical University of Wroclaw, 50-369 Wroclaw, Poland
| | - Katarzyna Zdanowicz
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, 15-274 Bialystok, Poland
| | - Dariusz Marek Lebensztejn
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, 15-274 Bialystok, Poland
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18
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Gorbounova I, Tham SW, Abu-El-Haija M, Palermo TM. Analgesic Patterns and Opioid Administration in Children Hospitalized With Acute Pancreatitis. J Pediatr Gastroenterol Nutr 2023; 76:793-798. [PMID: 36917846 PMCID: PMC10198933 DOI: 10.1097/mpg.0000000000003771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Pain is the most common symptom of acute pancreatitis (AP), and opioids have been utilized as the cornerstone of treatment. Despite the adverse effects of opioids, data on effective analgesia in children with AP is lacking. We aimed to evaluate analgesia prescribing patterns in pediatric AP, identify factors associated with opioid administration, and test the associations between opioid administration and hospital length of stay (LOS). METHODS This is a retrospective cohort study of pediatric AP hospitalizations in a single institution from 2010 to 2020. Opioid administration was calculated for the first 48 hours of admission (morphine milligram equivalent; MME48). Data on multimodal analgesia [defined as the administration of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)] during hospitalization was captured. RESULTS The sample included 224 patients, mean age 12.0 years (standard deviation = 4.9) and 58.9% female. Median LOS was 4 days (interquartile range 2-9). Most patients (71.4%) were prescribed opioids, 77.7% acetaminophen, 40.2% NSAIDs, and 37.5% multimodal analgesia. Opioid administration decreased over the study period; in contrast, there was an increase in multimodal analgesia administration. Opioid administration did not differ by sex, age, biliary versus non-biliary etiology, or race/ethnicity. In a multivariate regression model, lower albumin values ( P < 0.01) and younger age ( P < 0.05) were significant predictors of increased LOS, while MME48 was not associated with increased LOS. CONCLUSIONS Opioids were commonly administered; only 37.5% of children were administered multimodal analgesia during their hospitalization for AP. Opioid administration was not associated with increased LOS. Prospective studies are needed to determine optimal pain management for pediatric AP.
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Affiliation(s)
- Irina Gorbounova
- From the Department of Pediatric Gastroenterology, Hasbro Children's Hospital, Brown University, Providence, RI
| | - See Wan Tham
- the Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Maisam Abu-El-Haija
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tonya M Palermo
- the Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA
- the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
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Hassan AM, Lin TK, Smith MT, Hornung L, Abu-El-Haija M, Nathan JD, Vitale DS. Risk Factors for Post-ERCP Pancreatitis in Pediatric and Young Adult Patients. J Pediatr Gastroenterol Nutr 2023; 76:807-812. [PMID: 36930983 DOI: 10.1097/mpg.0000000000003766] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Post-ERCP pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Limited existing data suggest that prophylactic pancreatic duct (PD) stenting in pediatric patients may increase the risk of PEP. The aim of this study is to identify factors associated with PEP in pediatric patients. METHODS Patients at a single institution who underwent ERCP between 2012 and 2020 were retrospectively reviewed. Patient and procedure-related factors were collected. Data were analyzed using Chi-square or Fisher exact tests as appropriate and Mann-Whitney-Wilcoxon tests. RESULTS Seven hundred thirty-six ERCPs were performed for 402 unique patients. Ninety-four cases were complicated by PEP (12.8%), of which 91 were mild and 3 were moderately severe. Pancreatic indication, native major papilla, PD cannulation and injection, and higher American Society for Gastrointestinal Endoscopy (ASGE) complexity were associated with PEP. A higher proportion of patients who received rectal indomethacin (65% vs 47%, P = 0.002), or who had placement of a prophylactic (31% vs 20%, P = 0.01) or therapeutic PD stent (37% vs 27%, P = 0.04) developed PEP; however, in a subgroup analysis of high-risk patients, this association was not persistent. A smaller proportion of PEP patients had PRSS1 mutation compared to non-PEP patients (22% vs 40%, P = 0.04). CONCLUSIONS This study evaluates factors associated with developing PEP in a large pediatric cohort. A high rate of PEP was observed, likely secondary to higher rates of pancreatic indication and higher ASGE complexity scores compared to previously reported literature. Randomized prospective trials are needed to better define the utility of various interventions.
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Affiliation(s)
- Ahmad M Hassan
- From the Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Tom K Lin
- the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Milton T Smith
- From the Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Lindsey Hornung
- the Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Maisam Abu-El-Haija
- the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jaimie D Nathan
- the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David S Vitale
- the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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20
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Li L, Mostafavi M, Miller JW, Hirsch B, O'Connor S, Sayej WN. Severe Necrotizing Pancreatitis in a Pediatric Patient with COVID-19: A Case Report. JPGN REPORTS 2023; 4:e307. [PMID: 37181457 PMCID: PMC10174737 DOI: 10.1097/pg9.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/14/2023] [Indexed: 05/16/2023]
Abstract
We describe a 15-year-old female diagnosed with necrotizing pancreatitis in the setting of coronavirus disease 2019 with severe complications including splenic vein and portal vein thromboses, pleural effusion requiring chest tube, acute hypoxic respiratory failure requiring noninvasive positive-pressure ventilation, and new-onset insulin-dependent diabetes mellitus, requiring over a month-long hospitalization. Following discharge, the patient experienced a prolonged loss of appetite, nausea, and extreme weight loss., During her prolonged hospitalization, she was diagnosed with necrotizing pancreatitis with walled-off collection which was ultimately treated with transgastric endoscopic ultrasound-guided drainage, multiple endoscopic necrosectomies, lumen-apposing metal stents, and double-pigtail plastic stent. Nine months after her initial presentation, patient's clinical symptoms improved, and her weight stabilized. This case highlights the importance of recognizing acute and necrotizing pancreatitis and its morbidities as complications associated with coronavirus disease 2019.
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Affiliation(s)
- Lucinda Li
- From the Department of Internal Medicine and Pediatrics, University of Massachusetts Chan Medical School - Baystate, Springfield, MA
| | - Mojdeh Mostafavi
- From the Department of Internal Medicine and Pediatrics, University of Massachusetts Chan Medical School - Baystate, Springfield, MA
| | - John W Miller
- Department of Internal Medicine, Gastroenterology, University of Massachusetts Chan Medical School - Baystate, Springfield, MA
| | - Barry Hirsch
- Department of Pediatric Gastroenterology & Nutrition, University of Massachusetts Chan Medical School - Baystate, Springfield, MA
| | - Stephen O'Connor
- Department of Radiology, University of Massachusetts Chan Medical School - Baystate, Springfield, MA
| | - Wael N Sayej
- Department of Pediatric Gastroenterology & Nutrition, University of Massachusetts Chan Medical School - Baystate, Springfield, MA
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21
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Nasr A, Hornung L, Thompson T, Lin TK, Vitale DS, Nathan JD, Varni JW, Abu-El-Haija M. Prevalence of Gastrointestinal Symptoms and Impact on Quality of Life at 1-Year Follow-Up of Initial Attack of Acute Pancreatitis. J Pediatr Gastroenterol Nutr 2023; 76:199-205. [PMID: 36705700 PMCID: PMC9886336 DOI: 10.1097/mpg.0000000000003668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study aims to describe the prevalence of gastrointestinal (GI) symptoms following the first time occurrence of acute pancreatitis (AP) and to measure the impact of the episode on patient health-related quality of life (HRQOL) from the perspectives of patients and parents. METHODS Questionnaires regarding GI symptoms 1 year following the initial occurrence of AP were obtained from 74 pediatric patients. Thirty of these patients completed both the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and the PedsQL Gastrointestinal Symptoms and Worry Scales. These data were compared to legacy-matched healthy controls. RESULTS Children with a standalone occurrence of AP experienced a similar rate of GI symptoms compared to those who progressed to acute recurrent pancreatitis (ARP) within 1 year. PedsQL 4.0 Generic Core Scales scores were significantly lower for children self-report and parent proxy-report for patients that experienced AP compared to healthy controls. AP patients also demonstrated significantly more symptoms than healthy controls in the Gastrointestinal Symptoms and Worry Scales across multiple domains. CONCLUSIONS Gastrointestinal symptoms affect many children who experience a single AP event even without recurrent attacks. The burden of symptoms is not significantly different from those who develop ARP. This is a novel study that evaluates patient-reported outcomes in children following an AP attack and demonstrates there is a significant impact on HRQOL in children and family experiences post AP. More data are needed to study the progression of disease and the extended impact of AP following an initial AP attack in pediatric patients.
