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Freeman AJ, Ng K, Wang F, Abu-El-Haija MA, Chugh A, Cress GA, Fishman DS, Gariepy CE, Giefer MJ, Goday P, Gonska TY, Grover AS, Lindblad D, Liu QY, Maqbool A, Mark JA, McFerron BA, Mehta MS, Morinville VD, Noel RA, Ooi CY, Perito ER, Schwarzenberg SJ, Sellers ZM, Wilschanski M, Zheng Y, Yuan Y, Andersen DK, Lowe ME, Uc A. Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A Report From INSPPIRE. Am J Gastroenterol 2024:00000434-990000000-01083. [PMID: 38517077 DOI: 10.14309/ajg.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Among children who suffer from acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), acute pancreatitis (AP) episodes are painful, often require hospitalization, and contribute to disease complications and progression. Despite this recognition, there are currently no interventions to prevent AP episodes. In this retrospective cohort study, we assessed the impact of pancreatic enzyme therapy (PERT) use on clinical outcomes among children with pancreatic-sufficient ARP or CP. METHODS Children with pancreatic-sufficient ARP or CP in the INSPPIRE-2 cohort were included. Clinical outcomes were compared for those receiving vs not receiving PERT, as well as frequency of AP before and after PERT. Logistic regression was used to study the association between development of AP episodes after starting PERT and response predictors. RESULTS Among 356 pancreatic-sufficient participants, 270 (76%) had ARP, and 60 (17%) received PERT. Among those on PERT, 42% did not have a subsequent AP episode, during a mean 2.1 years of follow-up. Children with a SPINK1 mutation ( P = 0.005) and those with ARP (compared with CP, P = 0.008) were less likely to have an AP episode after starting PERT. After initiation of PERT, the mean AP annual incidence rate decreased from 3.14 down to 0.71 ( P < 0.001). DISCUSSION In a retrospective analysis, use of PERT was associated with a reduction in the incidence rate of AP among children with pancreatic-sufficient ARP or CP. These results support the need for a clinical trial to evaluate the efficacy of PERT to improve clinical outcomes among children with ARP or CP.
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Affiliation(s)
- Alvin Jay Freeman
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kenneth Ng
- Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fuchenchu Wang
- The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Maisam A Abu-El-Haija
- Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ankur Chugh
- Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gretchen A Cress
- University of Iowa, Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Douglas S Fishman
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Cheryl E Gariepy
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Praveen Goday
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Amit S Grover
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas Lindblad
- Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Quin Y Liu
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Asim Maqbool
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jacob A Mark
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Brian A McFerron
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Megha S Mehta
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | | | | | - Chee Y Ooi
- University of New South Wales, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Emily R Perito
- University of California San Francisco, San Francisco, California, USA
| | | | | | | | - Yuhua Zheng
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark E Lowe
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aliye Uc
- University of Iowa, Stead Family Children's Hospital, Iowa City, Iowa, USA
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2
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Abu-El-Haija M, Hornung L, Ellery K, Fishman DS, Gonska TY, Gariepy C, Lowe M, Larson Ode K, Maqbool A, Mascarenhas M, Morinville VD, Ooi CY, Perito ER, Schwarzenberg SJ, Sellers ZM, Zemel BS, Yuan Y, Wang F, Uc A, Kalkwarf HJ. Bone health in children with recurrent and chronic pancreatitis: A multi-center cross sectional analysis. Pancreatology 2023; 23:755-760. [PMID: 37723006 PMCID: PMC10843133 DOI: 10.1016/j.pan.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/02/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND/OBJECTIVES Bone health of children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) is not well studied. METHODS This retrospective study was performed at three sites and included data from INSPPIRE-2. RESULTS Of the 87 children in the study: 46 had ARP (53%), 41 had CP (47%). Mean age was 13.6 ± 3.9 years at last DXA scan. The prevalence of low height-for-age (Z-score < -2) (13%, 10/78) and low bone mineral density (BMD) adjusted for height (Z-score < -2) (6.4%, 5/78) were higher than a healthy reference sample (2.5%, p < 0.0001 and p = 0.03, respectively). CONCLUSION Children with ARP or CP have lower height and BMD than healthy peers. Attention to deficits in growth and bone mineral accrual in children with pancreatic disease is warranted.
