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Chronic pancreatitis in Chinese children: etiology, clinical presentation and imaging diagnosis
Wei Wang1, Zhuan Liao, Zhao-Shen Li
1Chronic Pancreatitis Study Group, Department of Gastroenterology, Changhai Hospital, The Second Military Medicine University, Shanghai, China.
Insights
Idiopathic chronic pancreatitis (CP) is common in Chinese children, presenting as recurrent abdominal pain. Diagnosis is often delayed, highlighting the need for advanced imaging like CT and MRCP.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Pancreatology
Background:
- Limited literature exists on the clinical profile of chronic pancreatitis (CP) in pediatric populations.
- Understanding the etiology and presentation of childhood CP is crucial for timely diagnosis and management.
Purpose of the Study:
- To investigate the causes and clinical characteristics of chronic pancreatitis in children in China.
- To share experiences in diagnosing pediatric CP in a Chinese center.
Main Methods:
- Retrospective review of clinical data from pediatric CP patients treated at Changhai Hospital (1997-2006).
- Analysis of etiological factors, clinical symptoms, diagnostic delays, and imaging modality effectiveness.
Main Results:
- 42 children (9.8%) were diagnosed with CP, with a mean age of 11.7 years.
- Idiopathic etiology was predominant (73.8%), with recurrent mild to moderate abdominal pain as the main symptom (78.5%).
- Diagnostic delay was common (57.1% diagnosed >2 years after symptom onset); CT and MRCP showed higher detection rates for ductal changes and calcifications.
Conclusions:
- Idiopathic chronic pancreatitis is the primary diagnosis in Chinese children.
- Recurrent abdominal pain frequently delays diagnosis, emphasizing the importance of advanced imaging.
- Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) are recommended as initial diagnostic tools.
Background And Aims:
There is a paucity of literature regarding the clinical profile of chronic pancreatitis (CP) in children. The aims of this retrospective study were to determine the etiology and clinical presentation, and to present our experience in diagnosing CP in children in China.
Methods:
Clinical data of children who were treated for CP at Changhai Hospital from January 1997 to August 2006 were reviewed.
Results:
A total of 427 CP patients presented to our center. There were 42 (9.8%) children with CP, including 21 males and 21 females, with a mean age of 11.7 years at the first onset. The main etiological factor was idiopathic (73.8%). Of the patients, 78.5% had episodes of mild to moderate abdominal pain and 54.8% had multiple (> or = 4) episodes. The mean duration of symptoms prior to the diagnosis was 41.6 months and a definite diagnosis was not made until 2 years later in 57.1% of these patients. The positive rates of ultrasound (US), computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) (or magnetic resonance imaging [MRI]) for detecting ductal changes and intraductal stones or pancreatic calcification were 51.4% and 45.4%, 71.4% and 87.5%, 80.0% and 61.5%, respectively.
Conclusion:
The main etiological factor of Chinese children with CP is idiopathic. The main symptom in these patients is multiple episodes of mild to moderate abdominal pain, which often lead to a delay in the definite diagnosis. CT and MRCP (or MRI) should be used as the first investigation in the evaluation of these cases.
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