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Affiliation(s)
- Alexander Nasr
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center; Cincinnati, Ohio
| | - Lindsey Hornung
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center; Cincinnati, Ohio
| | - Tyler Thompson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center; Cincinnati, Ohio
| | - Tom K. Lin
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center; Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine; Cincinnati, Ohio
| | - David S. Vitale
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center; Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine; Cincinnati, Ohio
| | - Jaimie D. Nathan
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center; Cincinnati, Ohio
| | - James W. Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX
| | - Maisam Abu-El-Haija
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center; Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine; Cincinnati, Ohio
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Rivera-Suazo Y, Vázquez-Frias R. Factors associated with hospital length of stay in children with acute pancreatitis. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:4-11. [PMID: 36707389 DOI: 10.1016/j.rgmxen.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 05/03/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND AIM Acute pancreatitis (AP) is the most common cause of pancreatic disease in children. Previous studies have described factors related to days of hospital length of stay (LOS) in children. Our aim was to identify factors associated with LOS in AP. MATERIALS AND METHODS A retrospective study was conducted at the Hospital Infantil de México Federico Gómez in Mexico City, encompassing the time frame of January 1, 2017 and March 31, 2019. AP was confirmed by medical chart review, according to the INSPPIRE criteria at the time of hospital admission, in patients below 18 years of age. AP grade was classified, following the NASPGHAN guidelines. Demographic, clinical, biochemical, nutritional, and treatment data were collected. Prolonged hospital LOS was considered that which lasted 7 days or longer. RESULTS Fifty-one events (32 patients) were registered. Median LOS was 8 days (IQR 4-14 days). Antibiotic use was significantly associated with longer LOS (OR 31.71; 95% CI: 2.71-370.65; p = 0.006) and early feeding (EF) (within 72 h of admission) was associated with shorter LOS (OR 0.05; 95% CI: 0.001-0.63; p = 0.02). There was no association between LOS and the variables of age, recurrence, grade, etiology, comorbidities, complications, fluid resuscitation, parenteral nutrition, or biochemical characteristics upon admission. CONCLUSION Our study, like others, corroborated the fact that EF in the management of AP was associated with fewer days of hospital LOS.
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Affiliation(s)
- Y Rivera-Suazo
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - R Vázquez-Frias
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
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Hawa K, Corker L, Hornung L, Noritz G, Gariepy C, Shaikhkhalil A, Abu-El-Haija M. Pancreatitis in the Complex Care Population: Presentation, Incidence, and Severity. J Pediatr Gastroenterol Nutr 2022; 75:749-754. [PMID: 36084229 PMCID: PMC10155109 DOI: 10.1097/mpg.0000000000003610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To describe the incidence and presentation of pancreatitis in Children with Medical Complexity (CMC) while evaluating severity of disease and outlining risk factors. METHODS This was a retrospective chart review between January 2010 and December 2019 of patients seen in the complex care clinic at Nationwide Children's Hospital (NCH) and Cincinnati Children's Hospital Medical Center (CCHMC). Data collected included sex, underlying diagnosis, family history of pancreatitis, type of pancreatitis, signs/symptoms, abdominal imaging, severity of attack, and presence of various risk factors associated with pancreatitis. Severity and diagnosis of pancreatitis was determined based on North American Society for Pediatric Gastroenterology, Hepatology and Nutrition criteria. RESULTS One hundred and twelve patients from both institutions were included, 62% from NCH, median age 11.5 [interquartile range (IQR): 5-16 years], 50% male. Most patients were less than 18 years of age with a median age of 8 years (IQR: 4-13 years). Underlying diagnoses included seizures (67%), cerebral palsy/spastic quadriplegia (65%), diabetes (3.6%), and mitochondrial disease (3%). Majority of patients were found to have multiple underlying diagnoses (88%). Incidence of pancreatitis for both institutions was 336 of 100,000 patients/year which is significantly higher than the general pediatric population ( P < 0.0001). Majority of first episodes of pancreatitis were mild (82%) with abdominal pain as the predominant symptom (50%). Adult patients were more likely to have pancreatitis related to medication use than pediatric patients (70% vs 38%, respectively P = 0.007). CONCLUSIONS Individuals in the CMC population at our institutions have a high incidence of pancreatitis with unique risk factors compared to the general pediatric/young adult populations.
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Affiliation(s)
- Kathryn Hawa
- Division of Gastroenterology, Hepatology, and Nutrition,
Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
| | - Lisa Corker
- Division of Hospital Medicine, Cincinnati
Children’s Medical Center, Cincinnati, OH
| | - Lindsey Hornung
- Division of Biostatistics and Epidemiology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Garey Noritz
- Division of Complex Care, Nationwide
Children’s Hospital, Columbus, OH
| | - Cheryl Gariepy
- Division of Gastroenterology, Hepatology, and Nutrition,
Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
| | - Ala Shaikhkhalil
- Division of Gastroenterology, Hepatology, and Nutrition,
Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
| | - Maisam Abu-El-Haija
- Division of Gastroenterology, Hepatology, and Nutrition,
Cincinnati Children’s Medical Center, Cincinnati, OH
- College of Medicine, Department of Pediatrics,
University of Cincinnati, Cincinnati, OH
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Ultrasound findings of acute pancreatitis in children. Pediatr Radiol 2022; 52:2342-2347. [PMID: 35554642 PMCID: PMC10103011 DOI: 10.1007/s00247-022-05381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/09/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Studies systematically documenting US findings in children with acute pancreatitis are limited. Pancreas duct dilation is described as the most reliable finding of acute pancreatitis but this has not been rigorously examined in children. OBJECTIVE To systematically document US findings in children with acute pancreatitis and to define interobserver agreement on those findings. MATERIALS AND METHODS In this cross-sectional study we retrospectively reviewed images for all pediatric patients <18 years of age who had been prospectively enrolled in a registry of patients with index admissions for acute pancreatitis between March 2013 and July 2020. Two blinded observers (R1, R2) reviewed the first transabdominal US examination performed within 2 weeks of the pancreatitis attack for each patient. RESULTS In 141 children, US was performed at a median of 1 day (interquartile range [IQR]: 0, 1) following acute attack. Thirty-three (23%, R1) and 38 (27%, R2) children had no abnormal findings on US. Peripancreatic edema was the most frequent finding documented by both reviewers (63% R1, 54% R2). The pancreatic duct was visible in only 35% of the children and was dilated in only 12% (R1) and 14% (R2). There was substantial to almost-perfect agreement between reviewers on findings of acute pancreatitis (κ=0.62-1), including duct visibility. CONCLUSION Peripancreatic edema was the most frequently identified finding in children with acute pancreatitis, present in up to 63%, with almost perfect interobserver agreement. Duct dilation, cited in the literature as a reliable finding of acute pancreatitis, was rarely identified in our sample.