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Affiliation(s)
- Maisam Abu-El-Haija
- Division of 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.
| | - Lindsey Hornung
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kate Ellery
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | | | | | - Mark Lowe
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Katie Larson Ode
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA
| | - Asim Maqbool
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Chee Y Ooi
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales and Department of Gastroenterology, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Emily R Perito
- University of California San Francisco, San Francisco, CA, USA
| | | | - Zachary M Sellers
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA, USA
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ying Yuan
- Department of Biostatistics, University of Texas MD, Anderson Cancer Center, Huston, TX, USA
| | - Fuchenchu Wang
- Department of Biostatistics, University of Texas MD, Anderson Cancer Center, Huston, TX, USA
| | - Aliye Uc
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA; Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Heidi J Kalkwarf
- Division of 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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3
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Morinville VD, Husain SZ, Wang F, Cress GA, Abu-El-Haija M, Chugh A, Downs E, Ellery K, Fishman DS, Freeman AJ, Gariepy CE, Giefer M, Gonska T, Liu Q, Maqbool A, Mark J, Mcferron BA, Mehta M, Nathan JD, Ng K, Ooi CY, Perito E, Ruan W, Schwarzenberg SJ, Sellers ZM, Serrano J, Troendle DM, Wilschanski M, Zheng Y, Yuan Y, Lowe M, Uc A. Pediatric Drug-Associated Pancreatitis Reveals Concomitant Risk Factors and Poor Reliability of Causality Scoring: Report From INSPPIRE. J Pediatr Gastroenterol Nutr 2023; 77:540-546. [PMID: 37496124 PMCID: PMC10529270 DOI: 10.1097/mpg.0000000000003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Drug-associated acute pancreatitis (DAP) studies typically focus on single acute pancreatitis (AP) cases. We aimed to analyze the (1) characteristics, (2) co-risk factors, and (3) reliability of the Naranjo scoring system for DAP using INSPPIRE-2 (the INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2) cohort study of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in children. METHODS Data were obtained from ARP group with ≥1 episode of DAP and CP group with medication exposure ± DAP. Physicians could report multiple risk factors. Pancreatitis associated with Medication (Med) (ARP+CP) was compared to Non-Medication cases, and ARP-Med vs CP-Med groups. Naranjo score was calculated for each DAP episode. RESULTS Of 726 children, 392 had ARP and 334 had CP; 51 children (39 ARP and 12 CP) had ≥1 AP associated with a medication; 61% had ≥1 AP without concurrent medication exposure. The Med group had other risk factors present (where tested): 10 of 35 (28.6%) genetic, 1 of 48 (2.1%) autoimmune pancreatitis, 13 of 51 (25.5%) immune-mediated conditions, 11 of 50 (22.0%) obstructive/anatomic, and 28 of 51 (54.9%) systemic risk factors. In Med group, 24 of 51 (47%) had involvement of >1 medication, simultaneously or over different AP episodes. There were 20 ARP and 4 CP cases in "probable" category and 19 ARP and 7 CP in "possible" category by Naranjo scores. CONCLUSIONS Medications were involved in 51 of 726 (7%) of ARP or CP patients in INSPPIRE-2 cohort; other pancreatitis risk factors were present in most, suggesting a potential additive role of different risks. The Naranjo scoring system failed to identify any cases as "definitive," raising questions about its reliability for DAP.
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Affiliation(s)
| | | | - Fuchenchu Wang
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Gretchen A Cress
- The University of Iowa, Stead Family Children's Hospital, Iowa City, IA
| | - Maisam Abu-El-Haija
- The Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Ankur Chugh
- The Medical College of Wisconsin, Milwaukee, WI
| | - Elissa Downs
- The University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Kate Ellery
- The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Douglas S Fishman
- The Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | | | - Tanja Gonska
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Quin Liu
- The Cedars-Sinai Medical Center, Los Angeles, CA
| | - Asim Maqbool
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jacob Mark
- the Children's Hospital Colorado, Aurora, CO
| | - Brian Arthur Mcferron
- The Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Megha Mehta
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ken Ng
- The John Hopkins Medical Center, Baltimore, MD
| | - Chee Y Ooi
- The School of Women's and Children's Health, Faculty of Medicine, University of New South Wales and Sydney Children's Hospital Randwick, Sydney, NSW, Australia
| | - Emily Perito
- The University of California San Francisco Medical Center, San Francisco, CA
| | - Wenly Ruan
- The Nationwide Children's Hospital, Columbus, OH
| | | | | | - Jose Serrano
- the Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD
| | | | | | - Yuhua Zheng
- The Children's Hospital of Los Angeles, Los Angeles, CA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Mark Lowe
- The Washington University School of Medicine, St Louis, MO
| | - Aliye Uc
- The University of Iowa, Stead Family Children's Hospital, Iowa City, IA
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4
