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Background Meandering main pancreatic duct (MMPD) refers to an uncommon ductal variant of the normal smooth curvilinear course of the pancreatic duct. More specifically, MMPD is characterized by a hairpin (reverse Z-type) or loop (loop-type) turn in the pancreatic head. It has been suggested as a predisposing factor for the development of pancreatitis. Studies regarding treatment are scarce. Method We conducted a narrative review of the current literature regarding MMPD. Additionally, we present a cohort of 9 symptomatic patients treated endoscopically at our tertiary center. Results Seven retrospective cohort studies and 4 case reports were included in our review. Only 1 study focuses on the clinical significance of MMPD and describes a positive association between MMPD and the onset of pancreatitis, especially recurrent acute pancreatitis. Only 1 case reports an endoscopic treatment. In our cohort of 9 MMPD patients, 7 did indeed present with recurrent acute pancreatitis. Endotherapy provided substantial regression of symptoms in 6 patients, all of whom had signs of ductal hypertension. Conclusions Our review shows the scarcity of data regarding MMPD, especially concerning treatment, in the current literature. With our cohort, we not only hope to raise awareness of this often-neglected entity of recurrent acute pancreatitis, but also support the case for endotherapy for the first time in 9 symptomatic MMPD patients, especially in the presence of ductal hypertension. [ABSTRACT FROM AUTHOR]

Acute recurrent pancreatitis (ARP) is defined as two distinct episodes of acute recurrent pancreatitis. Acute recurrent pancreatitis in children is rare, with an incidence rate of approximately one in 500000. The most common causes of acute recurrent pancreatitis in children are infection, blunt abdominal trauma, drug toxicity, biliary stones or cystolithiasis, systemic disease, anatomic anomalies, sphincter of Oddi dysfunction, and hereditary and idiopathic causes. ARP is a precursor to develop chronic pancreatitis. We report one case of ARP with pancreas divisum, which could be an important etiology for ARP. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of the study was to determine whether clinical characteristics and management of pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) differ across INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a cuRE) sites.Study designData were collected from INSPPIRE and analyzed per US regions and "non-US" sites. Between-group differences were compared by Pearson chi-square test. Differences in disease burden were compared by Kruskal-Wallis test.ResultsOut of the 479 subjects, 121 (25%) were enrolled in West, 151 (32%) Midwest, 45 Northeast (9%), 78 (16%) South, and 84 (18%) at non-US sites. Hispanic ethnicity was more common in South (P

IntroductionAbdominal pain is common and is associated with high disease burden and health care costs in pediatric acute recurrent and chronic pancreatitis (ARP/CP). Despite the strong central component of pain in ARP/CP and the efficacy of psychological therapies for other centralized pain syndromes, no studies have evaluated psychological pain interventions in children with ARP/CP. The current trial seeks to 1) evaluate the efficacy of a psychological pain intervention for pediatric ARP/CP, and 2) examine baseline patient-specific genetic, clinical, and psychosocial characteristics that may predict or moderate treatment response.MethodsThis single-blinded randomized placebo-controlled multicenter trial aims to enroll 260 youth (ages 10-18) with ARP/CP and their parents from twenty-one INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) centers. Participants will be randomly assigned to either a web-based cognitive behavioral pain management intervention (Web-based Management of Adolescent Pain Chronic Pancreatitis; WebMAP; N = 130) or to a web-based pain education program (WebED; N = 130). Assessments will be completed at baseline (T1), immediately after completion of the intervention (T2) and at 6 months post-intervention (T3). The primary study outcome is abdominal pain severity. Secondary outcomes include pain-related disability, pain interference, health-related quality of life, emotional distress, impact of pain, opioid use, and healthcare utilization.ConclusionsThis is the first clinical trial to evaluate the efficacy of a psychological pain intervention for children with CP for reduction of abdominal pain and improvement of health-related quality of life. Findings will inform delivery of web-based pain management and potentially identify patient-specific biological and psychosocial factors associated with favorable response to therapy. Clinical Trial Registration #: NCT03707431.

