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Clinical and Practice Variations in Pediatric Acute Recurrent or Chronic Pancreatitis: Report From the INSPPIRE Study
Chinenye R Dike1, Bridget Zimmerman2, Yuhua Zheng3
1Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE.
Insights
Pediatric pancreatitis care varies globally, with fewer chronic pancreatitis cases and treatments observed in non-US sites. Further research is needed to understand these geographical differences in pediatric acute recurrent pancreatitis and chronic pancreatitis management.
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.
Objective:
The aim of the study was to determine whether clinical characteristics and management of pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) differ across INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a cuRE) sites.
Study Design:
Data were collected from INSPPIRE and analyzed per US regions and "non-US" sites. Between-group differences were compared by Pearson chi-square test. Differences in disease burden were compared by Kruskal-Wallis test.
Results:
Out of the 479 subjects, 121 (25%) were enrolled in West, 151 (32%) Midwest, 45 Northeast (9%), 78 (16%) South, and 84 (18%) at non-US sites. Hispanic ethnicity was more common in South (P < 0.0001); white race in Northeast (P = 0.009). CP was less common and time from diagnosis of first acute pancreatitis to CP was longer in children at non-US sites (P = 0.0002 and P = 0.011, respectively). Genetic mutations were most common among all groups; PRSS1 variants predominated in Midwest (P = 0.002). Gallstones were more frequent in South (P = 0.002). Endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) imaging were more commonly utilized in United States compared with non-United States (P < 0.0001), but there were no differences in the use of MRI/MRCP. Disease burden was highest in the West and Midwest, possibly as total pancreatectomy and islet autotransplantation (TPIAT) referral sites were located in these regions. All therapies were less commonly administered in non-US sites (P < 0.0001).
Conclusions:
This is the first study to describe geographical variations in the INSPPIRE cohort, which possibly reflect variations in practice and referral patterns. The underlying reason behind the lower frequency of CP and fewer treatments in non-United States sites need to be further explored.
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