Acute and chronic pancreatitis in childhood

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Pancreatology

Background:

• The incidence and causes of acute and chronic pancreatitis in children remain largely unknown.
• Both conditions present significant morbidity and mortality risks, often being misdiagnosed due to subtle clinical presentations.
• Advances in molecular diagnostics and non-invasive tests for conditions like fat malabsorption are emerging.

Purpose of the Study:

• To review the current understanding of pediatric pancreatitis, encompassing its etiology, diagnosis, and therapeutic advancements.
• To highlight the importance of clinical suspicion in diagnosing these challenging conditions.
• To discuss the potential of novel therapies in managing systemic inflammatory response syndrome associated with pancreatitis.

Main Methods:

• Literature review of pediatric pancreatitis, focusing on etiological factors, diagnostic challenges, and emerging treatments.
• Analysis of the spectrum of causes for acute pancreatitis, including congenital, structural, inherited, infectious, and drug-induced origins.
• Examination of chronic tropical calculus pancreatitis and idiopathic recurrent pancreatitis, including genetic associations like cystic fibrosis gene mutations.

Main Results:

• The etiological spectrum of acute pancreatitis is broad, encompassing congenital anomalies, inherited conditions, trauma, infections, drug toxicity, and iatrogenic causes.
• Chronic tropical calculus pancreatitis is characterized by recurrent abdominal pain in childhood, often leading to diabetes by puberty.
• Idiopathic recurrent pancreatitis shows a higher prevalence of cystic fibrosis gene mutations, suggesting a genetic link.

Conclusions:

• Accurate diagnosis of pediatric pancreatitis requires high clinical suspicion due to potential misdiagnosis.
• New diagnostic tools, including non-invasive methods for fat malabsorption, are under development.
• Emerging therapies, such as lexipafant targeting systemic inflammatory response syndrome, offer promise for reducing pancreatitis-related morbidity and mortality.