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Juhász MF, Sipos Z, Ocskay K, Hegyi P, Nagy A, Párniczky A. Admission risk factors and predictors of moderate or severe pediatric acute pancreatitis: A systematic review and meta-analysis. Front Pediatr 2022; 10:947545. [PMID: 36245710 PMCID: PMC9561825 DOI: 10.3389/fped.2022.947545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Pediatric acute pancreatitis (PAP) has an increasing incidence and is now estimated to be almost as common as in adults. Up to 30% of patients with PAP will develop moderate or severe disease course (M/SPAP), characterized by organ failure, local or systemic complications. There is still no consensus regarding on-admission severity prediction in these patients. Our aim was to conduct a systematic review and meta-analysis of available predictive score systems and parameters, and differences between on-admission parameters in mild and M/SPAP. Methods We conducted a systematic search on the 14th February, 2022 in MEDLINE, Embase and CENTRAL. We performed random-effects meta-analysis of on-admission differences between mild and M/SPAP in laboratory parameters, etiology, demographic factors, etc. calculating risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) and created forest plots. For the meta-analysis of predictive score systems, we generated hierarchical summary receiver operating characteristic curves using a bivariate model. Chi-squared tests were performed and I2 values calculated to assess statistical heterogeneity. Results We included 44 studies - mostly retrospective cohorts - in our review. Among predictive score systems examined by at least 5 studies, the modified Glasgow scale had the highest specificity (91.5% for values ≥3), and the Pediatric Acute Pancreatitis Severity score the highest sensitivity (63.1% for values ≥3). The performance of other proposed score systems and values were summarized. Traumatic (RR: 1.70 95% CI: 1.09-2.67) and drug-induced (RR: 1.33 95% CI: 0.98-1.87) etiologies were associated with a higher rate of M/SPAP, while anatomical (RR: 0.6195% CI: 0.38-0.96) and biliary (RR: 0.72 95% CI: 0.53-0.99) PAP tended to be less severe. Discussion Many predictive score systems were proposed to assess the possibility of M/SPAP course. The most commonly used ones exhibit good specificity, but subpar sensitivity. Our systematic review provides a rigorous overview of predictive options assessed thus far, that can serve as a basis for future improvement of scores via the addition of parameters with a better observed sensitivity: e.g., lipase exceeding 7-times the upper threshold, hemoglobin, etc. The addition of etiological factors is another possibility, as they can herald a more severe disease course. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=307271, PROSPERO, identifier: CRD42022307271.
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Affiliation(s)
- Márk Félix Juhász
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Zoltán Sipos
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Klementina Ocskay
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
- Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Anikó Nagy
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Andrea Párniczky
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Morphological and functional recovery following acute and acute recurrent pancreatitis in children: A prospective sequential 2-point evaluation. Pancreatology 2022; 22:698-705. [PMID: 35717306 DOI: 10.1016/j.pan.2022.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/13/2022] [Accepted: 06/03/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The functional and morphological recovery following an episode of acute pancreatitis (AP) in children still remains ill understood as research exploring this is limited. We aimed to characterize the morphological and functional changes in pancreas following AP and ARP (acute recurrent pancreatitis) in children. METHODS Children with AP were followed prospectively and assessed at two time points at least 3 months apart, with the first assessment at least 3 months after the AP episode. Exocrine and endocrine functions were measured using fecal elastase and fasting blood sugar/HbA1c levels respectively. Morphological assessment was done using endoscopic ultrasound (EUS) and magnetic resonance imaging and cholangiopancreatography (MRI/MRCP). RESULTS Seventy-three children (boys:59%; mean age:8.4 ± 3.2years) were studied and 21 of them (29%) progressed to ARP. Altered glucose homeostasis was seen in 19 (26%) at first and 16 (22%) at second assessment and it was significantly more in ARP group than the AP group at first (42.8%vs19.2%; p = 0.03) as well as second assessment (38.1%vs15.3%; p = 0.03). Twenty-one children (28.7%) at first and 24 (32.8%) at second assessment developed biochemical exocrine pancreatic insufficiency. EUS detected indeterminate and suggestive changes of chronic pancreatitis in 21% at first (n = 38) and 27.6% at second assessment (n = 58). On MRCP, main pancreatic duct and side branch dilatation were seen in 15 (20.5%) and 2 (2.7%) children respectively. CONCLUSIONS More than one-quarter of children have evidence of altered glucose homeostasis and biochemical exocrine pancreatic insufficiency following an episode of AP. Similarly, morphological features of chronicity seen in some of the children suggest that a fraction of subjects may develop chronic pancreatitis on longer follow-up.
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Raut DS, Desai SA, Raje DV, Singh D, Dandge VP. Enlargement of the Pancreas in Children Diagnosed with Acute Pancreatitis: An Approach Based on P/V Ratio. Indian J Radiol Imaging 2022; 32:488-496. [DOI: 10.1055/s-0042-1754368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Background Acute pancreatitis is a reversible inflammation of the pancreatic parenchyma. Enlargement of the pancreas is often envisaged in such conditions. This study evaluates P/V ratio, as a marker to decide pancreatic enlargement in disease condition.
Purpose The aim of this study was to develop imaging-based diagnostic criterion for acute pancreatitis in children based on P/V ratio.
Material and Methods This study included 37 children with acute pancreatitis and 283 children asymptomatic for pancreatic disorders, from a single hospital center. The age of children ranged between 2 and 18 years. P/V ratio, which is the ratio of greatest anteroposterior dimension of the head, body, and tail of the pancreas relative to the transverse lumbar vertebral body, was obtained for each child through ultrasonographic examination. Age-adjusted receiver operating characteristics (AROC) analysis was performed on P/V ratio at presentation for each pancreatic region, and the sensitivity at 90% specificity, the threshold errors, and the corresponding cutoffs were obtained. The enlargement assessment was also done after clinical recovery by referring to the cutoffs of respective regions.
Results AROC analysis for males and females resulted into a maximum sensitivity of 83.33 and 81.67%, respectively, at 90% specificity for head. The error thresholds for both the groups were same, i.e., 0.098, indicating that 90% of the observations had errors less than the threshold. The corresponding P/V ratio cutoff for males and females was 0.43 and 0.42, respectively.
Conclusion Radiologists and clinicians can refer a cutoff value of 0.4 for each region, along with hypoechogenicity, to decide about enlargement of the pancreas in acute pancreatitis condition.
