Format

Send to

Choose Destination
JAMA Pediatr. 2016 Jun 1;170(6):562-9. doi: 10.1001/jamapediatrics.2015.4955.

Risk Factors Associated With Pediatric Acute Recurrent and Chronic Pancreatitis: Lessons From INSPPIRE.

Author information

1
Nationwide Children's Hospital, Columbus, Ohio.
2
University of New South Wales, Sydney Children's Hospital Randwick, Sydney, Australia.
3
Medical College of Wisconsin, Milwaukee.
4
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
5
University of Texas Southwestern Medical School, Dallas.
6
University of Minnesota Masonic Children's Hospital, Minneapolis.
7
Hospital for Sick Children, Toronto, Ontario, Canada.
8
Baylor College of Medicine, Houston, Texas.
9
Harvard Medical School, Boston, Massachusetts.
10
Seattle Children's Hospital, Seattle, Washington.
11
University of California, San Francisco.
12
Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
13
Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
14
University of Utah, Salt Lake City.
15
Hadassah Hebrew University Hospital, Jerusalem, Israel.
16
University of Iowa Children's Hospital, Iowa City.

Abstract

IMPORTANCE:

Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are poorly understood.

OBJECTIVE:

To characterize and identify risk factors associated with ARP and CP in childhood.

DESIGN, SETTING, AND PARTICIPANTS:

A multinational cross-sectional study of children with ARP or CP at the time of enrollment to the INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a Cure) study at participant institutions of the INSPPIRE Consortium. From August 22, 2012, to February 8, 2015, 155 children with ARP and 146 with CP (aged ≤19 years) were enrolled. Their demographic and clinical information was entered into the REDCap (Research Electronic Data Capture) database at the 15 centers. Differences were analyzed using 2-sample t test or Wilcoxon rank sum test for continuous variables and Pearson χ2 test or Fisher exact test for categorical variables. Disease burden variables (pain variables, hospital/emergency department visits, missed school days) were compared using Wilcoxon rank sum test.

MAIN OUTCOMES AND MEASURES:

Demographic characteristics, risk factors, abdominal pain, and disease burden.

RESULTS:

A total of 301 children were enrolled (mean [SD] age, 11.9 [4.5] years; 172 [57%] female); 155 had ARP and 146 had CP. The majority of children with CP (123 of 146 [84%]) reported prior recurrent episodes of acute pancreatitis. Sex distribution was similar between the groups (57% female in both). Hispanic children were less likely to have CP than ARP (17% vs 28%, respectively; odds ratio [OR] = 0.51; 95% CI, 0.29-0.92; P = .02). At least 1 gene mutation in pancreatitis-related genes was found in 48% of patients with ARP vs 73% of patients with CP (P < .001). Children with PRSS1 or SPINK1 mutations were more likely to present with CP compared with ARP (PRSS1: OR = 4.20; 95% CI, 2.14-8.22; P < .001; and SPINK1: OR = 2.30; 95% CI, 1.03-5.13; P = .04). Obstructive risk factors did not differ between children with ARP or CP (33% in both the ARP and CP groups), but toxic/metabolic risk factors were more common in children with ARP (21% overall; 26% in the ARP group and 15% in the CP group; OR = 0.55; 95% CI, 0.31-0.99; P = .046). Pancreatitis-related abdominal pain was a major symptom in 81% of children with ARP or CP within the last year. The disease burden was greater in the CP group compared with the ARP group (more emergency department visits, hospitalizations, and medical, endoscopic, and surgical interventions).

CONCLUSIONS AND RELEVANCE:

Genetic mutations are common in both ARP and CP. Ethnicity and mutations in PRSS1 or SPINK1 may influence the development of CP. The high disease burden in pediatric CP underscores the importance of identifying predisposing factors for progression of ARP to CP in children.

PMID:
27064572
PMCID:
PMC5317277
DOI:
10.1001/jamapediatrics.2015.4955
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center