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Uc A, Cress GA, Wang F, Abu-El-Haija M, Ellery KM, Fishman DS, Gariepy CE, Gonska T, Lin TK, Liu QY, Mehta M, Maqbool A, McFerron BA, Morinville VD, Ooi CY, Perito ER, Schwarzenberg SJ, Sellers ZM, Serrano J, Shah U, Troendle DM, Wilschanski M, Zheng Y, Yuan Y, Lowe ME. Analysis of INSPPIRE-2 Cohort: Risk Factors and Disease Burden in Children With Acute Recurrent or Chronic Pancreatitis. J Pediatr Gastroenterol Nutr 2022; 75:643-649. [PMID: 35976273 PMCID: PMC9617760 DOI: 10.1097/mpg.0000000000003590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The objective of this study is to investigate risk factors and disease burden in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). METHODS Data were obtained from INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2), the largest multi-center prospective cohort study in pediatric patients with ARP or CP. RESULTS Of 689 children, 365 had ARP (53%), 324 had CP (47%). CP was more commonly associated with female sex, younger age at first acute pancreatitis (AP) attack, Asian race, family history of CP, lower BMI%, genetic and obstructive factors, PRSS1 mutations and pancreas divisum. CFTR mutations, toxic-metabolic factors, medication use, hypertriglyceridemia, Crohn disease were more common in children with ARP. Constant or frequent abdominal pain, emergency room (ER) visits, hospitalizations, medical, endoscopic or surgical therapies were significantly more common in CP, episodic pain in ARP. A total of 33.1% of children with CP had exocrine pancreatic insufficiency (EPI), 8.7% had diabetes mellitus. Compared to boys, girls were more likely to report pain impacting socialization and school, medical therapies, cholecystectomy, but no increased opioid use. There was no difference in race, ethnicity, age at first AP episode, age at CP diagnosis, duration of disease, risk factors, prevalence of EPI or diabetes between boys and girls. Multivariate analysis revealed that family history of CP, constant pain, obstructive risk factors were predictors of CP. CONCLUSIONS Children with family history of CP, constant pain, or obstructive risk factors should raise suspicion for CP.
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Affiliation(s)
- Aliye Uc
- University of Iowa, Stead Family Children’s Hospital, Iowa City, IA
| | | | - Fuchenchu Wang
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Maisam Abu-El-Haija
- Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | | | - Douglas S. Fishman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | | | | | - Tom K. Lin
- Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Quin Y. Liu
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - Megha Mehta
- University of Texas Southwestern Medical School, Dallas, TX
| | - Asim Maqbool
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brian A. McFerron
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | | | - Chee Y. Ooi
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales and Sydney Children’s Hospital Randwick Sydney, Sydney, Australia
| | | | | | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD
| | - Uzma Shah
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | | | | | - Yuhua Zheng
- Children’s Hospital Los Angeles, Los Angeles, CA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Mark E. Lowe
- Washington University School of Medicine, St. Louis, MO
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5
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Tham SW, Wang F, Gariepy CE, Cress GA, Abu-El-Haija MA, Bellin MD, Ellery KM, Fishman DS, Gonska T, Heyman MB, Lin TK, Maqbool A, McFerron BA, Morinville VD, Nathan JD, Ooi CY, Perito ER, Schwarzenberg SJ, Sellers ZM, Shah U, Troendle DM, Wilschanski M, Zheng Y, Yuan Y, Lowe ME, Uc A, Palermo TM. Health-Related Quality of Life in Pediatric Acute Recurrent or Chronic Pancreatitis: Association With Biopsychosocial Risk Factors. J Pediatr Gastroenterol Nutr 2022; 74:636-642. [PMID: 35192575 PMCID: PMC9117452 DOI: 10.1097/mpg.0000000000003420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Abdominal pain, emergency department visits, and hospitalizations impact lives of children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Data on health-related quality of life (HRQOL) in this population, however, remains limited. We aimed to evaluate HRQOL in children with ARP or CP; and test biopsychosocial risk factors associated with low HRQOL. METHODS Data were acquired from the INternational Study Group of Pediatric Pancreatitis: In search for a cuRE registry. Baseline demographic and clinical questionnaires, the Child Health Questionnaire (measures HRQOL) and Child Behavior Checklist (measures emotional and behavioral functioning) were completed at enrollment. RESULTS The sample included 368 children (54.3% girls, mean age = 12.7years, standard deviation [SD] = 3.3); 65.2% had ARP and 34.8% with CP. Low physical HRQOL (M = 38.5, SD = 16.0) was demonstrated while psychosocial HRQOL (M = 49.5, SD = 10.2) was in the normative range. Multivariate regression analysis revealed that clinical levels of emotional and behavioral problems (B = -10.28, P < 0.001), episodic and constant abdominal pain (B = 04.66, P = 0.03; B = -13.25, P < 0.001) were associated with low physical HRQOL, after accounting for ARP/CP status, age, sex, exocrine, and endocrine disease (F [9, 271] = 8.34, P < 0.001). Borderline and clinical levels of emotional and behavioral problems (B = -10.18, P < 0.001; B = -15.98, P < 0.001), and constant pain (B = -4.46, P < 0.001) were associated with low psychosocial HRQOL (F [9, 271] = 17.18, P < 0.001). CONCLUSIONS Findings highlight the importance of assessing HRQOL and treating pain and psychosocial problems in this vulnerable group of children.
