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Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group
Cheryl E Gariepy1, Melvin B Heyman, Mark E Lowe
1*Nationwide Children's Hospital and The Ohio State University, Columbus †University of California at San Francisco, San Francisco ‡Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA §University of Utah, Salt Lake City ||Medical College of Wisconsin, Milwaukee ¶Hadassah-Hebrew University Medical Center, Jerusalem, Israel #University of Texas, Southwestern Medical School, Dallas **Baylor College of Medicine, Houston, TX ††Harvard Medical School, Boston, MA ‡‡Seattle Children's Hospital, Seattle, WA §§Hospital for Sick Children, Toronto, ON ||||Montreal Children's Hospital, McGill University, Montreal, QC, Canada ¶¶University of New South Wales and Sydney Children's Hospital Randwick, Sydney, Australia ##University of Minnesota, Masonic Children's Hospital, Minneapolis ***University of Iowa, Children's Hospital, Iowa City.
Insights
Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are increasingly diagnosed. This consensus provides guidelines for diagnosis and monitoring, emphasizing the need for more research due to weak current evidence.
Area of Science:
- Pediatric gastroenterology and hepatology.
- Clinical consensus development.
- Evidence-based medicine.
Background:
- Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) diagnoses in children are rising.
- Limited high-quality evidence exists for pediatric ARP and CP diagnosis and etiology.
- A need exists for standardized diagnostic and monitoring approaches in pediatric pancreatitis.
Framework:
- Systematic literature review and quality scoring.
- Modified Delphi method for expert consensus.
- Development of consensus statements on definitions, etiology evaluation, and monitoring.
Implementation:
- Panel of pediatric specialists reviewed literature.
- Consensus reached on 27 statements regarding pediatric pancreatitis.
- Identified areas with no recommendations or lack of consensus.
Implications:
- Establishes minimal diagnostic evaluation and monitoring standards for pediatric ARP and CP.
- Highlights critical need for further research due to weak evidence base.
- Improved etiological understanding is crucial for developing targeted treatments.
Objectives:
Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates during the past decade. As pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. The aim of the study was to review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research.
Methods:
A systematic review of the literature was performed and scored for quality, followed by consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group.
Results:
The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed.
Conclusions:
This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting.
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01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
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Assessment:
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01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include: