Acute pancreatitis and recurrent acute pancreatitis: an exploration of clinical and etiologic factors and outcomes

Sepúlveda, Eileen Viviana Fonseca; Guerrero-Lozano, Rafael

doi:10.1016/j.jped.2018.06.011

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • J. Pediatr. (Rio J.) 95 (6) • Nov-Dec 2019 • https://doi.org/10.1016/j.jped.2018.06.011 copy

Acute pancreatitis and recurrent acute pancreatitis: an exploration of clinical and etiologic factors and outcomes^☆ ☆ Please cite this article as: Fonseca Sepúlveda EV, Guerrero-Lozano R. Acute pancreatitis and recurrent acute pancreatitis: an exploration of clinical and etiologic factors and outcomes. J Pediatr (Rio J). 2019;95:713–9. , ^☆☆ ☆☆ Study conducted at Universidad Nacional de Colombia, Bogota, Colombia.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe the epidemiology and clinical features of acute pancreatitis and recurrent acute pancreatitis in children.

Methods:

Observational and retrospective study with an analytical component. Patients were classified into two groups: Acute pancreatitis and recurrent pancreatitis. The relationship with each parameter obtained was analyzed using the chi-squared test, Student's t-test, or the Mann–Whitney U test.

Results:

There were 130 patients with acute pancreatitis; recurrent pancreatitis was diagnosed in 23.8% of the cases. The most frequent causes were anatomical (29.6%), pharmacological (19.2%), and biliary (14.6%), although in 29.2% etiology was not identified. Fasting lasted 3.5 ± 3.8 days and parenteral nutrition was indicated in 26.9% of the cases for 10.8 ± 11.3 days. A statistical association with anatomical (p = 0.02) and pharmacological causes (p = 0.01) was found in the recurrent pancreatitis group; no other differences between acute pancreatitis and recurrent pancreatitis groups were observed. The mortality rate was 3.1%, it was not attributable to acute pancreatitis in any cases.

Conclusion:

Acute pancreatitis is associated with a high frequency of acute recurrent pancreatitis. Severity and complications did not show statistically significant differences in this investigation. Anatomical etiologies were the most relevant cause in this cohort. Fasting time and parenteral nutrition use were relevant. Genetics testing is required in this population.

Keywords
Pancreatitis; Pediatrics; Recurrence; Enteral nutrition

Comorbidities	AP n (%) (n = 99)	ARP n (%) (n = 31)	p-value
Leukemias^a a Types of leukemia: acute lymphoblastic leukemia, promyelocytic leukemia.	10 (10.1%)	5 (16.1%)	0.35
Epilepsy	5 (5.1%)	2 (6.5%)	0.76
Systemic lupus erythematosus	3 (3.0%)	1 (3.2%)	1.00
Diabetes mellitus type 1	1 (1%)	2 (6.5%)	0.14
Lymphomas	2 (2.0%)	1 (3.2%)	0.56
Immune thrombocytopenic purpura	2 (2%)	0	1.00
Other^b b Neuroendocrine tumor, tuberous sclerosis, Fanconi anemia, thalassemia trait, rhabdomyosarcoma, dengue, factor VI deficiency.	5 (5.1%)	2 (6.5%)	0.76

Etiology	AP n (%) (n = 99)	ARP n (%) (n = 31)	p-value
Anatomical	20 (20.2)	15 (48.4)	0.02
Choledochal cyst	5 (25)	1 (6.6)	-
Biliary-pancreatic junction alterations	5 (25)	6 (40)	-
Pancreatic duct stenosis	5 (25)	7 (46.6)	-
Pancreas divisum	3 (15)	1 (6.6)	-
Biliary ectasia	2 (10)	-	-
Pharmacological	24 (24.2)	1 (3.2)	0.01
l-Asparaginase	9 (37.5)	1 (100)	-
Valproic acid	5 (20.8)	0 (0)	-
Carbamazepine	3 (12.5)	0 (0)	-
Mercaptopurine	3 (12.5)	0 (0)	-
Methotrexate	3 (12.5)	0 (0)	-
Trans retinoic-acid	1 (4.16)	0 (0)	-
Biliary ^a a Choledocholithiasis, cholecystitis with cholelithiasis.	16 (16.2)	3 (9.7)	0.37
Idiopathic	28 (28.3)	10 (32.2)	0.67
Traumatic	5 (5.1)	1 (3.2)	1.0
Autoimmune	3 (3.0)	0	0.52
Other ^b b Infectious: only one case that was attributed to dengue, postsurgical, neoplastic infiltration.	3 (3.0)	1 (3.2)	0.54

Variable	AP n (%)	ARP n (%)	p-value
Ultrasound	n = 86	n = 25
Normal	24 (27.9)	6 (24.0)	0.05
Intrahepatic and extrahepatic biliary dilatation	8 (9.3)	8 (32.0)	0.56
Cholelithiasis, choledocholithiasis, cholecystitis	13 (15.1)	1 (4.0)	0.04
Edema/enlargement	19 (22.1)	3 (12.0)	0.03
Other findings	15 (17.4)	4 (16.0)	0.03
Peripancreatic collection	1 (1.2)	2 (8.0)	0.09
Pseudocyst		1 (4.0)
Choledochal cyst	6 (7.0)	0
Tomography	n = 42	n = 18
Normal	12 (28.6)	9 (50)	0.82
Edema/enlargement	16 (38.1)	0
Peripancreatic fat	6 (14.3)	2 (11.1)	0.52
Multiple collection	1 (2.4)	0
Single collection	2 (4.8)	2 (11.1)
Other unrelated findings	5 (11.9)	4 (22.2)	0.52
Pancreatic laceration	0	1 (5.6)
Magnetic resonance cholangiopancreatography	n = 35	n = 13
Normal	12 (34.3)	2 (15.4)	0.02
Malformation of the bile duct and the pancreatic duct^a a Pancreaticobiliary malunion, dilatation of intra- and extra-hepatic biliary tract, biliary ectasia.	10 (28.5)	5 (38.4)	0.04
Pancreatic and peripancreatic inflammation	6 (17.1)	0
Bile duct abnormalities^b b Choledochal cyst, choledocholithiasis.	4 (11.4)	3(23.0)	0.23
Anatomical alterations pancreas^c c Pancreas divisum, pseudocyst.	2 (5.7)	1 (7.7)	0.35
Not related to pancreatitis	1 (2.9)	1 (7.7)	0.26
Pancreatic tumor	0	1 (7.7)

Variable	AP	ARP	p-value
Fasting time (days)	3 (IQR 2-5) (n = 79)	2 (IQR 1-2.5) (n = 29)	0.01
Parenteral nutrition time (days)	9 (IQR 5.5-15.3) (n = 30)	3 (IQR 1.5-8) (n = 5)	0.043
Hospital stay (days)	9 (IQR 6-13.5) (n = 85)	10 (IQR 6.5-17.7) (n = 26)	0.44
Admission to the PICU n (%)	34 (36.2)	14 (48.3)	0.24
Stay at the PICU (days)	5 (IQR 3-10) (n = 34)	6.5 (IQR 3.8 -10.3) (n = 29)	0.37

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:evfonsecas@unal.edu.co (E.V. Fonseca Sepúlveda).