alpha-chymotrypsin and Abdominal-Pain

Pancreatitis in children is an appreciable problem that has become increasingly prevalent. This Review covers the principles related to the definitions, epidemiology, risk factors, diagnosis and management of acute pancreatitis in children and identifies features that are unique among children. Additionally, knowledge gaps related to management principles are identified.

Topics: Abdominal Pain; Acute Disease; Amylases; Antioxidants; Carrier Proteins; Child; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Chymotrypsin; Cystic Fibrosis Transmembrane Conductance Regulator; Disease Progression; Fluid Therapy; Hospitalization; Humans; Lipase; Nutritional Support; Pancreatitis; Risk Factors; Trypsin; Trypsin Inhibitor, Kazal Pancreatic

Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are poorly understood.. To characterize and identify risk factors associated with ARP and CP in childhood.. A multinational cross-sectional study of children with ARP or CP at the time of enrollment to the INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a Cure) study at participant institutions of the INSPPIRE Consortium. From August 22, 2012, to February 8, 2015, 155 children with ARP and 146 with CP (aged ≤19 years) were enrolled. Their demographic and clinical information was entered into the REDCap (Research Electronic Data Capture) database at the 15 centers. Differences were analyzed using 2-sample t test or Wilcoxon rank sum test for continuous variables and Pearson χ2 test or Fisher exact test for categorical variables. Disease burden variables (pain variables, hospital/emergency department visits, missed school days) were compared using Wilcoxon rank sum test.. Demographic characteristics, risk factors, abdominal pain, and disease burden.. A total of 301 children were enrolled (mean [SD] age, 11.9 [4.5] years; 172 [57%] female); 155 had ARP and 146 had CP. The majority of children with CP (123 of 146 [84%]) reported prior recurrent episodes of acute pancreatitis. Sex distribution was similar between the groups (57% female in both). Hispanic children were less likely to have CP than ARP (17% vs 28%, respectively; odds ratio [OR] = 0.51; 95% CI, 0.29-0.92; P = .02). At least 1 gene mutation in pancreatitis-related genes was found in 48% of patients with ARP vs 73% of patients with CP (P < .001). Children with PRSS1 or SPINK1 mutations were more likely to present with CP compared with ARP (PRSS1: OR = 4.20; 95% CI, 2.14-8.22; P < .001; and SPINK1: OR = 2.30; 95% CI, 1.03-5.13; P = .04). Obstructive risk factors did not differ between children with ARP or CP (33% in both the ARP and CP groups), but toxic/metabolic risk factors were more common in children with ARP (21% overall; 26% in the ARP group and 15% in the CP group; OR = 0.55; 95% CI, 0.31-0.99; P = .046). Pancreatitis-related abdominal pain was a major symptom in 81% of children with ARP or CP within the last year. The disease burden was greater in the CP group compared with the ARP group (more emergency department visits, hospitalizations, and medical, endoscopic, and surgical interventions).. Genetic mutations are common in both ARP and CP. Ethnicity and mutations in PRSS1 or SPINK1 may influence the development of CP. The high disease burden in pediatric CP underscores the importance of identifying predisposing factors for progression of ARP to CP in children.

Topics: Abdominal Pain; Acute Disease; Carrier Proteins; Child; Chymotrypsin; Cost of Illness; Cross-Sectional Studies; Cystic Fibrosis Transmembrane Conductance Regulator; Disease Progression; Emergency Service, Hospital; Female; Genetic Predisposition to Disease; Hospitalization; Humans; Male; Mutation; Pancreatitis; Pancreatitis, Chronic; Recurrence; Risk Factors; Trypsin; Trypsin Inhibitor, Kazal Pancreatic

Group of 100 patients with proven CP was analysed through the period of 5-20 years. According to duration of pancreatic disease patients were divided in three groups: 2-5 years from the onset of disease (12 patients), 5-8 years from the onset of disease (35 pts) and more than 8 years from the onset of disease (35 pts). At the start of the study all patients have refereed abdominal pain. Chymotripsin activity, BMI, patients' age, occurrence of diabetes and frequency of pain cessation between groups was compared. Significantly higher frequency of diabetics was found in group with longer duration of CP, as expected. Occurrence of pain declined significantly more often in those CP patients with associated diabetes as compared to those without diabetes. Cessation of pain was most prominent in patients with diabetes lasting for more than 8 years. Decline of pain frequency in CP patients despite the progressive pancreatic damage seems to be caused primarily by microvascular changes similar or identical to those occurring in diabetes.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Chronic Disease; Chymotrypsin; Diabetes Complications; Female; Humans; Longitudinal Studies; Male; Middle Aged; Pancreatitis