Ujjal Poddar1, Surender K Yachha2, Vibhor Borkar2, Anshu Srivastava2. 1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. Electronic address: ujjalpoddar@hotmail.com. 2. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Abstract
BACKGROUND/AIMS: In view of paucity of literature we analyzed our experience of acute recurrent pancreatitis (ARP) to study clinical profile and long-term outcome. METHODS: Over 13 years, 93 consecutive children (≤18 years) diagnosed to have ARP were included in this study. Magnetic resonance cholangiopancreatography was done at baseline and on follow-up. Common mutations for serine-protease-inhibitor (SPINK1 N34S), protease inhibitor (PRSS1 R122S) and cystic fibrosis transmembrane conductance regulator (CFTR deltaF508, 5T) were studied in 22 idiopathic cases. RESULTS: The median age of the children with ARP was 13 (10-14.5) years, 53 were males. Etiology included biliary in 14 (15%), pancreas divisum in 6 (7%), others in 3 (3.5%) and idiopathic in the remaining 70 (75%). SPINK1 mutation was found in 10/22 (45%) cases. Over a median follow-up of 25.5 (8.25-48) months, 37 (42%) of 88 (5 lost to follow-up) developed chronic pancreatitis (CP). On multivariate analysis idiopathic etiology (p<0.03), presence of SPINK1 mutation (p=0.01), longer follow-up (p<0.001) were associated with progression to CP. CONCLUSIONS: Biliopancreatic structural/obstructive causes should always be looked for. It seems ARP is a precursor of CP and progression is associated with idiopathic etiology and presence of genetic mutations. Hence, patients with ARP should be kept on regular follow-up to detect CP.
BACKGROUND/AIMS: In view of paucity of literature we analyzed our experience of acute recurrent pancreatitis (ARP) to study clinical profile and long-term outcome. METHODS: Over 13 years, 93 consecutive children (≤18 years) diagnosed to have ARP were included in this study. Magnetic resonance cholangiopancreatography was done at baseline and on follow-up. Common mutations for serine-protease-inhibitor (SPINK1N34S), protease inhibitor (PRSS1R122S) and cystic fibrosis transmembrane conductance regulator (CFTRdeltaF508, 5T) were studied in 22 idiopathic cases. RESULTS: The median age of the children with ARP was 13 (10-14.5) years, 53 were males. Etiology included biliary in 14 (15%), pancreas divisum in 6 (7%), others in 3 (3.5%) and idiopathic in the remaining 70 (75%). SPINK1 mutation was found in 10/22 (45%) cases. Over a median follow-up of 25.5 (8.25-48) months, 37 (42%) of 88 (5 lost to follow-up) developed chronic pancreatitis (CP). On multivariate analysis idiopathic etiology (p<0.03), presence of SPINK1 mutation (p=0.01), longer follow-up (p<0.001) were associated with progression to CP. CONCLUSIONS: Biliopancreatic structural/obstructive causes should always be looked for. It seems ARP is a precursor of CP and progression is associated with idiopathic etiology and presence of genetic mutations. Hence, patients with ARP should be kept on regular follow-up to detect CP.
Authors: Quin Y Liu; Maisam Abu-El-Haija; Sohail Z Husain; Bradley Barth; Melena Bellin; Douglas S Fishman; Steven D Freedman; Cheryl E Gariepy; Matthew J Giefer; Tanja Gonska; Melvin B Heyman; Ryan Himes; Tom K Lin; Asim Maqbool; Maria Mascarenhas; Brian A McFerron; Veronique D Morinville; Jaimie D Nathan; Chee Y Ooi; Emily R Perito; John F Pohl; Sue Rhee; Sarah J Schwarzenberg; Uzma Shah; David Troendle; Steven L Werlin; Michael Wilschanski; M Bridget Zimmerman; Mark E Lowe; Aliye Uc Journal: J Pediatr Gastroenterol Nutr Date: 2019-08 Impact factor: 2.839
Authors: Chinenye R Dike; Bridget Zimmerman; Yuhua Zheng; Michael Wilschanski; Steven L Werlin; David Troendle; Uzma Shah; Sarah Jane Schwarzenberg; John Pohl; Emily R Perito; Chee Y Ooi; Jaimie D Nathan; Veronique D Morinville; Brian McFerron; Maria Mascarenhas; Asim Maqbool; Quin Liu; Tom K Lin; Sohail Z Husain; Melvin B Heyman; Tanja Gonska; Matthew J Giefer; Cheryl E Gariepy; Douglas S Fishman; Melena Bellin; Bradley Barth; Maisam Abu-El-Haija; Mark E Lowe; Aliye Uc Journal: J Pediatr Gastroenterol Nutr Date: 2020-07 Impact factor: 3.288