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Affiliation(s)
- Dhanraj S. Raut
- Department of Pediatrics, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
| | | | | | - Dinesh Singh
- Spiral CT Scan and Diagnostic Center, Nagpur, Maharashtra, India
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Bukowski JS, Dembiński Ł, Dziekiewicz M, Banaszkiewicz A. Early Enteral Nutrition in Paediatric Acute Pancreatitis-A Review of Published Studies. Nutrients 2022; 14:3441. [PMID: 36014947 PMCID: PMC9416066 DOI: 10.3390/nu14163441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Nowadays, nutrition is said to be an integral aspect of acute pancreatitis (AP) treatment. Early enteral nutrition (EEN) is safe and beneficial for patients. This was confirmed by clinical experience and can be found in guidelines on managing adults with AP. Furthermore, paediatric recommendations encourage EEN use in AP. However, paediatric guidelines are based exclusively on studies in adults. Therefore, we present a review of published studies on the time of nutritional interventions in children with AP. A search was independently conducted in April 2022 by two of the authors. Only full-text papers published in English involving children between 0-21 were considered. Only four papers met our inclusion criteria: one randomised-control trial (RCT), one prospective study with retrospective chart review, and two retrospective chart reviews. All studies supported EEN and there was no recommendation of any delay in its initiation. The results of all four papers suggested EEN with a regular, normal-fat diet. EEN is safe in children with mild or moderately severe AP and may decrease the length of hospitalisation. Unfortunately, all the conclusions are based on a small amount of heterogeneous data that are mostly retrospective. Future prospective RCTs are needed.
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Affiliation(s)
- Jan Stanisław Bukowski
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warszawa, Poland
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Kwiatek-Średzińska K, Kiryłowska M, Uścinowicz M, Daniluk U, Lebensztejn D. The course of acute pancreatitis in children and potential simple laboratory markers of severity - a single centre retrospective study. Acta Paediatr 2022; 111:2229-2234. [PMID: 35960175 DOI: 10.1111/apa.16514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/10/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the usefulness of routinely measured biochemical and complete blood count parameters as potential markers of the severity of pediatric acute pancreatitis. METHODS The retrospective study included children with acute pancreatitis hospitalised over a 3-year period. Demographic, clinical and laboratory data were collected. RESULTS 55 patients were enrolled in the study. Mild acute pancreatitis was diagnosed in 45 children (82%), moderately severe in 7 (13%), and severe in 3 patients (5%). Together 10 children (18%) were categorized into a single severe group. Children with severe acute pancreatitis had higher white blood cell and platelet counts on admission as well as a C-reactive protein concentration after 48 hours. The C-reactive protein concentration after 48 hours (cut-off: 127,2 mg/l) and the white blood cell count on admission (cut-off: 13,5x103 /μl) were found to be statistically significant markers in predicting the severity of the disease. The C-reactive protein concentration after 48 hours was demonstrated as an independent predictor. CONCLUSION Severe acute pancreatitis is observed in a quite significant percentage of children. The white blood cell count on admission and the C-reactive protein concentration after 48 hours (as an independent predictor) may be potential simple laboratory markers of the severity of the disease.
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Affiliation(s)
- Kamila Kwiatek-Średzińska
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Martyna Kiryłowska
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Mirosława Uścinowicz
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Urszula Daniluk
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Dariusz Lebensztejn
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
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Acute Pancreatitis in Childhood: A 10-Year Experience From A Thai University Surgical Center. Pancreas 2022; 51:808-813. [PMID: 36395407 PMCID: PMC9722370 DOI: 10.1097/mpa.0000000000002109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study aimed to describe etiology, management, and health outcomes of children developing acute pancreatitis at a tertiary Thailand pediatric surgery center. METHODS Medical case records of all index cases during 2006-2016 were analyzed and reported. RESULTS There were 42 male and 37 female patients, with a mean (standard deviation) age of 10.4 (4.5) years, included in the study. Medications were the commonest etiology for 39.3% of acute pancreatitis attacks, 11.4% for biliary tract disease cases, and 8% for postinterventional studies. In 30% of cases, no cause(s) was defined. Sixty-two patients (78.5%) had elevated serum lipase on hospital admission, whereas only 30.4% showed a raised amylase. Hospital stay was 15 days (interquartile range, 6-27 days). Two major complications in the series were pseudocysts (8.8%) and necrotizing pancreatitis (7.6%). Etiological factors and/or antibiotics were not directly linked to any specific complications. Seventeen children (22.8%) had 1 recurrent episode of acute pancreatitis documented. Mortality rate in index cases was 28%, with a higher percentage harboring a preexisting illness (34.4% vs 5.6%; P = 0.01) and in male than in female patients (41% vs 14%; P = 0.01). CONCLUSIONS Deaths from pediatric acute pancreatitis are more prevalent in male individuals and those with a preexisting illness. Targeted strategies aimed at "highest-risk" patients may potentially offset mortality.
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Acute Pancreatitis and Recurrent Acute Pancreatitis in Children: A 10-Year Retrospective Study. Gastroenterol Res Pract 2022; 2022:5505484. [PMID: 35911080 PMCID: PMC9337950 DOI: 10.1155/2022/5505484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/08/2022] [Accepted: 07/09/2022] [Indexed: 12/03/2022] Open
Abstract
Aim To compare the clinical characteristics of acute pancreatitis (AP) and recurrent acute pancreatitis (ARP) in children. Method From January 2011 to January 2021, a total of 275 pediatric patients with AP admitted to a tertiary teaching hospital were enrolled. Results The median age of 275 children was 12.0 years. Among them, 55 cases were ARP. The leading causes of pediatric pancreatitis were biliary tract and virus infection. The percent of male in the AP group was higher than that in the ARP group. Viral infection in the AP group were higher than that in the ARP group, but anatomical abnormalities were lower than those in the ARP group. The incidence of pancreatic pseudocysts in the ARP group was higher than that in the AP group. The median interval time from AP to ARP was 3.0 months. Conclusion The main causes of pediatric pancreatitis were biliary tract and virus infection in the study. AP caused by virus infection seems to be less likely to develop into ARP. Female and anatomical abnormality are risks of ARP. Children with ARP are more likely to be complicated with pancreatic pseudocyst. There was no difference in ICU admission or mortality between AP and ARP.
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Smolka V, Rohanova M, Seda M, Karaskova E, Tkachyk O, Zapalka M, Volejnikova J. Etiology and classification of acute pancreatitis in children admitted to ICU using the Pediatric Sequential Organ Failure Assessment (pSOFA) score. Hepatobiliary Pancreat Dis Int 2022; 22:317-322. [PMID: 35842294 DOI: 10.1016/j.hbpd.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/29/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pediatric acute pancreatitis (AP) is rare but increasing. Severe AP is associated with higher morbidity and mortality. However, there are no universally accepted prognostic criteria for AP. METHODS This retrospective study included children with AP admitted to an intensive care unit (ICU) of our tertiary pediatric center between January 2009 and December 2018. The severity of organ dysfunction in AP was assessed according to the modified Atlanta criteria using the Pediatric Sequential Organ Failure Assessment (pSOFA) and Computed Tomography Severity Index (CTSI). RESULTS Seventy acute episodes of AP were evaluated in 55 children with primary pancreatitis. In addition, secondary AP was diagnosed in 15 patients originally admitted to ICU for different indications. Mild AP [no organ dysfunction, normal computed tomography (CT) finding] was the most prevalent (64/85 episodes in 49 children), followed by moderate AP (15 children; pSOFA 2-9 points, CTSI 3-4 points on admission). Severe AP (pSOFA 4-17 points, CTSI 6-10 points) was diagnosed in 6 children with traumatic or secondary AP. The most frequent etiologies of primary AP episodes were idiopathic (39%) and biliary (31%). Children with idiopathic AP had frequent relapses and comorbidities. Hereditary AP was typically mild, but presented with high pancreatic enzyme levels and recurrence rates. Admission at ICU and an interval without enteral nutrition (EN) were relatively short in drug-induced AP and relatively long in secondary and traumatic AP. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 13 patients with biliary AP and in 4 patients with traumatic AP. No AP-related death was observed. CONCLUSION pSOFA score accurately reflects the severity and prognosis of AP in children.
