Morphological and functional recovery following acute and acute recurrent pancreatitis in children: A prospective
Neha Anushree1, Sadhna Bhasin Lal1, Surinder Singh Rana2
1Division of Pediatric Gastroenterology and Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Children experiencing acute pancreatitis (AP) often show lasting functional and morphological changes. Over a quarter develop impaired glucose homeostasis and exocrine pancreatic insufficiency, indicating potential long-term issues.
Area of Science:
- Pediatric Gastroenterology
- Pancreatic Diseases
- Medical Imaging
Background:
- Limited understanding of functional and morphological recovery after pediatric acute pancreatitis (AP).
- Need to characterize pancreatic changes following AP and acute recurrent pancreatitis (ARP) in children.
Purpose of the Study:
- To characterize the morphological and functional pancreatic changes in children following AP and ARP.
Main Methods:
- Prospective follow-up of children with AP, with assessments at least 3 months apart.
- Exocrine function assessed by fecal elastase; endocrine function by fasting blood sugar/HbA1c.
- Morphological assessment using endoscopic ultrasound (EUS) and MRI/MRCP.
Main Results:
- 29% of children progressed to ARP. Altered glucose homeostasis affected 22-26% of children, significantly higher in the ARP group.
- Biochemical exocrine pancreatic insufficiency developed in 28.7% at first and 32.8% at second assessment.
- EUS showed chronic pancreatitis changes in 21-27.6%; MRCP revealed pancreatic duct dilatation in 20.5%.
Conclusions:
- Over a quarter of children exhibit altered glucose homeostasis and exocrine pancreatic insufficiency post-AP.
- Morphological evidence suggests some children may develop chronic pancreatitis with longer follow-up.
Background:
The functional and morphological recovery following an episode of acute pancreatitis (AP) in children still remains ill understood as research exploring this is limited. We aimed to characterize the morphological and functional changes in pancreas following AP and ARP (acute recurrent pancreatitis) in children.
Methods:
Children with AP were followed prospectively and assessed at two time points at least 3 months apart, with the first assessment at least 3 months after the AP episode. Exocrine and endocrine functions were measured using fecal elastase and fasting blood sugar/HbA1c levels respectively. Morphological assessment was done using endoscopic ultrasound (EUS) and magnetic resonance imaging and cholangiopancreatography (MRI/MRCP).
Results:
Seventy-three children (boys:59%; mean age:8.4 ± 3.2years) were studied and 21 of them (29%) progressed to ARP. Altered glucose homeostasis was seen in 19 (26%) at first and 16 (22%) at second assessment and it was significantly more in ARP group than the AP group at first (42.8%vs19.2%; p = 0.03) as well as second assessment (38.1%vs15.3%; p = 0.03). Twenty-one children (28.7%) at first and 24 (32.8%) at second assessment developed biochemical exocrine pancreatic insufficiency. EUS detected indeterminate and suggestive changes of chronic pancreatitis in 21% at first (n = 38) and 27.6% at second assessment (n = 58). On MRCP, main pancreatic duct and side branch dilatation were seen in 15 (20.5%) and 2 (2.7%) children respectively.
Conclusions:
More than one-quarter of children have evidence of altered glucose homeostasis and biochemical exocrine pancreatic insufficiency following an episode of AP. Similarly, morphological features of chronicity seen in some of the children suggest that a fraction of subjects may develop chronic pancreatitis on longer follow-up.
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