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Pancreas Divisum in Pediatric Acute Recurrent and Chronic Pancreatitis: Report From INSPPIRE
Tom K Lin1, Maisam Abu-El-Haija1, Jaimie D Nathan1
1Cincinnati Children's Hospital Medical Center, Cincinnati.
Insights
Pancreas divisum (PD) is a risk factor for pediatric pancreatitis, independent of genetics. Children with PD and pancreatic duct stones benefit most from endoscopic retrograde cholangiopancreatography.
Area of Science:
- Pediatric Gastroenterology
- Pancreatology
- Medical Genetics
Background:
- Pancreas divisum (PD) is a congenital anomaly with controversial significance as a pancreatitis risk factor.
- Understanding PD's role in pediatric pancreatitis is crucial for diagnosis and management.
Purpose of the Study:
- To analyze the characteristics of children with PD and pancreatitis.
- To determine if PD is an independent risk factor for pancreatitis in children.
Main Methods:
- Comparison of children with and without PD within the INSPPIRE cohort.
- Statistical analysis of continuous and categorical variables.
- Genetic mutation analysis (SPINK1, CFTR, CTRC, PRSS1) and family history assessment.
Main Results:
- PD prevalence was 14.5% in the cohort, higher than the general population.
- Children with PD had fewer PRSS1 mutations and less family history of pancreatitis.
- PD was associated with hypertriglyceridemia, more endoscopic procedures, fewer acute pancreatitis attacks, and less exocrine insufficiency.
Conclusions:
- PD is a likely risk factor for pediatric acute recurrent and chronic pancreatitis, independent of genetic factors.
- Patients with PD and pancreatic duct stones show the most benefit from therapeutic endoscopic retrograde cholangiopancreatography.
Introduction:
The significance of pancreas divisum (PD) as a risk factor for pancreatitis is controversial. We analyzed the characteristics of children with PD associated with acute recurrent or chronic pancreatitis to better understand its impact.
Patients And Methods:
We compared children with or without PD in the well-phenotyped INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) cohort. Differences were analyzed using 2-sample t test or Wilcoxon rank sum test for continuous variables, Pearson χ or Fisher exact test for categorical variables.
Results:
PD was found in 52 of 359 (14.5%) subjects, a higher prevalence than the general population (∼7%). Females more commonly had PD (71% vs. 55%; P=0.02). Children with PD did not have a higher incidence of mutations in SPINK1, CFTR, CTRC compared with children with no PD. Children with PD were less likely to have PRSS1 mutations (10% vs. 34%; P<0.01) or a family history of pancreatitis (P<0.05), and more likely to have hypertriglyceridemia (11% vs. 3%; P=0.03). Children with PD underwent significantly more endoscopic procedures and pancreatic sphincterotomy. Patients with PD had fewer attacks of acute pancreatitis (P=0.03) and were less likely to develop exocrine pancreatic insufficiency (P=0.01). Therapeutic endoscopic retrograde cholangiopancreatography was considered most helpful if pancreatic duct was impacted with stones (83% helpful).
Conclusions:
PD is likely a risk factor for acute recurrent pancreatitis and chronic pancreatitis in children that appears to act independently of genetic risk factors. Patients with PD and stones obstructing the pancreatic duct benefit most from therapeutic endoscopic retrograde cholangiopancreatography.
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