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Affiliation(s)
- See Wan Tham
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Fuchenchu Wang
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | | | - Gretchen A Cress
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA
| | - Maisam A Abu-El-Haija
- Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Melena D Bellin
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Kate M Ellery
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | - Tom K Lin
- Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Asim Maqbool
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brian A McFerron
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Chee Y Ooi
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales and Department of Gastroenterology, Sydney Children's Hospital Randwick, Sydney, NSW, Australia
| | - Emily R Perito
- University of California San Francisco, San Francisco, CA
| | | | | | - Uzma Shah
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | | | | | - Yuhua Zheng
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Mark E Lowe
- Washington University School of Medicine, St. Louis, MO
| | - Aliye Uc
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA
| | - Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA
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Nathan JD, Ellery K, Balakrishnan K, Bhatt H, Ganoza A, Husain SZ, Kumar R, Morinville VD, Quiros JA, Schwarzenberg SJ, Sellers ZM, Uc A, Abu-El-Haija M. The Role of Surgical Management in Chronic Pancreatitis in Children: A Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr 2022; 74:706-719. [PMID: 35258494 PMCID: PMC10286947 DOI: 10.1097/mpg.0000000000003439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Chronic pancreatitis (CP) is rare in childhood but impactful because of its high disease burden. There is limited literature regarding the management of CP in children, specifically about the various surgical approaches. Herein, we summarize the current pediatric and adult literature and provide recommendations for the surgical management of CP in children. METHODS The literature review was performed to include the scope of the problem, indications for operation, conventional surgical options as well as total pancreatectomy with islet autotransplantation, and outcomes following operations for CP. RESULTS Surgery is indicated for children with debilitating CP who have failed maximal medical and endoscopic interventions. Surgical management must be tailored to the patient's unique needs, considering the anatomy and morphology of their disease. A conventional surgical approach (eg, drainage operation, partial resection, combination drainage-resection) may be considered in the presence of significant and uniform pancreatic duct dilation or an inflammatory head mass. Total pancreatectomy with islet autotransplantation is the best surgical option in patients with small duct disease. The presence of genetic risk factors often portends a suboptimal outcome following a conventional operation. CONCLUSIONS The morphology of disease and the presence of genetic risk factors must be considered while determining the optimal surgical approach for children with CP. Surgical outcomes for CP are variable and depend on the type of intervention. A multidisciplinary team approach is needed to assure that the best possible operation is selected for each patient, their recovery is optimized, and their immediate and long-term postoperative needs are well-met.
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Affiliation(s)
- Jaimie D. Nathan
- Nationwide Children’s Hospital, Department of Abdominal Transplant and Hepatopancreatobiliary Surgery, The Ohio State University College of Medicine, Department of Surgery, Columbus, Ohio, United States
| | - Kate Ellery
- University of Pittsburgh Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh, Pennsylvania, United States
| | - Keshawadhana Balakrishnan
- Texas Children’s Hospital, Section of Pediatric Gastroenterology, Baylor College of Medicine, Department of Pediatrics, Houston, Texas, United States
| | - Heli Bhatt
- University of Minnesota, Masonic Children’s Hospital, Minneapolis, Minnesota, United States
| | - Armando Ganoza
- University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, Pittsburgh, Pennsylvania, United States
| | - Sohail Z. Husain
- Lucile Packard Children’s Hospital at Stanford, Pediatric Gastroenterology, Hepatology and Nutrition and Department of Pediatrics, Stanford University, Palo Alto, California, United States
| | - Rakesh Kumar
- Promedica Russell J. Ebeid Children’s Hospital, Toledo, Ohio, United States
| | - Veronique D. Morinville
- McGill University Health Center, Montreal Children’s Hospital, Division of Pediatric Gastroenterology and Nutrition, Montreal, Quebec, Canada
| | - J. Antonio Quiros
- Icahn School of Medicine, Mount Sinai Kravis Children’s Hospital, New York, New York, United States
| | - Sarah J. Schwarzenberg
- University of Minnesota, Masonic Children’s Hospital, Minneapolis, Minnesota, United States
| | - Zachary M. Sellers
- Lucile Packard Children’s Hospital at Stanford, Pediatric Gastroenterology, Hepatology and Nutrition and Department of Pediatrics, Stanford University, Palo Alto, California, United States
| | - Aliye Uc
- University of Iowa, Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, Iowa, United States
| | - Maisam Abu-El-Haija
- Cincinnati Children’s Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, United States
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7
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D'Arienzo D, Rumjahn Gryte K, Noya F, Morinville VD. Disseminated and Central Nervous System Vaccine-Strain Herpes Zoster Infection in a Teenager With Crohn's Disease on Maintenance Adalimumab Therapy. JPGN Rep 2021; 2:e072. [PMID: 37207068 PMCID: PMC10191570 DOI: 10.1097/pg9.0000000000000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/14/2021] [Indexed: 05/21/2023]
Abstract
Patients on immunosuppression, including inflammatory bowel disease patients on anti-tumor necrosis factor therapies, are at increased risk of severe varicella and herpes zoster infections. Although varicella vaccine-related herpes zoster reactivation is a rare complication, physicians must remain vigilant about this diagnosis, particularly in those on immunosuppressive medications. Here, we report a case of a patient with Crohn disease, on only adalimumab immunosuppression, who developed varicella vaccine-related disseminated herpes zoster with meningitis, over 15 years after immunization.