Background Acute pancreatitis is a reversible inflammation of the pancreatic parenchyma. Enlargement of the pancreas is often envisaged in such conditions. This study evaluates P/V ratio, as a marker to decide pancreatic enlargement in disease condition. Purpose The aim of this study was to develop imaging-based diagnostic criterion for acute pancreatitis in children based on P/V ratio. Material and Methods This study included 37 children with acute pancreatitis and 283 children asymptomatic for pancreatic disorders, from a single hospital center. The age of children ranged between 2 and 18 years. P/V ratio, which is the ratio of greatest anteroposterior dimension of the head, body, and tail of the pancreas relative to the transverse lumbar vertebral body, was obtained for each child through ultrasonographic examination. Age-adjusted receiver operating characteristics (AROC) analysis was performed on P/V ratio at presentation for each pancreatic region, and the sensitivity at 90% specificity, the threshold errors, and the corresponding cutoffs were obtained. The enlargement assessment was also done after clinical recovery by referring to the cutoffs of respective regions. Results AROC analysis for males and females resulted into a maximum sensitivity of 83.33 and 81.67%, respectively, at 90% specificity for head. The error thresholds for both the groups were same, i.e., 0.098, indicating that 90% of the observations had errors less than the threshold. The corresponding P/V ratio cutoff for males and females was 0.43 and 0.42, respectively. Conclusion Radiologists and clinicians can refer a cutoff value of 0.4 for each region, along with hypoechogenicity, to decide about enlargement of the pancreas in acute pancreatitis condition.

ObjectivesIn patients with acute recurrent pancreatitis (ARP), pancreas divisum, and no other etiologic factors, endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) is often performed to enlarge the minor papillary orifice, based on limited data. The aims of this study are to describe the rationale and methodology of a sham-controlled clinical trial designed to test the hypothesis that miES reduces the risk of acute pancreatitis.MethodsThe SpHincterotomy for Acute Recurrent Pancreatitis (SHARP) trial is a multicenter, international, sham-controlled, randomized trial comparing endoscopic ultrasound + ERCP with miES versus endoscopic ultrasound + sham for the management of ARP. A total of 234 consented patients having 2 or more discrete episodes of acute pancreatitis, pancreas divisum confirmed by magnetic resonance cholangiopancreatography, and no other clear etiology for acute pancreatitis will be randomized. Both cohorts will be followed for a minimum of 6 months and a maximum of 48 months.ResultsThe trial is powered to detect a 33% risk reduction of acute pancreatitis frequency.ConclusionsThe SHARP trial will determine whether ERCP with miES benefits patients with idiopathic ARP and pancreas divisum. Trial planning has informed the importance of blinded outcome assessors and long-term follow-up.

Synopsis: We describe a case of recurrent idiopathic pancreatitis in a pregnant diabetic who presented with euglycemic diabetic ketoacidosis (DKA), was managed successfully and delivered a healthy baby. [ABSTRACT FROM AUTHOR]

Background Acute pancreatitis is a reversible inflammation of the pancreatic parenchyma. Enlargement of the pancreas is often envisaged in such conditions. This study evaluates P/V ratio, as a marker to decide pancreatic enlargement in disease condition. Purpose The aim of this study was to develop imaging-based diagnostic criterion for acute pancreatitis in children based on P/V ratio. Material and Methods This study included 37 children with acute pancreatitis and 283 children asymptomatic for pancreatic disorders, from a single hospital center. The age of children ranged between 2 and 18 years. P/V ratio, which is the ratio of greatest anteroposterior dimension of the head, body, and tail of the pancreas relative to the transverse lumbar vertebral body, was obtained for each child through ultrasonographic examination. Age-adjusted receiver operating characteristics (AROC) analysis was performed on P/V ratio at presentation for each pancreatic region, and the sensitivity at 90% specificity, the threshold errors, and the corresponding cutoffs were obtained. The enlargement assessment was also done after clinical recovery by referring to the cutoffs of respective regions. Results AROC analysis for males and females resulted into a maximum sensitivity of 83.33 and 81.67%, respectively, at 90% specificity for head. The error thresholds for both the groups were same, i.e., 0.098, indicating that 90% of the observations had errors less than the threshold. The corresponding P/V ratio cutoff for males and females was 0.43 and 0.42, respectively. Conclusion Radiologists and clinicians can refer a cutoff value of 0.4 for each region, along with hypoechogenicity, to decide about enlargement of the pancreas in acute pancreatitis condition. [ABSTRACT FROM AUTHOR]

