Medical terms can be difficult for children and their families to understand, especially when simple, everyday words like acute and chronic seem to lose their meaning. This is the unfortunate experience for many parents of children with pancreatitis. The terms acute and chronic, as they relate to pancreatitis, are not related to the length of time a child has suffered with pancreatitis but rather the injury to the pancreas itself. Fortunately, the definitions for these three categories of pancreatitis can be simplified.
Acute Pancreatitis
Acute pancreatitis is a sudden case of inflammation within the pancreas that most frequently results in severe belly pain and vomiting. It is defined as having at least two of the following criteria present:
Belly pain commonly seen in acute pancreatitis (upper abdomen/epigastric area that comes on quickly)
Blood test (either amylase or lipase) that is at least three times higher than normal
Inflammation of the pancreas on imaging (typically an ultrasound but can be a CT or MRI)
Acute pancreatitis can be used to describe a person’s first episode of pancreatitis, or any additional episodes that may occur. It is believed that about 30% (or 3 out of every 10) of children will go on to have more than one episode of acute pancreatitis. Since acute pancreatitis refers to the single episode, a child with chronic pancreatitis can have episodes of acute pancreatitis.
Acute Recurrent Pancreatitis
When a child has an episode of pancreatitis that completely resolves (child is pain free for at least one month or amylase/lipase return to normal) and then experiences a second episode of acute pancreatitis, they now have acute recurrent pancreatitis. A child may have any number of episodes of acute pancreatitis over any length of time and remain categorized as acute recurrent pancreatitis unless the specific criteria for chronic pancreatitis are met.
Chronic Pancreatitis
A child who has experienced acute pancreatitis and has imaging that shows irreversible damage to the pancreas suggestive of chronic pancreatitis is considered to have chronic pancreatitis. While most children with chronic pancreatitis will have had acute recurrent pancreatitis, it is not required. About 10% of children are diagnosed with chronic pancreatitis during their first episode of pancreatitis. For some children with chronic pancreatitis, they will also experience exocrine dysfunction (inability to digest nutrients, especially fats, due to decreased output of pancreatic enzymes) or endocrine dysfunction (diabetes).
Progression of Pancreatitis
Currently there is no way to predict which children that experience acute pancreatitis will progress to acute recurrent or chronic pancreatitis. It is understood though that even a single episode of acute pancreatitis increases a child’s risk for diabetes and other complications. Therefore, it is recommended that any child who experiences acute pancreatitis have a follow up appointment with a pediatric gastroenterologist knowledgeable in pediatric pancreatitis. Children with chronic pancreatitis have variable, and often complicated, progression and are best cared for within a comprehensive, multidisciplinary pediatric pancreas program.
The pancreas care specialists at Nationwide Children’s Hospital include our expert team of physicians, surgeons and other medical professionals with in-depth knowledge and experience in pancreatitis and related conditions.
A. Jay Freeman, MD, MSc, is medical director of Pancreatic Care for the Pancreas and Liver Care Center at Nationwide Children’s Hospital, and professor of Pediatrics at The Ohio State University College of Medicine. Dr. Freeman is a leader in the care of children with pancreatic disorders as well as the GI and liver complications of cystic fibrosis.
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