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Affiliation(s)
- David D'Arienzo
- From the Department of Pediatrics, Montreal Children's Hospital, McGill University
| | | | - Francisco Noya
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital
| | - Veronique D Morinville
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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Freeman AJ, Maqbool A, Bellin MD, Goldschneider KR, Grover AS, Hartzell C, Piester TL, Szabo F, Kiernan BD, Khalaf R, Kumar R, Rios M, Husain SZ, Morinville VD, Abu-El-Haija M. Medical Management of Chronic Pancreatitis in Children: A Position Paper by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr 2021; 72:324-340. [PMID: 33230082 PMCID: PMC8054312 DOI: 10.1097/mpg.0000000000003001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT This position paper summarizes the current understanding of the medical management of chronic pancreatitis (CP) in children in light of the existing medical literature, incorporating recent advances in understanding of nutrition, pain, lifestyle considerations, and sequelae of CP. This article complements and is intended to integrate with parallel position papers on endoscopic and surgical aspects of CP in children. Concepts and controversies related to pancreatic enzyme replacement therapy (PERT), the use of antioxidants and other CP medical therapies are also reviewed. Highlights include inclusion of tools for medical decision-making for PERT, CP-related diabetes, and multimodal pain management (including an analgesia ladder). Gaps in our understanding of CP in children and avenues for further investigations are also reviewed.
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Affiliation(s)
- A. Jay Freeman
- Department of Gastroenterology, Hepatology and Nutrition, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Asim Maqbool
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Melena D. Bellin
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN
| | | | - Amit S. Grover
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Cheryl Hartzell
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Travis L. Piester
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Flora Szabo
- Division of Pediatric Gastroenterology and Nutrition, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA
| | - Bridget Dowd Kiernan
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Racha Khalaf
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Rakesh Kumar
- Department of Gastroenterology, Hepatology and Nutrition, Promedica Toledo Children’s Hospital, Toledo, OH
| | - Mirta Rios
- Food and Nutrition Department, Nicklaus Children’s Hospital, Miami, FL
| | - Sohail Z. Husain
- Department of Pediatrics, Stanford University, and the Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Veronique D. Morinville
- Division of Pediatric Gastroenterology and Nutrition, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Maisam Abu-El-Haija
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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9
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Trout AT, Anupindi SA, Freeman AJ, Macias-Flores JA, Martinez JA, Parashette KR, Shah U, Squires JH, Morinville VD, Husain SZ, Abu-El-Haija M. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the Society for Pediatric Radiology Joint Position Paper on Noninvasive Imaging of Pediatric Pancreatitis: Literature Summary and Recommendations. J Pediatr Gastroenterol Nutr 2021; 72:151-167. [PMID: 33003171 DOI: 10.1097/mpg.0000000000002964] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT The reported incidence of pediatric pancreatitis is increasing. Noninvasive imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), play important roles in the diagnosis, staging, follow-up, and management of pancreatitis in children. In this position paper, generated by members of the Pancreas Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the Abdominal Imaging Committee of The Society for Pediatric Radiology (SPR), we review the roles of noninvasive imaging in pediatric acute, acute recurrent, and chronic pancreatitis. We discuss available evidence related to noninvasive imaging, highlighting evidence specific to pediatric populations, and we make joint recommendations for use of noninvasive imaging. Further, we highlight the need for research to define the performance and role of noninvasive imaging in pediatric pancreatitis.