The evolution of pancreatic endoscopic retrograde cholangiopancreatography (ERCP) has transformed from a diagnostic tool to now a primarily therapeutic modality. Mainly utilized within the spectrum of pancreatitis, pancreatic ERCP can help resolve pancreatic duct (PD) leaks, disruptions, and pancreatic fluid collections. In chronic pancreatitis, ERCP is effective for the treatment of PD strictures and stones with the improvement of pancreatoscopy greatly facilitating targeted therapy. Pancreatoscopy also allows for accurate mapping of main duct intraductal papillary mucinous neoplasms, which can help guide surgical resection., Competing Interests: Disclosure Author S. Han is a Consultant for Boston Scientific. Author V. Chandrasekhara is a Consultant for Boston Scientific, a shareholder for Nevakar Corp, and receives research support from Micro-tech Endoscopy and STARmed., (Copyright © 2024 Elsevier Inc. All rights reserved.)

INTRODUCTION: It was aimed to evaluate the etiology, clinical, laboratory and imaging findings and treatment methods of patients who have admitted with acute pancreatitis (AP) and progressed to chronic pancreatitis (CP) with ARP (acute recurrent pancreatitis). METHODS: The data of children under the age of 18 years who were admitted to our hospital between January 2013-July 2020 and were diagnosed with acute, acute recurrent or chronic pancreatitis according to INSPPIRE diagnostic criteria were evaluated retrospectively. RESULTS: There were 77 patients who were followed-up with the diagnosis of acute pancreatitis. Pancreatitis attack did not recur in 53/77 patients and no underlying cause was found in 35.84% (19/53) of the patients. The most common factor in those whose cause could be determined was gallstones (15.1%) (8/53). The pancreatitis attack recurred in 24 (31%) of the patients. Congenital anomalies (9/24) and hereditary pancreatitis (5/24) were the most common causes of pancreatitis in these patients and these factors were a risk factor for the recurrence of pancreatitis attack. There was no difference between the groups in terms of complications (p=0.423); however, chronicity was more common in the group with ARP (p=0.003). DISCUSSION AND CONCLUSION: Beside the pancreatitis is a rare disease in childhood, with the increase of awareness and increased accessibility to diagnostic imaging methods, more and more pancreatitis is diagnosed day by day. Idiopathic acute pancreatitis cases still constitute the largest group. If other causes are excluded in these cases, it is important to investigate congenital anomalies, genetic and metabolic etiologies.

Keywords: Smoking; chronic pancreatitis; acute pancreatitis; acute recurrent pancreatitis; smoking cessation EN Smoking chronic pancreatitis acute pancreatitis acute recurrent pancreatitis smoking cessation 313 315 3 04/13/23 20230401 NES 230401 1. Smoking, chronic pancreatitis, acute pancreatitis, acute recurrent pancreatitis, smoking cessation The challenge of smoking cessation in pancreatitis Despite physician recommendations to quit smoking, achieving this remains challenging in patients with pancreatitis. [Extracted from the article]

