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Chronic Pancreatitis in Children - Management and Outcomes
Vijay Kumar1, Nitin G Pai1, Sundeep Payyanur Thotan1
1Department of Pediatric Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Insights
Pediatric chronic pancreatitis (CP) presents a significant burden, often diagnosed late due to vague symptoms. Early evaluation and multidisciplinary care are crucial for managing this complex pediatric disease.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Internal Medicine
Background:
- Pediatric chronic pancreatitis (CP) is increasingly prevalent globally.
- Diagnosis is often delayed in primary health centers (PHCs) due to nonspecific symptoms, leading to advanced disease presentation.
- Existing literature primarily focuses on low- and middle-income countries.
Purpose of the Study:
- To investigate the etiology, clinical presentation, and management of pediatric CP.
- To analyze data from a tertiary care hospital in southern India over an 8-year period.
Main Methods:
- Retrospective study of pediatric patients diagnosed with CP.
- Data collected over 8 years at a tertiary care hospital.
Main Results:
- Forty-eight pediatric patients diagnosed with CP.
- Abdominal pain was the most common symptom; idiopathic etiology was most frequent.
- Management included conservative treatment (27 patients), endoscopic intervention (14 patients), and surgery (6 patients).
- Twenty patients required multiple hospital admissions.
Conclusions:
- Pediatric CP is a chronic condition with substantial morbidity.
- Early evaluation for CP is essential, rather than solely symptomatic treatment.
- Prompt diagnosis, vigilant monitoring, and aggressive multidisciplinary interventions are vital to reduce complications and mortality.
Objectives:
With the increasing global prevalence of pediatric chronic pancreatitis (CP), the literature on its disease burden and clinical profile remains limited to low- and middle-income countries. Early diagnosis of CP is frequently missed, particularly in local primary health centers (PHCs), because of nonspecific symptoms. This leads to patients presenting at tertiary hospitals at advanced stages, necessitating hospitalization for complications.
Subjects And Methods:
We conducted a retrospective study spanning 8 years on pediatric patients diagnosed with CP with an aim to investigate the etiology, clinical presentation, and multidisciplinary management strategies of CP among pediatric patients at a tertiary care hospital in southern India.
Results:
Forty-eight unique patients were diagnosed with CP. Twenty out of forty-eight children experienced multiple admissions, with an average of two readmissions per patient. Pain in the abdomen was the predominant presenting complaint. The most common etiology was idiopathic. Conservative management was employed in 27 patients. Fourteen patients underwent endoscopic intervention, with twelve requiring stenting and 2 requiring drainage procedures. Six patients required pancreatic surgery.
Conclusions:
CP in children is a disease with a protracted course and significant disease burden. Pediatric patients should undergo evaluation for CP rather than receiving symptomatic management alone very early in the evaluation of pain in the abdomen at PHCs. Early diagnosis, close monitoring, and aggressive multidisciplinary intervention are imperative to mitigate the morbidity and mortality associated with this condition.
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