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Affiliation(s)
- Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center
- Department of Radiology
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A Jay Freeman
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA
| | | | - J Andres Martinez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Kalyan R Parashette
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA
| | - Uzma Shah
- Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | - Judy H Squires
- Department of Radiology, University of Pittsburgh Medical Center, Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Veronique D Morinville
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Sohail Z Husain
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford School of Medicine, Stanford, CA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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10
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Trout AT, Anupindi SA, Husain SZ, Morinville VD, Abu-El-Haija M. Noninvasive imaging of pediatric pancreatitis: joint recommendations from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the Society for Pediatric Radiology. Pediatr Radiol 2021; 51:8-10. [PMID: 33057774 DOI: 10.1007/s00247-020-04813-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/13/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229-3026, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sohail Z Husain
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - Veronique D Morinville
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Maisam Abu-El-Haija
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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11
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Perito ER, Palermo TM, Pohl JF, Mascarenhas M, Abu-El-Haija M, Barth B, Bellin MD, Fishman DS, Freedman S, Gariepy C, Giefer M, Gonska T, Heyman MB, Himes RW, Husain SZ, Lin T, Liu Q, Maqbool A, McFerron B, Morinville VD, Nathan JD, Ooi CY, Rhee S, Schwarzenberg SJ, Shah U, Troendle DM, Werlin S, Wilschanski M, Zheng Y, Zimmerman MB, Lowe M, Uc A. Factors Associated With Frequent Opioid Use in Children With Acute Recurrent and Chronic Pancreatitis. J Pediatr Gastroenterol Nutr 2020; 70:106-114. [PMID: 31567889 PMCID: PMC6934913 DOI: 10.1097/mpg.0000000000002502] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP). METHODS Cross-sectional study of children <19 years with ARP or CP, at enrollment into the INSPPIRE cohort. We categorized patients as opioid "frequent use" (daily/weekly) or "nonfrequent use" (monthly or less, or no opioids), based on patient and parent self-report. RESULTS Of 427 children with ARP or CP, 17% reported frequent opioid use. More children with CP (65%) reported frequent opioid use than with ARP (41%, P = 0.0002). In multivariate analysis, frequent opioid use was associated with older age at diagnosis (odds ratio [OR] 1.67 per 5 years, 95% confidence interval [CI] 1.13-2.47, P = 0.01), exocrine insufficiency (OR 2.44, 95% CI 1.13-5.24, P = 0.02), constant/severe pain (OR 4.14, 95% CI 2.06-8.34, P < 0.0001), and higher average pain impact score across all 6 functional domains (OR 1.62 per 1-point increase, 95% CI 1.28-2.06, P < 0.0001). Children with frequent opioid use also reported more missed school days, hospitalizations, and emergency room visits in the past year than children with no frequent use (P < 0.0002 for each). Participants in the US West and Midwest accounted for 83% of frequent opioid users but only 56% of the total cohort. CONCLUSIONS In children with CP or ARP, frequent opioid use is associated with constant pain, more healthcare use, and higher levels of pain interference with functioning. Longitudinal and prospective research is needed to identify risk factors for frequent opioid use and to evaluate nonopioid interventions for reducing pain and disability in these children.
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Affiliation(s)
- Emily R. Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - John F. Pohl
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Maria Mascarenhas
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bradley Barth
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Melena D. Bellin
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | - Cheryl Gariepy
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Matthew Giefer
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Tanja Gonska
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, ON, Canada
| | - Melvin B. Heyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ryan W. Himes
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
| | - Sohail Z. Husain
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Tom Lin
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Quin Liu
- Department of Pediatrics, Cedars-Sinai, Los Angeles, CA
| | - Asim Maqbool
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brian McFerron
- Department of Pediatrics, Indiana University, Indianapolis, IN
| | - Veronique D. Morinville
- Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Jaime D. Nathan
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chee Y. Ooi
- School of Women’s and Children’s Health, Medicine, University of New South Wales, New South Wales, Sydney, Australia
| | - Sue Rhee
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | | | - Uzma Shah
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - David M. Troendle
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Steven Werlin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Yuhua Zheng
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Mark Lowe
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Aliye Uc
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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12
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Palermo TM, Murray C, Aalfs H, Abu-El-Haija M, Barth B, Bellin MD, Ellery K, Fishman DS, Gariepy CE, Giefer MJ, Goday P, Gonska T, Heyman MB, Husain SZ, Lin TK, Liu QY, Mascarenhas MR, Maqbool A, McFerron B, Morinville VD, Nathan JD, Ooi CY, Perito ER, Pohl JF, Schwarzenberg SJ, Sellers ZM, Serrano J, Shah U, Troendle D, Zheng Y, Yuan Y, Lowe M, Uc A. Web-based cognitive-behavioral intervention for pain in pediatric acute recurrent and chronic pancreatitis: Protocol of a multicenter randomized controlled trial from the study of chronic pancreatitis, diabetes and pancreatic cancer (CPDPC). Contemp Clin Trials 2019; 88:105898. [PMID: 31756383 DOI: 10.1016/j.cct.2019.105898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Abdominal pain is common and is associated with high disease burden and health care costs in pediatric acute recurrent and chronic pancreatitis (ARP/CP). Despite the strong central component of pain in ARP/CP and the efficacy of psychological therapies for other centralized pain syndromes, no studies have evaluated psychological pain interventions in children with ARP/CP. The current trial seeks to 1) evaluate the efficacy of a psychological pain intervention for pediatric ARP/CP, and 2) examine baseline patient-specific genetic, clinical, and psychosocial characteristics that may predict or moderate treatment response. METHODS This single-blinded randomized placebo-controlled multicenter trial aims to enroll 260 youth (ages 10-18) with ARP/CP and their parents from twenty-one INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) centers. Participants will be randomly assigned to either a web-based cognitive behavioral pain management intervention (Web-based Management of Adolescent Pain Chronic Pancreatitis; WebMAP; N = 130) or to a web-based pain education program (WebED; N = 130). Assessments will be completed at baseline (T1), immediately after completion of the intervention (T2) and at 6 months post-intervention (T3). The primary study outcome is abdominal pain severity. Secondary outcomes include pain-related disability, pain interference, health-related quality of life, emotional distress, impact of pain, opioid use, and healthcare utilization. CONCLUSIONS This is the first clinical trial to evaluate the efficacy of a psychological pain intervention for children with CP for reduction of abdominal pain and improvement of health-related quality of life. Findings will inform delivery of web-based pain management and potentially identify patient-specific biological and psychosocial factors associated with favorable response to therapy. Clinical Trial Registration #: NCT03707431.
