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Risk Factors Associated With Biliary Pancreatitis in Children

Ma, Michael H.*; Bai, Harrison X.*; Park, Alexander J.; Latif, Sahibzada U.; Mistry, Pramod K.*; Pashankar, Dinesh*; Northrup, Veronika S.§; Bhandari, Vineet*; Husain, Sohail Z.*

Journal of Pediatric Gastroenterology & Nutrition: May 2012 - Volume 54 - Issue 5 - p 651–656
doi: 10.1097/MPG.0b013e31823a897d
Original Articles: Gastroenterology

Objectives: Little is known about risk factors for biliary pancreatitis in children. We characterized cases of pediatric biliary pancreatitis, compared biliary with nonbiliary cases, examined differences in presentation between younger and older children, and studied features distinguishing gallstone- from sludge-induced pancreatitis.

Methods: We evaluated 76 episodes of biliary pancreatitis from 271 cases of acute pancreatitis in children admitted to a tertiary care hospital from 1994 to 2007.

Results: Of the 76 cases, 55% had gallstones, 21% had sludge, and 24% had structural defects. Hispanic children had 2.85 (P = 0.01) and 5.59 (P = 0.003) times higher probability for biliary pancreatitis than white and black children, respectively. Median serum amylase and lipase in children with biliary pancreatitis were 64% and 49% higher, respectively, compared with other causes (P < 0.05). In multiple logistic regression, aspartate aminotransferase was an independent predictor of biliary pancreatitis (odds ratio 6.69, P = 0.001). When comparing gallstone- with sludge-induced causes, obesity was an independent predictor (38% more prevalent, P < 0.01) of gallstone cases.

Conclusions: Hispanic ethnicity is a risk factor and aspartate aminotransferase is a biomarker for biliary pancreatitis over other causes. Furthermore, obesity can distinguish gallstone- from sludge-induced pancreatitis. These findings may spur prospective studies to determine the optimal evaluation and management of children with biliary pancreatitis.

*Department of Pediatrics, Yale University School of Medicine, New Haven, CT

Department of Internal Medicine, University of Washington, Seattle, WA

Department of Internal Medicine, University of Alabama, Birmingham, AL

§Center for Analytical Sciences, Yale School of Public Health, New Haven, CT.

Address correspondence and reprint requests to Sohail Z. Husain, 333 Cedar St, PO Box 208064, New Haven, CT 06520 (e-mail: sohail.husain@yale.edu).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

Received 16 June, 2011

Accepted 21 September, 2011

Our work was supported by a Children's Digestive Health and Nutrition Young Investigator Award (S.Z.H.), a Yale University School of Medicine Medical Student Research Fellowship (M.H.M.), and the Richard Alan Hirschfield Memorial Fellowship (M.H.M.). Biostatistical collaboration was provided through CTSA grant no. UL1 RR024139 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research (V.S.N.). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on Re-engineering the Clinical Research Enterprise can be obtained from the NIH Web site.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN