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Rapid Progression of Acute Pancreatitis to Acute Recurrent Pancreatitis in Children

Sweeny, Katherine F.*; Lin, Tom K.†,‡; Nathan, Jaimie D.§; Denson, Lee A.†,‡; Husain, Sohail Z.||; Hornung, Lindsey; Thompson, Tyler; Abu-El-Haija, Maisam†,‡

Journal of Pediatric Gastroenterology and Nutrition: January 2019 - Volume 68 - Issue 1 - p 104–109
doi: 10.1097/MPG.0000000000002145
Original Articles: Pancreatology
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Objective: Research is lacking on the natural history of acute pancreatitis (AP) progression to acute recurrent pancreatitis (ARP). The aim of this project was to study the progression from AP to ARP among pediatric patients with pancreatitis to better understand the presentation and natural history of pancreatitis.

Methods: Patients presenting with AP were included in a prospective database in Research Electronic Data Capture. We enrolled 115 patients with AP from March 2013 to November 2016. Physicians completed surveys regarding clinical data for patients with first attack of AP. Patients were followed prospectively, with data on progression entered when patients presented with ARP.

Results: The most common etiologies for the first attack of AP were idiopathic (31%), toxic/drug-related (23%), and biliary/gallstone (18%). Twenty of the 115 patients (17%) developed ARP during the follow-up period. Seventy percent (14/20) of patients with ARP progressed from AP to ARP within 5 months from first diagnosis. A comparison of patients who rapidly progressed to ARP within 3 months (n = 12) to those followed for >3 months without progression in 3 months (n = 97) revealed associations with a higher weight percentile for age (P = 0.045), male sex (P = 0.03), and presence of pancreatic necrosis during first AP attack (P = 0.004). Progression to ARP significantly differed by etiology group with genetics having the highest risk for ARP progression over time and patients with gallstone/biliary, viral/systemic, and obstructive (nongallstone) having the lowest risk for ARP progression over time (P = 0.02).

Conclusions: Most patients who progressed from AP to ARP progressed within 5 months. The presence of a higher weight percentile for age, male sex, and pancreatic necrosis during the first AP attack are associated with rapid progression to ARP.

*Department of Pediatrics

Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center

Department of Pediatrics, College of Medicine, University of Cincinnati

§Department of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

||Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, Pittsburgh, PA

Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Address correspondence and reprint requests to Maisam Abu-El-Haija, MD, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (e-mail: Maisam.haija@cchmc.org).

Received 15 March, 2018

Accepted 17 August, 2018

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).

Dr Sweeny is now affiliated with the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,