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Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, USA; Center for Child Health, Behavior & Development, Seattle Children's Research Institute, USA.
| | - Caitlin Murray
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, USA
| | - Homer Aalfs
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, USA
| | - Maisam Abu-El-Haija
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Bradley Barth
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Melena D Bellin
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Kate Ellery
- Children's Hospital; of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | | | | | | | - Melvin B Heyman
- University of California San Francisco, San Francisco, CA, USA
| | | | - Tom K Lin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Quin Y Liu
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Asim Maqbool
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian McFerron
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Jaimie D Nathan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Chee Y Ooi
- School of Women's and Children's Health, Medicine, University of New South Wales and Sydney Children's Hospital Randwick Sydney, Australia
| | - Emily R Perito
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD, USA
| | - Uzma Shah
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - David Troendle
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Yuhua Zheng
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Lowe
- Washington University School of Medicine, Iowa City, IA, USA
| | - Aliye Uc
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, USA
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Alahmari AA, Nguyen V, Morinville VD, Ahmed N, Sant’Anna A. A159 VERY EARLY-ONSET INFLAMMATORY BOWEL DISEASE (VEO-IBD): CASE REPORT AND REVIEW OF THE LITERATURE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A A Alahmari
- Montreal Children’s Hospital - McGill University, Montreal, QC, Canada
| | - V Nguyen
- Montreal Children’s Hospital - McGill University, Montreal, QC, Canada
| | - V D Morinville
- Montreal Children’s Hospital - McGill University, Montreal, QC, Canada
| | - N Ahmed
- Montreal Children’s Hospital - McGill University, Montreal, QC, Canada
| | - A Sant’Anna
- Montreal Children’s Hospital - McGill University, Montreal, QC, Canada
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14
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Gariepy CE, Heyman MB, Lowe ME, Pohl JF, Werlin SL, Wilschanski M, Barth B, Fishman DS, Freedman SD, Giefer MJ, Gonska T, Himes R, Husain SZ, Morinville VD, Ooi CY, Schwarzenberg SJ, Troendle DM, Yen E, Uc A. Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group. J Pediatr Gastroenterol Nutr 2017; 64:95-103. [PMID: 27782962 PMCID: PMC5191966 DOI: 10.1097/mpg.0000000000001446] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates during the past decade. As pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. The aim of the study was to review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research. METHODS A systematic review of the literature was performed and scored for quality, followed by consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group. RESULTS The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed. CONCLUSIONS This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting.
