Columbus, OH — September 2017
Once thought to be conditions of adulthood, acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are now seen so regularly in children that pediatric gastroenterologists have recognized this population needs its own standards of evaluation and treatment.
The INSPPIRE Group (or INternational Study group of Pediatric Pancreatitis: In search for a curRE) has taken a first step in that direction with publication of its consensus for causal evaluation of ARP and CP. Cheryl Gariepy, MD, member of the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s Hospital and director of its Pancreas Center, is lead author of the consensus. It was published in the Journal of Pediatric Gastroenterology and Nutrition.
“This will be new information for many pediatric gastroenterologists who were trained before pancreatitis was on the radar for our patients,” says Dr. Gariepy, who is also an associate professor of Pediatrics at The Ohio State University College of Medicine. “There still is a lack of research about pancreatitis in children, and this consensus is based largely on expert opinion.”
The group reached consensus on 27 statements covering definitions, evaluation of etiology and long-term monitoring. All of them are important, but a few issues are likely to be of particular interest, Dr. Gariepy says. Among them:
- Genetic testing. The group recommends that nearly all patients should receive genetic testing for PRSS1 mutations and a sweat chloride test at minimum because results can affect the course of treatment. Additional tests for of SPINK1, CFTR and CTRC mutations may help identify risk factors but are not immediately actionable at this time.
- Pancreas divisum and annular pancreas. These two abnormalities are often thought to be causes of ARP, so clinicians will cease looking for other causes when they are found. The consensus says they are risk factors, but evaluation for causes should continue even if pancreas divisum and/or annular pancreas are discovered.
The publication also highlights how much research is needed for true evidence-based guidelines, Dr. Gariepy says. The INSPPIRE Group has been awarded a U01 grant from the National Institutes of Health, and Nationwide Children’s is now enrolling patients for future studies.
“Even five years ago, there was little talk about pancreatitis in children,” Dr. Gariepy says. “We’re changing that.”
Gariepy CE, Heyman MB, Lowe ME, Pohl JF, Werlin SL, Wilschanski M, Barth B, Fishman DS, Freedman SD, Giefer MJ, Gonska T, Himes R, Husain SZ, Morinville VD, Ooi CY, Schwarzenberg SJ, Troendle DM, Yen E, Uc A. Causal evaluation of acute recurrent and chronic pancreatitis in children: consensus From the INSPPIRE group. Journal of Pediatric Gastroenterology and Nutrition.2017 Jan; 64(1):95-103.