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Morphological and functional recovery following acute and acute recurrent pancreatitis in children: A prospective sequential 2-point evaluation
Institution:1. Division of Pediatric Gastroenterology and Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;2. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;3. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India;4. Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India;1. Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy;2. Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy;3. Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy;4. Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy;5. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy;1. Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, USA;2. Institute for Technology Assessment, Massachusetts General Hospital, USA;3. Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Current Affiliation: Division of Gastroenterology, Columbia University College of Physicians and Surgeons, USA;4. Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, USA;1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA;2. Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children''s Hospital at Stanford, Stanford, CA, USA;3. Department of Biostatistics, University of Pittsburgh, Pittsburg, PA, USA;4. Nationwide Children''s Hospital, Columbus, OH, USA;5. University of Pittsburgh, School of Dental Medicine, Pittsburg, PA, USA;6. University of Pittsburgh, School of Medicine, Pittsburg, PA, USA;7. Johns Hopkins Medical Institutions, Baltimore, MD, USA;8. Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;9. The Ohio State University Wexner Medical Center, Columbus, OH, USA;1. Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China;2. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China;3. Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China;1. Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA;2. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA;3. Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA;4. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
Abstract:BackgroundThe functional and morphological recovery following an episode of acute pancreatitis (AP) in children still remains ill understood as research exploring this is limited. We aimed to characterize the morphological and functional changes in pancreas following AP and ARP (acute recurrent pancreatitis) in children.MethodsChildren with AP were followed prospectively and assessed at two time points at least 3 months apart, with the first assessment at least 3 months after the AP episode. Exocrine and endocrine functions were measured using fecal elastase and fasting blood sugar/HbA1c levels respectively. Morphological assessment was done using endoscopic ultrasound (EUS) and magnetic resonance imaging and cholangiopancreatography (MRI/MRCP).ResultsSeventy-three children (boys:59%; mean age:8.4 ± 3.2years) were studied and 21 of them (29%) progressed to ARP. Altered glucose homeostasis was seen in 19 (26%) at first and 16 (22%) at second assessment and it was significantly more in ARP group than the AP group at first (42.8%vs19.2%; p = 0.03) as well as second assessment (38.1%vs15.3%; p = 0.03). Twenty-one children (28.7%) at first and 24 (32.8%) at second assessment developed biochemical exocrine pancreatic insufficiency. EUS detected indeterminate and suggestive changes of chronic pancreatitis in 21% at first (n = 38) and 27.6% at second assessment (n = 58). On MRCP, main pancreatic duct and side branch dilatation were seen in 15 (20.5%) and 2 (2.7%) children respectively.ConclusionsMore than one-quarter of children have evidence of altered glucose homeostasis and biochemical exocrine pancreatic insufficiency following an episode of AP. Similarly, morphological features of chronicity seen in some of the children suggest that a fraction of subjects may develop chronic pancreatitis on longer follow-up.
Keywords:Pancreatitis  Exocrine pancreatic insufficiency  Endoscopic ultrasound  Magnetic resonance cholangiopancreatography  Chronic pancreatitis  Fecal elastase
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