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Toxic-metabolic Risk Factors in Pediatric Pancreatitis: Recommendations for Diagnosis, Management, and Future
Sohail Z Husain1, Veronique Morinville, John Pohl
1*Children's Hospital of Pittsburgh, Pittsburgh, PA †Montreal Children's Hospital, McGill University, Montreal, QC, Canada ‡University of Utah, Salt Lake City §Cincinnati Children's Hospital Medical Center, Cincinnati, OH ||University of Minnesota Masonic Children's Hospital, Minneapolis ¶Harvard Medical School, Boston, MA #First Department of Medicine, University of Szeged and HAS-SZTE Monument Gastroenterology Multidisciplinary Research Group, Szeged, Hungary **University of California at San Francisco, San Francisco ††Baylor College of Medicine, Houston, TX ‡‡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 §§University of Iowa Carver College of Medicine, Iowa City.
Insights
Metabolic and toxic factors can cause pancreatitis in children, but evidence is limited. Further research is needed to clarify the roles of hypertriglyceridemia, hypercalcemia, renal failure, smoking, alcohol, and medications in pediatric pancreatitis.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Metabolic Disorders
Background:
- Pancreatitis in children is multifactorial, with metabolic and toxic factors implicated.
- Existing evidence linking specific metabolic and toxic risk factors to pediatric pancreatitis is often sparse.
- Understanding these associations is crucial for accurate diagnosis and management.
Purpose of the Study:
- To review the evidence for association or causality of metabolic and toxic risk factors in pediatric pancreatitis.
- To discuss current management strategies and their rationale.
- To identify areas requiring further research in pediatric pancreatitis etiology.
Main Methods:
- Conducted a literature review of pediatric pancreatitis.
- Focused on risk factors including hyperlipidemia, hypercalcemia, chronic renal failure, smoking, alcohol, and medications.
- Assessed the quality of evidence for each factor's role.
Main Results:
- Hypertriglyceridemia (≥1000 mg/dL) is an absolute risk factor; persistent hypercalcemia is predisposing.
- The role of end-stage renal disease, smoking, and alcohol in pediatric pancreatitis requires further investigation.
- Evidence for medication-induced pancreatitis is generally weak, with potential mechanisms including drug structure and host factors.
Conclusions:
- The quality of evidence for metabolic and toxic factors in pediatric pancreatitis varies.
- Comprehensive phenotyping and investigation for diverse etiologic risk factors are essential.
- Management involves removing identified agents and supportive care, with ongoing research needed to improve understanding.
Abstract:
Pancreatitis in children can result from metabolic and toxic risk factors, but the evidence linking these factors is sparse. We review the evidence for association or causality of these risk factors in pancreatitis, discuss management strategies, and their rationale. We conducted a review of the pediatric pancreatitis literature with respect to the following risk factors: hyperlipidemia, hypercalcemia, chronic renal failure, smoking exposure, alcohol, and medications. Areas of additional research were identified. Hypertriglyceridemia of 1000 mg/dL or greater poses an absolute risk for pancreatitis; persistent elevations of calcium are predisposing. Further research is necessary to determine whether end-stage renal disease leads to increased pancreatitis in children similar to adults. It is unknown whether cigarette smoking exposure, which clearly increases risk in adults, also increases risk in children. The role of alcohol in pediatric pancreatitis, whether direct or modifying, needs to be elucidated. The evidence supporting most cases of medication-induced pancreatitis is poor. Drug structure, improper handling of drug by host, and bystander status may be implicated. Other pancreatitis risk factors must be sought in all cases. The quality of evidence supporting causative role of various toxic and metabolic factors in pediatric pancreatitis is variable. Careful phenotyping is essential, including search for other etiologic risk factors. Directed therapy includes correction/removal of any agent identified, and general supportive measures. Further research is necessary to improve our understanding of these pancreatitis risk factors in children.
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