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Affiliation(s)
- Cheryl E. Gariepy
- Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Melvin B. Heyman
- University of California at San Francisco, San Francisco, CA, USA
| | - Mark E. Lowe
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | | | | | - Bradley Barth
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | | | | | | | - Ryan Himes
- Baylor College of Medicine, Houston, TX, USA
| | | | | | - Chee Y. Ooi
- University of New South Wales and Sydney Children’s Hospital Randwick Sydney, Australia
| | | | | | - Elizabeth Yen
- University of California at San Francisco, San Francisco, CA, USA
| | - Aliye Uc
- University of Iowa Children’s Hospital, Iowa City, IA, USA
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15
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Schwarzenberg SJ, Bellin M, Husain SZ, Ahuja M, Barth B, Davis H, Durie PR, Fishman DS, Freedman SD, Gariepy CE, Giefer MJ, Gonska T, Heyman MB, Himes R, Kumar S, Morinville VD, Lowe ME, Nuehring NE, Ooi CY, Pohl JF, Troendle D, Werlin SL, Wilschanski M, Yen E, Uc A. Pediatric chronic pancreatitis is associated with genetic risk factors and substantial disease burden. J Pediatr 2015; 166:890-896.e1. [PMID: 25556020 PMCID: PMC4380827 DOI: 10.1016/j.jpeds.2014.11.019] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/09/2014] [Accepted: 11/06/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the clinical presentation, diagnostic variables, risk factors, and disease burden in children with chronic pancreatitis. STUDY DESIGN We performed a cross-sectional study of data from the International Study Group of Pediatric Pancreatitis: In Search for a Cure, a registry of children with acute recurrent pancreatitis and chronic pancreatitis. Between-group differences were compared using Wilcoxon rank-sum test. RESULTS Among 170 subjects in the registry, 76 (45%) had chronic pancreatitis; 57% were female, 80% were white; median age at diagnosis was 9.9 years. Pancreatitis-predisposing genetic mutations were identified in 51 (67%) and obstructive risk factors in 25 (33%). Toxic/metabolic and autoimmune factors were uncommon. Imaging demonstrated ductal abnormalities and pancreatic atrophy more commonly than calcifications. Fifty-nine (77%) reported abdominal pain within the past year; pain was reported as constant and receiving narcotics in 28%. Children with chronic pancreatitis reported a median of 3 emergency department visits and 2 hospitalizations in the last year. Forty-seven subjects (70%) missed 1 day of school in the past month as the result of chronic pancreatitis; 26 (34%) missed 3 or more days. Children reporting constant pain were more likely to miss school (P = .002), visit the emergency department (P = .01), and experience hospitalizations (P = .03) compared with children with episodic pain. Thirty-three children (43%) underwent therapeutic endoscopic retrograde pancreatography; one or more pancreatic surgeries were performed in 30 (39%). CONCLUSIONS Chronic pancreatitis occurs at a young age with distinct clinical features. Genetic and obstructive risk factors are common, and disease burden is substantial.
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Affiliation(s)
| | - Melena Bellin
- University of Minnesota Children’s Hospital, Minneapolis, Minnesota, USA
| | | | - Monika Ahuja
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bradley Barth
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Heather Davis
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | | | | | | | | | | | - Melvin B. Heyman
- University of California at San Francisco, San Francisco, CA, USA
| | - Ryan Himes
- Baylor College of Medicine, Houston, TX, USA
| | - Soma Kumar
- Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Mark E. Lowe
- Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Neil E. Nuehring
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Chee Y. Ooi
- Discipline of Paediatrics, School of Women’s and Children’s Health, Medicine, University of New South Wales and Sydney Children’s Hospital Randwick Sydney, Australia
| | | | - David Troendle
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | | | - Elizabeth Yen
- University of California at San Francisco, San Francisco, CA, USA
| | - Aliye Uc
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Al Mandhari HK, Lefrançois M, Li P, Morinville VD, Al-Hertani W. Efficacy of a MCT supplementation with galactose restricted diet in an infant with citrin deficiency and a novel variant in the SLC25A13 gene. Clin Biochem 2014. [DOI: 10.1016/j.clinbiochem.2014.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Papachristou GI, Papachristou DJ, Morinville VD, Slivka A, Whitcomb DC. Chronic alcohol consumption is a major risk factor for pancreatic necrosis in acute pancreatitis. Am J Gastroenterol 2006; 101:2605-10. [PMID: 17029614 DOI: 10.1111/j.1572-0241.2006.00795.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Much of the late morbidity and mortality of acute pancreatitis (AP) is attributed to complications of pancreatic necrosis (PNEC). Early diagnosis of PNEC in high-risk patients is critical to management. Hemoconcentration is one risk factor for PNEC, but additional risk factors are likely implicated. AIMS (1) To evaluate a series of preselected clinical factors in a prospectively collected cohort with AP to identify risk factors for PNEC and (2) to verify the relative risk of any newly identified factor(s) by retrospective analysis of a large patient cohort. METHODS Phase I: 102 AP patients were prospectively ascertained, of which 77 (mean age 49 yr; 35 women, 42 men) underwent contrast-enhanced computerized tomography (CECT) and were studied. Eleven subjects developed PNEC (14%). Binary logistic regression was performed to identify any clinical factors associated with PNEC. Phase II: 1,474 anonymized patients admitted to the hospital with a diagnosis of AP were electronically reviewed to identify 359 subjects (mean age 54 yr; 157 women, 202 men) with AP and CECT. Seventy-six of these patients (21%) exhibited CECT evidence of PNEC. The associations found in the Phase I group were compared with Phase II by logistic regression analysis. RESULTS In Phase I, only chronic alcohol consumption was identified as a significant new risk factor for the development of PNEC (6/19 vs 5/58, p= 0.02, OR 4.8, CI 1.27-18.2). In Phase II, it was verified that excessive alcohol consumption was a significant risk factor for PNEC (18/52 vs 58/307, p= 0.012, OR 2.27, CI 1.19-4.30). CONCLUSION Chronic alcohol consumption seems to constitute a strong risk factor for PNEC.
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