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Affiliation(s)
- Vratislav Smolka
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
| | - Marie Rohanova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
| | - Miroslav Seda
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
| | - Eva Karaskova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
| | - Oksana Tkachyk
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
| | - Martin Zapalka
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
| | - Jana Volejnikova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic.
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Thavamani A, Umapathi KK, Dalal J, Sferra TJ, Sankararaman S. Acute Pancreatitis Is Associated with Increased Risk of In-Hospital Mortality and Health Care Utilization Among Pediatric Patients with Hematopoietic Stem Cell Transplantation. J Pediatr 2022; 246:110-115.e4. [PMID: 35358587 DOI: 10.1016/j.jpeds.2022.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/10/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To analyze the impact of acute pancreatitis on mortality and hospital outcomes among the pediatric population following hematopoietic stem cell transplantation (HSCT). STUDY DESIGN We analyzed nationally representative, nonoverlapping years of the National Inpatient Sample and Kids Inpatient Database between 2003 and 2016, including all pediatric patients who had HSCT. Patients were divided into those with and without a diagnosis of acute pancreatitis and compared for demographics, clinical characteristics, comorbid conditions related to both HSCT and acute pancreatitis, and outcome measures such as in-hospital mortality and health care resource use (length of hospital stay and total hospitalization charges). RESULTS We analyzed a total of 128 772 hospitalizations of children and adolescents with HSCT. The overall incidence rate of acute pancreatitis was approximately 1%, with an overall increasing trend between 2003 and 2016, P < .001. The overall mortality rate was significantly greater among patients with acute pancreatitis (14.9% vs 3.6%, P < .001). Multivariate regression analysis showed that acute pancreatitis was independently associated with 3.4 times (95% CI 2.86-4.02, P < .001) increased risk of in-hospital mortality. Patients with acute pancreatitis who underwent HSCT had a greater incidence of end-organ damage and thrombotic events. Pediatric acute pancreatitis was associated with 24.3 additional days of hospitalization (95% CI 22.9-25.7, P < .001) and incurred additional $213 496 in hospitalization charges (95% CI 193 768-233 063, P < .001). CONCLUSIONS Pediatric recipients of HSCT who develop acute pancreatitis have adverse outcomes with increased in-hospital mortality, end-organ damage, prolonged hospital stay, and greater hospitalization charges.
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Affiliation(s)
- Aravind Thavamani
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Jignesh Dalal
- Division of Pediatric Hematology/Oncology, UH Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH
| | - Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH.
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Bhattacharya P, Kumar M, Kumari A, Kumar S. Risk Factors, Clinical Features, and Outcomes of Acute Pancreatitis in Children in Endemic Zone of Ascariasis in Eastern Bihar: A Hospital-Based Study. Cureus 2022; 14:e26177. [PMID: 35891851 PMCID: PMC9306399 DOI: 10.7759/cureus.26177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/20/2022] Open
Abstract
Objective This study aims to describe the etiology, clinical features, and outcomes of acute pancreatitis (AP) in children in an endemic area of hepatobiliary ascariasis. Methods This retrospective observational study included acute pancreatitis (AP) patients in the age group of 2-15 years from January 2019 to January 2022. Demographic profile, risk factors, clinical features, laboratory imaging, and outcome data were collected and analyzed. Results A total of 40 patients comprising of 21 males (52.5%) and 19 females (47.5%) were included. The median age of the diagnosis of AP was 8.3 years (range: 4-14 years). Biliary ascariasis was the most frequent etiology of AP (n=18, 45%), followed by gallbladder (GB) stone (n=6, 12%), trauma (n=1, 2.5%), hepatitis (n=1, 2.5%), valproate drug (n=1, 2.5%), and GB sludge (n=1, 2.5%). In clinical features, all cases had pain in the abdomen (n=40, 100%), followed by fever (n=9, 22.5%), nausea/vomiting (n=33, 82.5%), jaundice (n=2, 5%), and anemia (n=2, 5%). Three (7.5%) patients developed complications such as shock, pseudocyst, and necrotizing pancreatitis, respectively. The average median hospital stay was nine days (range: 4-20 days). No mortality occurred in our study. Conclusions This study revealed a high prevalence (12-13 cases/year) of AP in children in this area. Biliary ascariasis (45%) emerged as the commonest risk factor. Most of the cases suffered from mild AP (92%) and so recovered completely without any complication.
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Wilson DP, Williams L, Kavey REW. Hypertriglyceridemia in Youth. J Pediatr 2022; 243:200-207. [PMID: 34929246 DOI: 10.1016/j.jpeds.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Don P Wilson
- Pediatric Cardiovascular Health and Risk Prevention Program, Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX.
| | - Lauren Williams
- Pediatric Cardiovascular Health and Risk Prevention Program, Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX
| | - Rae-Ellen W Kavey
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY
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Kuo SH, Chen JS, Cheng CN, Lo HY, Chen WC, Lai FP, Yang YJ. The Characteristics and Risk Factors of Asparaginase-Associated Pancreatitis in Pediatric Acute Lymphoblastic Leukemia. Pancreas 2022; 51:366-371. [PMID: 35695827 DOI: 10.1097/mpa.0000000000002036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE This study aimed to elucidate the characteristics and the risk factors for asparaginase-associated pancreatitis (AAP) in pediatric acute lymphoblastic leukemia (ALL) under the Taiwan Pediatric Oncology Group (TPOG)-ALL regimen. METHODS The study was conducted by reviewing the chart records of 191 patients aged 1 to 18 years treated with TPOG-ALL (2002 and 2013) protocols at the National Cheng Kung University Hospital, Tainan, Taiwan, from 2002 to 2019. The disease incidence, clinical presentations, laboratory data, complications, and outcomes of AAP were investigated. RESULTS The incidence of AAP was 4.7%. The incidence was significantly higher in children treated with the TPOG-ALL-2013 (n = 62) than TPOG-ALL-2002 (n = 129) protocol (11.3% vs 1.6%, P = 0.006). Multivariate analysis identified using TPOG-ALL-2013 protocol was an independent risk factor for AAP. Pancreatic necrosis or pseudocysts developed in 7 patients (78%). Notably, 1 AAP case (11%) developed diabetes mellitus and 4 (44%) had chronic pancreatitis during a 1-year observational period. None were mortality. CONCLUSIONS The incidence of AAP was 4.7% in ALL patients treated with TPOG-ALL protocol. Although a higher cumulative dose of asparaginase in TPOG-ALL-2013 may attribute to the pancreatic toxicity, unidentified factors such as genetic predisposition or other drugs still need further study.
