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Progression from acute to chronic pancreatitis in children: a systematic review and meta-analysis
Endre Botond Gagyi1,2,3, Mahmoud Obeidat1, Edina Tari1,4
1Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Insights
Approximately 18% of children develop recurrent acute pancreatitis (RAP) after an initial episode, with 35% of those progressing to chronic pancreatitis (CP). Etiology, severity, structural, and genetic factors influence these pediatric pancreatitis progression risks.
Area of Science:
- Pediatric Gastroenterology
- Pancreatology
- Clinical Epidemiology
Background:
- Acute pancreatitis (AP) in children can lead to recurrent AP (RAP) or chronic pancreatitis (CP).
- Understanding progression rates and risk factors is crucial for pediatric AP management.
Purpose of the Study:
- To quantify the progression rates from initial AP to RAP and CP in pediatric populations.
- To identify clinical, structural, and genetic risk factors associated with AP progression.
Main Methods:
- Systematic review and meta-analysis of observational studies from PubMed/MEDLINE, Embase, and Cochrane databases.
- Included studies reported progression to RAP or CP in pediatric patients.
- Pooled proportions and odds ratios (ORs) using a random-effects model; assessed heterogeneity with I² statistic.
Main Results:
- 18% of children developed RAP after the first AP episode; 10% developed CP.
- Among children with RAP, 35% progressed to CP.
- RAP rates varied by etiology (e.g., hypertriglyceridemia 33%) and severity (severe 39%).
- Structural abnormalities (OR 3.15), pancreas divisum (OR 2.64), and PRSS1 mutation (OR 4.56) were associated with progression to RAP/CP.
Conclusions:
- Pediatric AP recurrence is significant, with a substantial proportion progressing to chronic disease.
- Initial AP episode characteristics (etiology, severity) impact RAP risk.
- Structural and genetic factors are key predictors of long-term progression to CP.
Background:
Most children recover after an initial acute pancreatitis (AP) episode; however, some progress to recurrent AP (RAP) or chronic pancreatitis (CP).
Purpose:
We aimed to quantify progression rates and identify the risk factors associated with these transitions.
Methods:
PubMed/MEDLINE, Embase, and Cochrane databases were searched on December 21, 2024, for pediatric studies reporting progression to RAP or CP (PROSPERO number: CRD420251086520). All observational studies were included, while case reports and case series were excluded. To evaluate the differences in RAP rates, we conducted subgroup analyses of etiology and severity. We also assessed clinical, structural, and genetic risk factors for disease progression. A random-effects model was used to pool proportions and odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic.
Results:
A total of 68 studies met the inclusion criteria. After the first AP attack, RAP developed in 18% (95% CI, 16-22%; I2=76%; k=39 studies) and CP developed in 10% (95% CI, 6-16%; I2=67%; k=5 studies) of patients. Among children with RAP, 35% (95% CI, 24-49%; I2=78%; k=7 studies) progressed to CP. The RAP rates varied according to etiology and severity: hypertriglyceridemia, 33%; idiopathic, 28%; biliary, 19%; traumatic, 16%; drug-induced, 14%; virus-induced, 3%; severe, 39%; moderate, 24%; and mild, 21%. Structural abnormalities were associated with a higher risk of RAP (OR, 3.15; 95% CI, 1.51-6.56; I2=0%; k=5 studies). Pancreas divisum (OR, 2.64; 95% CI, 1.51-4.63; I2=17%; k=7 studies) and PRSS1 mutation (OR: 4.56; 95% CI, 3.06-6.80; I2=0%; k=7 studies) were associated with CP.
Conclusion:
Approximately one in five pediatric AP episodes recurred, and over one-third of the RAP cases progressed to CP. The risk of RAP is influenced by the underlying etiology and severity of the initial episode, whereas structural and genetic factors are associated with later progression.
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