Until quite recently, pancreatitis was thought to be almost exclusively a disease of adults and most frequently associated with alcohol abuse. However, pancreatitis occurs in all age groups, even infants.
Pancreatitis is divided into “acute” and “chronic” disease. Acute pancreatitis typically produces severe pain and vomiting and can affect other organ systems. However, once the illness resolves the pancreas tissue and ducts appear normal. Best estimates are that there are between 3.6 and 13.2 cases of pediatric acute pancreatitis per 100,000 individuals each year, a number that turns out to not be much different from the incidence of the disease in adults.
Some Children Get Pancreatitis over and over Again
Acute pancreatitis can occur as an isolated, once-in-a-lifetime event or it can recur multiple times. Patients who have many episodes of acute pancreatitis often develop irreversible damage to the pancreas. This is known as chronic pancreatitis. Chronic pancreatitis involves loss of pancreatic tissue, calcifications (calcium stones) and loss of pancreatic function.
The most common causes of acute pancreatitis in children are biliary disorders (including gallstones and malformations), medications and trauma. Children who are very sick from other causes also frequently develop pancreatitis and viral infections can sometimes cause pancreatitis.
Metabolic disorders, genetic conditions and autoimmune disorders are less common causes of acute pancreatitis in children, but they are much more common in the 10 percent to 35 percent of children with pancreatitis who will have recurrent episodes. In the past, children with these conditions would commonly be taken to an emergency department or urgent care multiple times with belly pain and vomiting before physicians would think to check for pancreatitis.
Greater physician awareness in recent years has led to more testing for pancreatitis in children and, hopefully, more rapid identification of these children and referral to specialized care.
What Does the Pancreas Do?
The pancreas is an organ with two main functions. It secretes proteins (digestive juices) into the small intestine just past the stomach to help break down ingested food so it can be absorbed into the body. This is its “exocrine” function (“exo” meaning outside the body because the digestive juices leave the body).
The pancreas also secrets proteins, primarily insulin, into the blood stream to regulate blood sugar level. This is its “endocrine” function (“endo” meaning into or internal). Loss of the exocrine function of the pancreas results in malnutrition and weight loss. Symptoms include diarrhea and bloating. Loss of the endocrine function of the pancreas results in type 3c (as opposed to the more common Type 1 or Type 2) diabetes.
What Happens in Pancreatitis?
The digestive juices produced by the pancreas travel down the pancreatic duct and into the small bowel in response to food ingestion. They become activated in the small bowel by an enzyme on the lining of the small bowel.
Acute pancreatitis results when the digestive juices are activated before they can travel out of the pancreas. This leads to “auto-digestion” of the pancreas tissues. Most children have mild pancreatitis, but pancreatitis can be severe, leading to death of parts of the pancreas (necrotizing pancreatitis), fluid collections in the abdomen, breathing problems, clotting of blood vessels in the abdomen and kidney injury.
How Is Pancreatitis Treated?
Most pancreatitis in children will resolve with fluids, pain medications and rest. However, sometimes they will need breathing support, blood pressure support, anti-coagulation, antibiotics and drainage of fluid collections. If the pancreatitis is caused by gallstones, the child will often get an endoscopic procedure to make sure there is not ongoing obstruction of the ducts followed by gallbladder removal.
If there is a narrowing in the pancreatic duct leading to repeat episodes, the area of narrowing can be stretched and kept open with a small tube. Patients with very frequent episodes or who have chronic pancreatitis with pain may be candidates for a Total Pancreatectomy with Islet Cell Autotransplantation (TPAIT).
In this procedure, the pancreas is removed and the insulin-producing islet cells are sorted out of the pancreas and injected back into the patients. The islet cells are then located in the liver where they continue their work secreting insulin. Children who have this procedure have significant reductions in pain and improvement in quality of life, though they may need additional insulin to keep their blood sugars normal.
The Pancreas Center at Nationwide Children’s
For more information about the highly skilled pediatric intensive care specialists, interventional radiologists, social workers, psychologists and surgeons at Nationwide Children’s and to learn more about our work with the physicians and advanced endoscopists at The Ohio State University Wexner Medical Center, click here.
Cheryl E. Gariepy, MD, is an associate professor of Gastroenterology, Hepatology and Nutrition at Nationwide Children's Hospital and The Ohio State University College of Medicine. She is the associate director for research of the Pediatric Gastroenterology Fellowship at Nationwide Children's. Her areas of clinical interest include genetic gastrointestinal disease and disorders of the liver and pancreas.
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