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Affiliation(s)
- Shu-Han Kuo
- From the Departments of Pediatrics, National Cheng Kung University Hospital
| | - Jiann-Shiuh Chen
- From the Departments of Pediatrics, National Cheng Kung University Hospital
| | - Chao-Neng Cheng
- From the Departments of Pediatrics, National Cheng Kung University Hospital
| | | | - Wei-Che Chen
- From the Departments of Pediatrics, National Cheng Kung University Hospital
| | - Fu-Ping Lai
- From the Departments of Pediatrics, National Cheng Kung University Hospital
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Multidisciplinary Approach to the Care of Children With Acute Recurrent Pancreatitis and Chronic Pancreatitis. Pancreas 2022; 51:256-260. [PMID: 35584383 DOI: 10.1097/mpa.0000000000002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of this article is to provide guidance to centers and organizations on the personnel (both physician and nonphysician) needed to create and sustain an optimal team, along with potential alternatives, to provide care to children with acute recurrent pancreatitis and chronic pancreatitis. METHODS This document was developed in collaboration with the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Pancreas Committee and the National Pancreas Foundation (NPF) after several meetings. RESULTS This document highlights both physician and nonphysician personnel needed to provide multidisciplinary care to children with pancreatitis per the recommendation of the NASPGHAN Pancreas Committee members in year 2021 and added to the currently published NPF criteria. We summarize how the NPF criteria would fit with the recently published pediatric pancreatitis society articles from the NASPGHAN. CONCLUSIONS It is important to manage children with acute recurrent pancreatitis and chronic pancreatitis in a multidisciplinary setting. There is need to study the impact of these personnel on the outcomes of children with pancreatitis.
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Mauney EE, Power-Hays A, Flamand Y, Vrooman L, Silverman LB, Grover AS. Clinical Characteristics and Short-Term Outcomes of Children With Asparaginase-Associated Pancreatitis. J Pediatr Gastroenterol Nutr 2022; 74:402-407. [PMID: 34694268 DOI: 10.1097/mpg.0000000000003334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Acute pancreatitis is a significant toxicity of l-asparaginase, a chemotherapeutic agent used to treat acute lymphoblastic leukemia. This case series describes the short-term clinical course and disposition of patients who developed asparaginase-associated pancreatitis (AAP) at one quaternary pediatric center. METHODS Clinical data, including laboratory data, inpatient and intensive care unit (ICU) days, imaging findings, presence of complications such as need for ventilation, dialysis, and the development of pleural effusions, and mode of nutrition were abstracted from the medical record of patients with AAP. Pediatric criteria were used to classify episode severity based on the development of organ failure and local complications, such as pancreatic necrosis. RESULTS Between 2005 and 2015, 34 patients had AAP with 43 distinct episodes of pancreatitis. The median inpatient length of stay was 10 days (range 2-65). Seven episodes (16.3%) required intensive care unit (ICU)-level care. Seventeen episodes (39.5%) were severe based on the development of organ failure or presence of pancreatic necrosis. Total parenteral nutrition (TPN) was used in 17 episodes (39.5%); for 34 episodes (79.1%), patients were discharged on entirely oral feeds. Antibiotics were administered in 20 episodes (46.5%). Pancreatic necrosis was identified within the first week in 12 episodes (27.9%). There were no deaths due to AAP. CONCLUSIONS The clinical course varies widely among patients with AAP. Over one-third of the patients in this series developed severe pancreatitis. Although the prognosis of AAP is generally good, many patients develop systemic complications of AAP, requiring TPN or ICU-level care.
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Affiliation(s)
- Erin E Mauney
- Department of Pediatrics, Boston Children's Hospital
- Division of Pediatric Gastroenterology & Nutrition, MassGeneral Hospital for Children, Boston, MA
| | | | - Yael Flamand
- Division of Hematology-Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute
| | - Lynda Vrooman
- Division of Hematology-Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute
| | - Lewis B Silverman
- Division of Hematology-Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute
| | - Amit S Grover
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
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Magnetic resonance imaging glossary of findings of pediatric pancreatitis and the revised Atlanta classification. Pediatr Radiol 2022; 52:189-199. [PMID: 33978804 DOI: 10.1007/s00247-021-05017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/23/2020] [Accepted: 02/11/2021] [Indexed: 02/07/2023]
Abstract
While still uncommon, the incidence of acute pancreatitis in children has been increasing over the last two decades. The Atlanta classification for acute pancreatitis, developed for adults, stratifies cases of acute pancreatitis based on imaging and clinical criteria. This classification scheme allows for standardized use of terminology to facilitate treatment and prognostication. Although US and CT should be used in critical or unstable patients, MRI is an ideal imaging modality in pediatric patients with acute pancreatitis because of its ability to characterize tissue without ionizing radiation. We review MRI examples specific to Atlanta classification terminology in pediatric patients. Chronic pancreatitis has also been increasingly diagnosed in children, and imaging plays a key role in the diagnosis and management of this insidious disease. MRI with magnetic resonance cholangiopancreatography is the optimal modality for assessing the pancreas in a child with known or suspected chronic pancreatitis because it provides tissue characterization and high-contrast imaging of the pancreatic duct without the use of invasive instrumentation or ionizing radiation. We also review and demonstrate accepted MRI findings of chronic pancreatitis.
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Al Droubi B, Altamimi E. Acute Pancreatitis in Jordanian Children: A Single Center Experience. Front Pediatr 2022; 10:908472. [PMID: 35844741 PMCID: PMC9283568 DOI: 10.3389/fped.2022.908472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is still much to understand and discover regarding pediatric pancreatitis. The etiology, clinical presentation, and prognosis of pancreatitis differs considerably between young children and adults. The incidence of pancreatitis has been increasing; it is no longer as rare in children as previously thought and could cause significant morbidity and mortality when severe. METHODS In this retrospective study conducted at a tertiary care hospital in Jordan, we present a cohort of children with 64 episodes of acute pancreatitis. RESULTS While abdominal pain was the most common presenting complaint in our cohort (97%), the classical features of radiation to the back and relief by the forward-lean position were observed in only one-third of our patients. Compared to serum amylase, serum lipase had a higher sensitivity for detecting pancreatitis (98 vs. 67%). Abdominal ultrasound is a non-invasive, widely available imaging modality; when performed, it revealed an enlarged pancreas in almost 60% of the patients. However, abdominal ultrasonography is often limited by the presence of excessive bowel gas. Anatomical abnormalities were the most common etiologies of pancreatitis (29%), followed by idiopathic pancreatitis (21%), and biliary causes (21%). CONCLUSION In our cohort, serum lipase was a better diagnostic tool compared to serum amylase. Congenital biliary-pancreatic abnormalities were the most common causes of acute pancreatitis in our cohort. Almost half of these patients developed recurrent acute pancreatitis. The prevalence of pancreatic pseudocysts was 16.7%, and nearly half of them required an intervention.
