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Clinical profile and outcome of chronic pancreatitis in children
S D Chowdhury1, A Chacko, B S Ramakrishna
1Department of GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India. Correspondence to: Professor Ashok Chacko, Department of G.I. Sciences, Christian Medical College, Vellore, Tamil Nadu, India. gastro@cmcvellore.ac.in.
Insights
Idiopathic chronic pancreatitis is common in children, often without a clear cause. The calcific form presents aggressively with early pancreatic damage.
Area of Science:
- Pediatric Gastroenterology
- Pancreatology
Background:
- Chronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas.
- While common in adults, CP in children is less understood, with varying etiologies and presentations.
Purpose of the Study:
- To investigate the causes, clinical features, complications, and management strategies for chronic pancreatitis in pediatric patients.
- To characterize idiopathic chronic pancreatitis (ICP) in children, including its association with calcification and other clinical outcomes.
Main Methods:
- A retrospective chart review was conducted.
- Data from 99 children diagnosed with chronic pancreatitis between January 2005 and December 2010 were analyzed.
- Etiology, clinical presentation, complications, and treatment outcomes were evaluated.
Main Results:
- 99 children (2.5% of pediatric gastroenterology attendees) were diagnosed with CP; 60.6% were male.
- Idiopathic chronic pancreatitis (ICP) accounted for 95.9% of cases.
- Abdominal pain was universal; 9.1% had diabetes mellitus, and 45.5% of tested children had steatorrhea.
- Calcification was present in 69.7% of patients, particularly in the calcific ICP subgroup, which showed higher rates of diabetes mellitus and steatorrhea.
- Pseudocyst (17.1%) and ascites (9.1%) were the most frequent complications.
- Pancreatic enzyme supplementation provided pain relief in 56.1% of patients.
- Endotherapy and surgery were performed in 10 and 15 patients, respectively, with lower reported pain relief rates compared to enzyme supplementation.
Conclusions:
- Idiopathic chronic pancreatitis is the predominant form of CP in children and adolescents.
- CP in children can manifest with or without pancreatic calcification.
- The calcific variant of ICP represents an aggressive disease course with early pancreatic damage.
Objective:
To evaluate the etiology, presentation, complications and management of chronic pancreatitis in children.
Design:
Retrospective chart review.
Setting:
Gastroenterology department at Christian Medical College and Hospital, Vellore, India between January 2005 and December 2010.
Participants:
99 Children (>18 yrs) diagnosed with chronic pancreatitis based on clinical and imaging features.
Main Outcome Measures:
Etiology, clinical presentation, complications and management of chronic pancreatitis in children.
Results:
Of 3887 children who attended the Gastroenterology department, 99(2.5%) had chronic pancreatitis, of which 60 (60.6%) were males. In 95(95.9%) patients no definite cause was detected and they were labeled as Idiopathic chronic pancreatitis. All patients had abdominal pain, while 9(9.1%) had diabetes mellitus. Of the 22 children tested for stool fat, 10(45.5%) had steatorrhea. Pancreatic calcification was seen in 69 (69.7%). 68 (71.6%) patients with idiopathic chronic pancreatitis had calcification. Calcific idiopathic chronic pancreatitis was more frequent in males (67.6% vs. 48.1%, P=0.07), and was more commonly associated with diabetes mellitus (13.2% vs. none, P=0.047) and steatorrhea (61.5% vs. 16.7%, P=0.069). Pseudocyst (17.1%) and ascites (9.1%) were the most common complications. All children were treated with pancreatic enzyme supplements for pain relief. 57 patients were followed up. With enzyme supplementation, pain relief was present in 32 (56.1%) patients. Of those who did not improve, 10 underwent endotherapy and 15 underwent surgery. Follow up of 8 patients who underwent endotherapy, showed that 5 (62.5%) had relief. Follow up of 11 patients who underwent surgery showed that only 3 (27%) had pain relief. There was no death.
Conclusions:
Idiopathic chronic pancreatitis is the predominant form of chronic pancreatitis in children and adolescents. It can present with or without calcification. The calcific variety is an aggressive disease characterized by early morphological and functional damage to the pancreas.
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