Chronic pancreatitis in children

Chronic pancreatitis in children - 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 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 pancreatology of childhood are referred to the most complicated section of clinical gastroenterology. As evidenced by the work of leading gastroenterologists, the prevalence of pancreatitis in recent decades clearly grows in both adults and children.

In patients of early age, the pancreatic malformation is relatively more often diagnosed, and in older patients acute and chronic pancreatitis. Data on the occurrence of chronic pancreatitis in children in the structure of diseases of the digestive system according to the results of specialized pediatric medical institutions are highly contradictory and constitute 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, is of a polyethological nature and serves as the main form of pancreatic pathology. In children, duodenal diseases (41.8%), bile ducts (41.3%), and less frequent intestinal pathology, pancreatic abnormalities, and abdominal trauma are considered to be the leading etiological cause. Concomitant factors: bacterial and viral infections (hepatitis, enterovirus, cytomegalovirus, herpetic, mycoplasmal infections, infectious mononucleosis, epidemic parotitis, salmonella, 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 intrasecretory 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 painful.

Symptoms of Chronic Pancreatitis

Classification of chronic pancreatitis in children

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

1. Etiology:
   • primary;
   • secondary.
2. Clinical variant:
   • recurrent pain;
   • latent.
3. Period of the disease:
   • exacerbation;
   • suppression of exacerbation;
   • remission.
4. Current severity:
   • lung;
   • moderate;
   • heavy.
5. Type of pancreatic secretion:
   • hypersecretory;
   • hypoxecretory;
   • obstructive.
6. Infringement of the endocrine function:
   • hyperinsulism;
   • hypofunction of the insular apparatus.
7. Morphological variant:
   • interstitial (edematous);
   • parenchymatous;
   • cystic;
   • calcifying.
8. Complications:
   • pseudocysts;
   • calcification;
   • left-sided pleurisy;
   • ascites;
   • abscess;
   • fistulas;
   • bleeding;
   • cholestasis;
   • thrombophlebitis of the spleen vein;
   • diabetes.

[11], [12]

Diagnosis of chronic pancreatitis in children

Anamnesis provides an analysis of the developmental features of the child in different periods of life, the nature of nutrition, heredity, the timing of the onset of early symptoms of the disease.

The increase in the concentration of amylase, lipase, trypsin and its inhibitors in the serum, as well as amylase, lipase in the urine reflects the activity of the inflammatory process in the pancreas and indicates pancreatitis. Amylase belongs to the group of indicator enzymes. The level of amylase in healthy children is constant. The activity index of amylase supports renal and extrarenal elimination of the enzyme, it practically does not depend on the functional state of other enzyme-producing organs. Determination of the activity of amylase in the urine is an informative and convenient screening test for pancreatic diseases. A long-term increase in the activity of amylase in the urine, even against the background of a normal concentration of the enzyme in the blood, may indicate a complicated course of chronic pancreatitis or the formation of a false cyst. In acute pancreatitis, the content of amylase in blood and urine increases by 10 times or more. The frequency of detection of hyperfermentemia depends on the phase of the disease and the timing of admission to hospital. It is informative to study isoenzymes of amylase, 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 the determination of fecal elastase-1.

Treatment of chronic pancreatitis in children

Creation of functional dormancy for the pancreas, relief of pain syndrome, inhibition of pancreatic secretion, prevention of complications.

The main principles of treatment of chronic pancreatitis provide for the mandatory appointment of therapeutic nutrition with a lower fat content and physiological protein norm to ensure functional dormancy of the pancreas.

Therapeutic diet in chronic pancreatitis is based on mechanical, thermal and chemical shaking of the pancreas, suppression of hyperfermentemia, reduction of stagnation in the ducts and duodenum, reduction of the reflex excitability of the gallbladder.

Treatment of chronic pancreatitis

Prevention of chronic pancreatitis in children

Primary prophylaxis is aimed at preventing pancreatitis in children at high risk (often ill children, children from socially disadvantaged families with non-observance of the principles of rational nutrition, patients with infectious diseases, patients with gastroenterological pathology, etc.). Secondary prevention consists in timely anti-relapse and restorative treatment.