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Affiliation(s)
- Belal Al Droubi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Eyad Altamimi
- Department of Pediatrics, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Thavamani A, Umapathi KK, Khatana J, Sankararaman S. Clostridioides difficile Infection Is Associated with Adverse Outcomes among Hospitalized Pediatric Patients with Acute Pancreatitis. Pediatr Gastroenterol Hepatol Nutr 2022; 25:61-69. [PMID: 35087734 PMCID: PMC8762601 DOI: 10.5223/pghn.2022.25.1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/28/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Studies in adults have shown an increasing incidence of Clostridioides difficile infection (CDI) in patients hospitalized with acute pancreatitis (AP). There is lack of epidemiological data on CDI and its impact on hospitalized pediatric patients with AP. METHODS We analyzed the National Inpatient Sample and Kids' Inpatient Database between the years 2003 and 2016 and included all patients (age <21 years) with a primary diagnosis of AP using specific International Classification of Diseases codes. We compared clinical outcomes between children with CDI and those without CDI. Our primary outcome was severe AP and secondary outcomes included length of stay and hospital charges. RESULTS A total of 123,240 hospitalizations related to AP were analyzed and CDI was noted in 0.6% of the hospital. The prevalence rate of CDI doubled from 0.4% (2003) to 0.8% (2016), p=0.03. AP patients with CDI had increased comorbidities, and also underwent more invasive surgical procedures, p<0.05. AP patients with CDI had a higher in-hospital mortality rate and increased prevalence of severe AP, p<0.001. Multivariate regression models showed that CDI was associated with 2.4 times (confidence interval [CI]: 1.91 to 3.01, p<0.001) increased odds of severe AP. CDI patients had 7.24 (CI: 6.81 to 7.67, p<0.001) additional hospital days while incurring $59,032 (CI: 54,050 to 64,014, p<0.001) additional hospitalization charges. CONCLUSION CDI in pediatric patients with AP is associated with adverse clinical outcomes and increased healthcare resource utilization. Further studies are needed to elucidate this association to prevent the development of CDI and to improve outcomes.
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Affiliation(s)
- Aravind Thavamani
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Jasmine Khatana
- Department of Pediatrics, MetroHealth Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
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42
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Hopson P, Moreau C, Yazici C, Han S, Akshintala V, Archibugi L, Lee P, Uc A. An assessment of pancreatology education in North American pediatric gastroenterology fellowship programs. Pancreatology 2022; 22:142-147. [PMID: 34753657 PMCID: PMC8767525 DOI: 10.1016/j.pan.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND/OBJECTIVES Within the last two decades, an increased incidence of acute pancreatitis (AP) has been reported in childhood, with some progressing to acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Training future pancreatologists is critical to improve the care of children with pancreatic diseases. There are no studies to assess whether the pediatric gastroenterology (GI) fellowship curriculum prepares specialists to care for children with pancreatic diseases. METHODS An electronic survey was distributed to all North American Pediatric Gastroenterology Fellows. The survey included 31 questions on pancreatology training including academic resources, research experience, clinical exposure, clinical confidence, and career plans. RESULTS A total of 112 (25.8%) fellows responded from 41 (41/72, 56.9%) training centers in North America. Pancreas-specific didactic lectures were reported by 90.2% (n = 101); 49.5% (50/101) had at least quarterly or monthly lectures. Clinical confidence (Likert 4-5) was highest in managing and treating AP (94.6% and 93.8% respectively), relatively lower for ARP (84.8% and 71.4%) and lowest for CP (63.4% and 42.0%). Confidence in diagnosing both ARP and CP was associated with the variety of pancreatic diseases seen (p < 0.001) and total number of patients followed over a 6 month period (p = 0.04). Nine (8%) reported interest in specializing in pancreatology, 12 (10.7%) in pursuing research in the pancreatology. CONCLUSIONS Trainee confidence is highest in managing AP, lowest in CP, and seems to be directly correlated with the variety of pancreatic diseases and number of patients followed. Continued commitment is necessary to foster training of the next generation of pediatric pancreatologists.
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Affiliation(s)
- Puanani Hopson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mayo Clinic, Rochester, Minnesota USA
| | - Chris Moreau
- University of Texas Health Science Center, San Antonio, Texas USA
| | - Cemal Yazici
- Division of Gastroenterology and Hepatology, University of Illinois Chicago, Chicago, Illinois USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio USA
| | | | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Peter Lee
- Division of Gastroenterology, Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Aliye Uc
- University of Iowa, Stead Family Department of Pediatrics, Iowa City, Iowa USA,Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center,Fraternal Order of Eagles Diabetes Research Center
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43
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Cohen RZ, Freeman AJ. Pancreatitis in Children. Pediatr Clin North Am 2021; 68:1273-1291. [PMID: 34736589 DOI: 10.1016/j.pcl.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pediatric pancreatitis describes a spectrum covering acute pancreatitis, acute recurrent pancreatitis, and chronic pancreatitis, each with varying clinical manifestations and risk factors requiring a tailored diagnostic approach. We emphasize management strategies based on age, risk factors, recurrence, and complications. A discussion of the role of therapeutic endoscopy is reviewed and highlights the growing role of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in children with pancreatitis. Particular diagnostic challenges in autoimmune pancreatitis are reviewed with an emphasis on differentiating this entity from alternate pancreaticobiliary pathologies. Finally, we explore a multidisciplinary approach to acute recurrent and chronic pancreatitis.
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Affiliation(s)
- Reuven Zev Cohen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road Northeast, Atlanta, GA 30329, USA.
| | - A Jay Freeman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road Northeast, Atlanta, GA 30329, USA
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Farrel PR, Jones EK, Hornung L, Thompson T, Patel J, Lin TK, Nathan JD, Vitale DS, Habtezion A, Abu-El-Haija M. Cytokine Profile Elevations on Admission Can Determine Risks of Severe Acute Pancreatitis in Children. J Pediatr 2021; 238:33-41.e4. [PMID: 34273357 PMCID: PMC8551034 DOI: 10.1016/j.jpeds.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/10/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To utilize a Luminex platform to examine multiple cytokines simultaneously as well as clinical laboratory testing to identify markers that predict acute pancreatitis severity in the pediatric population on admission. STUDY DESIGN Patients (<19 years of age) prospectively enrolled over a 4-year period in a single institution acute pancreatitis database were included in separate derivation and validation cohorts. Plasma samples were obtained within 48 hours of admission and stored for analysis. Samples from mild acute pancreatitis and severe acute pancreatitis (moderately severe and severe combined) were analyzed using Luminex panels and C-reactive protein (CRP) testing. RESULTS The derivation cohort examined 62 cytokines in 66 subject samples (20 control, 36 mild acute pancreatitis, 10 severe acute pancreatitis) and identified interleukin 6 (IL-6) (P = .02) and monocyte chemotactic protein-1 (MCP-1) (P = .02) as cytokines that were differentially expressed between mild and severe acute pancreatitis. Our validation cohort analyzed 76 cytokines between 10 controls, 19 mild acute pancreatitis, and 6 severe acute pancreatitis subjects. IL-6 (P = .02) and MCP-1 (P = .007) were again found to differentiate mild acute pancreatitis from severe acute pancreatitis. CRP values were obtained from 53 of the subjects, revealing a strong association between elevated CRP values and progression to severe disease (P < .0001). CONCLUSIONS This study identified and validated IL-6 and MCP-1 as predictors of severe acute pancreatitis using 2 distinct cohorts and showed that CRP elevation is a marker of progression to severe acute pancreatitis. These biomarkers have not been extensively studied in the pediatric acute pancreatitis population. Our data allows for risk-stratification of patients with acute pancreatitis, and represent novel insight into the immunologic response in severe acute pancreatitis.
