Chronic pancreatitis in children

Chronic pancreatitis in children is an inflammatory process in the pancreas with a phase-progressive course, focal or diffuse destructive and degenerative changes in the acinar tissue, duct system, the development of functional insufficiency of varying degrees of severity and subsequent decrease in external and internal secretory functions and the development of fibrosis of the pancreatic parenchyma.

ICD-10 code

K86.1. Other chronic pancreatitis.

Epidemiology of chronic pancreatitis

Problems of pediatric pancreatology are considered to be the most complex section of clinical gastroenterology. As evidenced by the works of leading gastroenterologists, the prevalence of pancreatitis has been clearly increasing in recent decades both in adults and children.

In young patients, malformations of the pancreas are diagnosed relatively more often, in older patients - acute and chronic pancreatitis. Data on the incidence of chronic pancreatitis in children in the structure of diseases of the digestive organs according to the results of specialized pediatric medical institutions are extremely contradictory and make up from 5 to 25% of all patients with gastroenterological pathology.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Causes of chronic pancreatitis in children

Chronic pancreatitis in children, as in adults, has a polyetiological nature and is the main form of pancreatic pathology. In children, the leading etiological cause is considered to be diseases of the duodenum (41.8%), biliary tract (41.3%), less often - intestinal pathology, pancreatic developmental anomalies, abdominal trauma. Concomitant factors: bacterial and viral infections (hepatitis, enterovirus, cytomegalovirus, herpes, mycoplasma infections, infectious mononucleosis, epidemic mumps, salmonellosis, sepsis, etc.) and helminthiases (opisthorchiasis, strongyloidiasis, giardiasis, etc.).

What causes chronic pancreatitis?

[ 7 ], [ 8 ], [ 9 ], [ 10 ]

Symptoms of chronic pancreatitis in children

The clinical picture of chronic pancreatitis in children is variable and depends on the duration of the disease, the form and stage of the disease, the degree of disorder of the external and internal secretory functions of the gland, the presence of concomitant pathology of other organs. Despite the variety of clinical symptoms of pancreatitis, the leading syndrome is considered to be pain.

Symptoms of chronic pancreatitis

Classification of chronic pancreatitis in children

There is no generally accepted classification of pancreatic diseases in pediatric gastroenterology. A working classification of chronic pancreatitis in children is proposed for practical use, reflecting the etiology, clinical and morphological variant, course, features of the secretory function of the gland, complications of pancreatitis, substantiating a set of therapeutic measures.

1. Etiology:
   • primary;
   • secondary.
2. Clinical variant:
   • recurrent pain;
   • latent.
3. Period of illness:
   • exacerbation;
   • abatement of exacerbation;
   • remission.
4. Severity of the course:
   • lung;
   • moderate;
   • heavy.
5. Type of pancreatic secretion:
   • hypersecretory;
   • hyposecretory;
   • obstructive.
6. Violation of endocrine function:
   • hyperinsulinism;
   • hypofunction of the insular apparatus.
7. Morphological variant:
   • interstitial (edematous);
   • parenchymatous;
   • cystic;
   • calcifying.
8. Complications:
   • pseudocysts;
   • calcifications;
   • left-sided pleurisy;
   • ascites;
   • abscess;
   • fistulas;
   • bleeding;
   • cholestasis;
   • thrombophlebitis of the splenic vein;
   • diabetes mellitus.

[ 11 ], [ 12 ]

Diagnosis of chronic pancreatitis in children

The anamnesis includes an analysis of the child’s developmental characteristics at different periods of life, nutritional status, heredity, and the timing of the onset of early symptoms of the disease.

Increased concentration of amylase, lipase, trypsin and its inhibitors in blood serum, as well as amylase, lipase in urine reflects the activity of the inflammatory process in the pancreas and indicates pancreatitis. Amylase is included in the group of indicator enzymes. The level of amylasemia in healthy children is a constant value. The amylase activity indicator is maintained by renal and extrarenal elimination of the enzyme, it practically does not depend on the functional state of other enzyme-producing organs. Determination of amylase activity in urine is an informative and convenient screening test for pancreatic diseases. A long-term recorded increase in amylase activity in urine, even against the background of normal enzyme concentration in the blood, may indicate a complicated course of chronic pancreatitis or the formation of a false cyst. In acute pancreatitis, the amylase content in the blood and urine increases by 10 times or more. The frequency of detection of hyperfermentemia depends on the phase of the disease and the time of admission of the patient to the hospital. The study of amylase isoenzymes is informative, especially with normal total amylase activity.

Diagnosis of chronic pancreatitis

[ 13 ], [ 14 ], [ 15 ]

Screening

The most accessible and informative methods for diagnosing chronic pancreatitis are ultrasound examination of the pancreas and determination of fecal elastase-1.

Treatment of chronic pancreatitis in children

Creating functional rest for the pancreas, relieving pain, inhibiting pancreatic secretion, preventing the development of complications.

The basic principles of treating chronic pancreatitis include the mandatory prescription of therapeutic nutrition with a reduced fat content and a physiological protein norm to ensure the functional rest of the pancreas.

Therapeutic nutrition for chronic pancreatitis is based on mechanical, thermal and chemical sparing of the pancreas, suppression of hyperfermentemia, reduction of congestion in the ducts and duodenum, and reduction of reflex excitability of the gallbladder.

Treatment of chronic pancreatitis

Prevention of chronic pancreatitis in children

Primary prevention is aimed at preventing pancreatitis in children from a high-risk group (frequently ill children, children from socially disadvantaged families with non-compliance with the principles of rational nutrition; patients who have had infectious diseases; patients with gastroenterological pathology, etc.). Secondary prevention consists of timely anti-relapse and restorative treatment.