Clinical and Practice Variations in Pediatric Acute Recurrent or Chronic Pancreatitis: Report From the INSPPIRE Study

Area of Science:

• Pediatric Gastroenterology
• Pancreatology
• Clinical Epidemiology

Background:

• Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) present unique challenges in diagnosis and management.
• Geographical variations in clinical characteristics and treatment protocols for pediatric pancreatitis are not well-documented.

Purpose of the Study:

• To investigate geographical differences in the clinical presentation and management of pediatric ARP and CP within the INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a cuRE) cohort.
• To identify potential disparities in disease burden and therapeutic interventions across different regions.

Main Methods:

• Retrospective analysis of data collected from the INSPPIRE study, comparing US regions (West, Midwest, Northeast, South) with non-US sites.
• Statistical comparison of demographic, clinical, and management data using Pearson chi-square and Kruskal-Wallis tests.

Main Results:

• Significant variations were observed in patient demographics, with higher prevalence of Hispanic ethnicity in the South and White race in the Northeast.
• Chronic pancreatitis (CP) was less common, and the time from initial acute pancreatitis to CP diagnosis was longer in non-US sites.
• Genetic mutations were prevalent across all groups, with PRSS1 variants predominant in the Midwest. Gallstones were more frequent in the South.
• Diagnostic imaging (ERCP, CT) utilization was higher in the US, while treatment administration and advanced therapies like total pancreatectomy and islet autotransplantation (TPIAT) were less common in non-US sites.
• Highest disease burden was noted in the West and Midwest, potentially linked to TPIAT referral centers.

Conclusions:

• This study highlights the first documented geographical variations in the INSPPIRE cohort, suggesting differences in clinical practice and referral patterns.
• The lower incidence of CP and reduced treatment frequency in non-US sites warrant further investigation to understand underlying factors.
• Understanding these disparities is crucial for optimizing global management strategies for pediatric pancreatitis.