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Affiliation(s)
- Peter R. Farrel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Elaina K. Jones
- Division of Gastroenterology, Stanford University College of Medicine, Palo Alto, California
| | - Lindsey Hornung
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tyler Thompson
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jyoti Patel
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tom K. Lin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jaimie D. Nathan
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David S. Vitale
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Aida Habtezion
- Division of Gastroenterology, Stanford University College of Medicine, Palo Alto, California
| | - Maisam Abu-El-Haija
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Franke D, Anupindi SA, Barnewolt CE, Green TG, Greer MLC, Harkanyi Z, Lorenz N, McCarville MB, Mentzel HJ, Ntoulia A, Squires JH. Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children. Pediatr Radiol 2021; 51:2229-2252. [PMID: 34431006 DOI: 10.1007/s00247-021-05131-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
Gray-scale and color/power Doppler ultrasound (US) are the first-line imaging modalities to evaluate the spleen, gallbladder and pancreas in children. The increasing use of contrast-enhanced ultrasound (CEUS) as a reliable and safe method to evaluate liver lesions in the pediatric population promises potential for imaging other internal organs. Although CEUS applications of the spleen, gallbladder and pancreas have been well described in adults, they have not been fully explored in children. In this manuscript, we present an overview of the applications of CEUS for normal variants and diseases affecting the spleen, gallbladder and pancreas. We highlight a variety of cases as examples of how CEUS can serve in the diagnosis and follow-up for such diseases in children. Our discussion includes specific examination techniques; presentation of the main imaging findings in various benign and malignant lesions of the spleen, gallbladder and pancreas in children; and acknowledgment of the limitations of CEUS for these organs.
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Affiliation(s)
- Doris Franke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, MHH, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Thomas G Green
- Department of Radiology, Crouse Hospital, Syracuse, NY, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Norbert Lorenz
- Children's Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy H Squires
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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46
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Artunduaga M, Grover AS, Callahan MJ. Acute pancreatitis in children: a review with clinical perspectives to enhance imaging interpretation. Pediatr Radiol 2021; 51:1970-1982. [PMID: 34110445 DOI: 10.1007/s00247-021-05105-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/26/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
Pediatric acute pancreatitis has distinct etiologic, clinical and prognostic characteristics in contrast to the adult form of the disease. This review offers a comprehensive imaging update that emphasizes the importance of recognizing specific findings that are relevant from the clinical standpoint. Knowledge of these features facilitates communication among multidisciplinary team members and ultimately could lead to the improved care of pediatric acute pancreatitis patients.
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Affiliation(s)
- Maddy Artunduaga
- Pediatric Radiology Division, Department of Radiology, University of Texas Southwestern Medical Center, Children's Health Medical Center, 5323 Harry Hines Blvd., CMC F1.02, Dallas, TX, 75390, USA. .,Children's Health Medical Center, Dallas, TX, USA.
| | - Amit S Grover
- Pancreatic Disorders Program, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael J Callahan
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital, Boston, MA, USA
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Abstract
We reviewed INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a Cure) database for splanchnic venous thrombosis or arterial pseudoaneurysms to determine the incidence, risk factors and outcomes of peripancreatic vascular complications in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Of 410 children with diagnostic imaging studies, vascular complications were reported in five (1.2%); two had ARP, three CP. The vascular events were reported during moderately severe or severe acute pancreatitis (AP) in four, mild AP in one. Venous thrombosis occurred in four, arterial pseudoaneurysm (left gastric artery) in one. Two patients with venous thrombosis were treated with anticoagulant, one achieved recanalization (splenic vein). In two patients who did not receive anticoagulants, one re-canalized. No adverse effects were observed with anticoagulants. The child with pseudoaneurysm underwent aneurysmal coiling. Anti-coagulants appear to be safe in children with acute pancreatitis, their long-term benefit needs to be further investigated.
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49
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Sellers ZM, Barakat MT, Abu-El-Haija M. A Practical Approach to Management of Acute Pancreatitis: Similarities and Dissimilarities of Disease in Children and Adults. J Clin Med 2021; 10:jcm10122545. [PMID: 34201374 PMCID: PMC8228675 DOI: 10.3390/jcm10122545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/25/2021] [Accepted: 06/03/2021] [Indexed: 12/13/2022] Open
Abstract
Acute pancreatitis (AP) is associated with significant morbidity and mortality, and it substantially contributes to the healthcare burden of gastrointestinal disease and quality of life in children and adults. AP across the lifespan is characterized by similarities and differences in epidemiology, diagnostic modality, etiologies, management, adverse events, long-term outcomes, and areas in greatest need of research. In this review, we touch on each of these shared and distinctive features of AP in children and adults, with an emphasis on recent advances in the conceptualization and management of AP.
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Affiliation(s)
- Zachary M. Sellers
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USA; (Z.M.S.); (M.T.B.)
| | - Monique T. Barakat
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USA; (Z.M.S.); (M.T.B.)
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA 94304, USA
| | - Maisam Abu-El-Haija
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Correspondence: ; Tel.: +1-(513)-803-2123; Fax: +1-(513)-487-5528
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50
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Al Hindi S, Khalaf Z, Nazzal K, Nazzal O, Ahmed A, Alshaibani L. Acute Pancreatitis in Children: The Clinical Profile at a Tertiary Hospital. Cureus 2021; 13:e14871. [PMID: 33968545 PMCID: PMC8103661 DOI: 10.7759/cureus.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives The clinical course and progression of acute pancreatitis are poorly understood to date, necessitating more studies of clinical profiles during the disease. Moreover, understanding the etiologies and clinical presentations of acute pancreatitis (AP) in children can contribute to early diagnosis and, hence, earlier interventions. Therefore, this article aims to study the clinical profiles of children with acute pancreatitis (AP) in relation to complications and other variables. Study design We retrospectively studied 56 patients who presented with AP to the pediatric department in Salmaniya Medical Complex between January 2006 and December 2017. Cases of chronic pancreatitis and ages above 12 years were excluded. The data concerned demographics, etiology, clinical data, hospital course, and outcomes. Results The study included 56 patients aged a mean of 8.46 years (male:female - 33:23). The average hospital stay was 7.68 days. Patients received parenteral feeds a mean of 2.77 days. All patients had an ultrasound, nine required CT scans (16.1%), and five MRIs (8.9%). There were 18 local complications (32.1%): pseudocysts (n=3, 5.36%), cholangitis (n=2, 3.6%), and edema (n=13, 23.2%). There were 23 intensive care unit (ICU) admissions (41.1%). No mortalities occurred but there were six recurrences (10.7%). Symptoms of abdominal pain, vomiting, fever, and nausea occurred in 100%, 57.1%, 35.7%, and 23.2% of patients, respectively. Etiologies were 41.1% biliary, 23.2% idiopathic, 19.6% traumatic, and 8.93% drug-induced. Leukocytes were elevated in 20 patients (35.7%), c-reactive protein (CRP) in five (8.93%), serum amylase in 45 (80.4%), and urinary amylase in all 56 patients (100%). Conclusion Most pediatric AP cases were attributed to biliary causes followed by trauma. Age was significantly correlated with complication rates (P=0.013). Abdominal pain was a more common symptom than vomiting. Leukocytosis was associated with ICU admissions. There was no significant relation between c-reactive protein, serum amylase, or urinary amylase, and complications or ICU admissions. Pediatric AP was self-limiting and there were no fatalities.
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Affiliation(s)
- Saeed Al Hindi
- Department of Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
| | - Zahra Khalaf
- Department of Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
| | - Khaled Nazzal
- Department of Surgery, Ibn Al-Nafees Hospital, Manama, BHR
| | - Osama Nazzal
- Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BHR
| | - Alya Ahmed
- Department of Internal Medicine, King Hamad University Hospital, Manama, BHR
| | - Lama Alshaibani
- Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BHR
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