Incomplete functional and morphological recovery after acute and acute recurrent pancreatitis in children.

Abstract

BACKGROUND AND AIM:

There is lack of data on functional and morphological recovery after an attack of acute pancreatitis (AP) or acute recurrent pancreatitis (ARP) in children. This study aims to evaluate the functional impairment and morphological changes in the pancreas after recovery.

METHODS:

All consecutive patients presenting with AP (n = 61) or ARP (n = 35), as per standard diagnostic criteria, were enrolled. After 2 months of pancreatitis, fecal elastase-1 (FE-1) (μg/g) and 2-h oral glucose tolerance test to calculate oral disposition index (DIo ) (mmol/L) (β-cell function) were performed. Morphological changes were assessed by endoscopic ultrasound and transabdominal ultrasound. Patients with chronic pancreatitis (CP) (n = 27) and healthy children (HC) (n = 26) were included as controls for functional parameters.

RESULTS:

At a median follow up of 12 (4-44) and 11 (2-108) months, 66.7% and 75.9% (P = 0.57) of AP and ARP demonstrated exocrine insufficiency (FE-1 < 200), respectively. Mean (SD) FE-1 was 183.64 ± 150.94 (AP), 135.70 ± 103.80 (ARP), 46.56 ± 30.20 (CP), and 240.00 ± 181.83 (HC) (P < 0.001; anova) (AP vs CP, ARP vs CP, and CP vs HC; P < 0.001). Prediabetes due to insulin resistance was seen in 16.6% and 22.6% (P = 0.56) of AP and ARP. Median (interquartile range) DIo (mmol/L) was comparable between AP (4.20 [2.36, 8.3]) and HC (5.20 [2.89, 8.68]), but was low in ARP (2.97 [1.80, 5.12]), which was comparable with CP (1.91 [1.20, 2.83]). Endoscopic ultrasound demonstrated morphological changes in 25% and 37% (P = 0.34) of AP and ARP, respectively.

CONCLUSION:

There was high frequency of biochemical evidence of exocrine insufficiency. β-Cell function (DIo ) was preserved among AP but was poor in ARP. Nearly one-third showed morphological changes in imaging.

• Authors: Srikanth Puttaiah Kadyada, Babu Ram Thapa, Karanvir Kaushal, Rama Walia, S V Rana, Narendra Dhaka, Sadhna B Lal, Rajendra Prasad, Subhamoy Das, Rajini Thakur, Kishore Kamal
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 34 Issue 1 Pg. 293-301 (Jan 2019) ISSN: 1440-1746 [Electronic] Australia
• PMID: 29791723 (Publication Type: Journal Article)
• Copyright: © 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Chemical References

• Pancreatic Elastase

Topics

• Acute Disease
• Adolescent
• Child
• Child, Preschool
• Endosonography
• Exocrine Pancreatic Insufficiency (etiology, physiopathology)
• Feces (chemistry)
• Female
• Follow-Up Studies
• Glucose Tolerance Test
• Humans
• Insulin-Secreting Cells (physiology)
• Male
• Pancreatic Elastase (analysis)
• Pancreatitis (complications, diagnostic imaging, pathology, physiopathology)
• Pancreatitis, Chronic (diagnostic imaging, pathology, physiopathology)
• Prediabetic State (blood, etiology)
• Prospective Studies
• Recovery of Function
• Recurrence