Pediatric Pancreatitis: Characteristic Features, Diagnosis and Management

Dear Colleagues,

Pediatric pancreatitis is a disease process that does not occur as often in children as in adults. Still, over the last several decades in the United States, and globally, the incidence of pancreatitis in children and adolescents has been steadily increasing. It is approaching the lower range of incidence estimates in adults (3–13/100,000 person-years vs. 5–60/100,000 person-years, respectively). While this may be due to an increased awareness of children’s ability to develop this painful inflammatory process, the standardization of diagnosis, and the increased utilization of testing, it is also likely that we are seeing a true increased incidence with the global rise in obesity, contributing to gallstones and biliary pancreatitis, even in adolescents. This has been particularly highlighted in low sociodemographic regions, which is likely related to the adoption of sedentary lifestyles and high-fat diets.

Despite this background, pancreatitis may still go unrecognized children where symptoms may be vague and non-specific, especially in younger children. Clinicians may still be dismissive of this etiology or may not even consider it in their decision.

Pancreatitis is associated with significant impacts on health and quality of life, even after only a single episode. However, up to one-third of children may progress to recurrent episodes, and a smaller number of children may progress to chronic pancreatitis, associated with frequent pain, irreversible pancreatic scarring, and exocrine and/or endocrine dysfunction. This may lead to increased healthcare utilization at high annual costs, as well as missed school days and activities for children and missed workdays for parents.

Significant efforts by INSPPIRE7 (the International Study Group of Pediatric Pancreatitis: In search for a cure; a multinational, multi-center consortium of pediatric gastroenterologists, radiologists, and endocrinologists) have already taken place over the last 15 years to raise awareness of pediatric pancreatitis as a disease process—to standardize the diagnosis; describe the epidemiology, risk factors, natural history, and outcomes of pancreatitis; and develop standards of care [1–8].

However, continued work is needed.

This Special Issue will continue to raise awareness of the significance of pancreatitis in the pediatric population, including characteristic features of the disease, the diagnosis and treatment of an acute episode, the assessment of complications after an episode, and risk factors for the development of recurrent or chronic episodes.

Yours Sincerely,

References

1. Uc A, Husain SZ. Pancreatitis in Children. Gastroenterology. 2019 May;156(7):1969-1978.
2. Liu P, Wang Y, Tian Z, Dong X, Li Z, Chen Y. Global, regional, and national burden of pancreatitis in children and adolescents. United European Gastroenterol J. 2024 Oct 3. Epub ahead of print.
3. Sellers ZM, MacIsaac D, Yu H, et al. Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007-2014. Gastroenterology. 2018 Aug;155(2):469-478.e1.
4. Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006 Nov;33(4):323-30.
5. Schwarzenberg SJ, Uc A, Zimmerman B, et al. Chronic Pancreatitis: Pediatric and Adult Cohorts Show Similarities in Disease Progress Despite Different Risk Factors. J Pediatr Gastroenterol Nutr. 2019;68(4):566-573.
6. Ting J, Wilson L, Schwarzenberg SJ, et al. Direct Costs of Acute Recurrent and Chronic Pancreatitis in Children in the INSPPIRE Registry. J Pediatr Gastroenterol Nutr. 2016;62(3):443-449.
7. Morinville VD, Lowe ME, Ahuja M, et al. Design and implementation of INSPPIRE. J Pediatr Gastroenterol Nutr. 2014 Sep;59(3):360-4.
8. Uc A, Perito ER, Pohl JF, et al. INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE Cohort Study: Design and Rationale for INSPPIRE 2 From the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Pancreas. 2018 Nov/Dec;47(10):1222-1228.

Dr. Elissa M. Downs
Prof. Dr. Melena D. Bellin
Guest Editors

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• pediatric pancreatitis
• inflammatory
• acute pancreatitis
• chronic pancreatitis
• high-fat diets
• nutrition