Is acute recurrent pancreatitis in children a precursor of chronic pancreatitis? A long-term follow-up study of 93 cases

被引:13
作者
Poddar, Ujjal [1 ]
Yachha, Surender K. [1 ]
Borkar, Vibhor [1 ]
Srivastava, Anshu [1 ]
机构
[1] Sanjay Gandhi Postgrad Inst Med Sci, Dept Pediat Gastroenterol, Lucknow, Uttar Pradesh, India
关键词
Biliopancreatic obstruction; Chronic pancreatitis; Genetic predisposition; Idiopathic; IDIOPATHIC CHRONIC-PANCREATITIS; TROPICAL CALCIFIC PANCREATITIS; TRYPSIN-INHIBITOR MUTATIONS; CHANGING INCIDENCE; GENETIC MUTATIONS; SPINK1; GENE; ASSOCIATION; DISEASE; POLYMORPHISMS; CHILDHOOD;
D O I
10.1016/j.dld.2017.02.019
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 (SPINKI 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%). SPINKI 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 SPINKI 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. (C) 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:796 / 801
页数:6
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