BackgroundRisk factors for progression from acute recurrent pancreatitis (ARP) to chronic pancreatitis (CP) in children are poorly understood.AimTo summarize the clinical characteristics of children with ARP and CP, identify the risk factors of CP, and investigate the factors associated with rapid progression from initial onset of ARP to CP.MethodsThe following variables were included in the risk factor analysis: sex, age at onset, family history, pancreas or biliary tract structural abnormalities, and genetic variations. Univariate and multivariate logistic regression analyses were used to assess the risk factors of CP. The Kaplan–Meier curves of the ARP progression to CP for various risk factor groupings were constructed and compared using the log-rank test. The Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR) of progression to CP for each risk variable.ResultsIn total, 276 children were studied, of whom 136 progressed to CP. Among them, 41 had pancreatic duct obstructive disease; 105 underwent genetic testing, of whom 68 were found to have genetic variations. Among the remaining 140 patients who did not progress to CP, 61 had biliary obstructions. Forty-three of these children underwent genetic testing, and 15 were found to have genetic variations. Risk factor analysis showed that children with gene mutations were at a higher risk of progressing to CP [odds ratio (OR) = 3.482; 95% confidence interval (CI): 1.444–8.398; P = 0.005]; children with pancreas divisum (PD) had a higher risk of CP than those without (OR = 8.665; 95% CI: 1.884, 9.851; P = 0.006). Further, children whose first ARP occurred at an older age might develop CP faster (HR = 1.070; 95% CI: 1.003, 1.141; P = 0.039). Children with gene mutations had a faster rate of progression to CP after onset than children without gene mutations (HR = 1.607; 95% CI: 1.024, 2.522; P = 0.039), PRSS1 gene mutations were more associated (P = 0.025). There was no difference in the rate of progression from ARP to CP in children with PD (P = 0.887); however, endoscopic retrograde cholangiopancreatography (ERCP) intervention delayed the progression to CP in ARP patients with PD (P = 0.033).ConclusionPRSS1 gene mutations and PD are key risk factors for ARP progression to CP in children. PD itself does not affect the disease progression rate, but therapeutic ERCP can be beneficial to patients with ARP with symptomatic PD and delay the progression to CP.

ABSTRACT Aim: In the present study, the purpose was to examine the clinical and laboratory characteristics of patients diagnosed with Acute Pancreatitis in a third-line Children’s Emergency Department, and to draw attention to the importance of Acute Pancreatitis in the differential diagnosis of children admitting with abdominal pain. Materials and Methods: The child patients who were diagnosed with acute pancreatitis at Çukurova University Faculty of Medicine, Department of Pediatric Emergency Medicine for a period of 5 years were included in the study. The patients were divided into two groups as Acute Pancreatitis and Recurrent Acute Pancreatitis. The clinical and laboratory data of the patients were examined retrospectively. Acute pancreatitis risk factors were determined according to the Modified Ranson Criteria. Results: A total of 53 patients who were diagnosed with acute pancreatitis were included in the study. The patients had had attacks for a total of 116 times. The mean age of the patients was 10.6±4.4 years (minimum: 0.5, maximum: 17.5), 28 (52.8%) were girls, and 22 (41.5%) had had ≥2 attacks. The etiology of Acute Pancreatitis could not be determined in 20 (38%) patients, and hyperlipidemia was detected in 10 patients (18.8%). Conclusion: Acute Pancreatitis should be considered in the differential diagnosis of patients admitting to Emergency Departments with abdominal pain, and the awareness about the subject should be increased. Keyword: Acute Pancreatitis, Acute Recurrent Pancreatitis, Abdominal Pain.

Pancreatitis in childhood is as common as in adults, with wide spectrum of etiologies and with relatively low risk of complications and mortality. Considering common non-typical clinical presentation and laboratory characteristics, especially in infants and younger children, timely recognition is of major importance. Early diagnosis, targeting detection of causes, would point out the group of children with risk of early and late complications as well as of progression to chronic pancreatitis. In a significant number of patients, accurate therapeutic approach could lead to lower morbidity and decreased risk of acute and chronic complications, enabling normal growth and development with good quality of life. [ABSTRACT FROM AUTHOR]

Abstract Background The diagnosis of pediatric pancreatitis has been increasing over the last 20 years. We aimed to compare the clinical characteristics for pediatric acute pancreatitis (AP) with adult AP, and investigate the risk factor for acute recurrent pancreatitis (ARP) in children. Method From June 2013 to June 2019, a total of 130 pediatric patients with AP at the inpatient database were enrolled. Univariate analysis and multivariate Cox regression analysis were performed to identify the risk factors for ARP in children. Result Major etiologic factors in 130 patients were biliary (31.5%), idiopathic (28.5%). The etiology of pancreatitis in children was markedly different from that in adults (p

Pancreatitis in children can result from metabolic and toxic risk factors, but the evidence linking these factors is sparse. We review the evidence for association or causality of these risk factors in pancreatitis, discuss management strategies, and their rationale. We conducted a review of the pediatric pancreatitis literature with respect to the following risk factors: hyperlipidemia, hypercalcemia, chronic renal failure, smoking exposure, alcohol, and medications. Areas of additional research were identified. Hypertriglyceridemia of 1000 mg/dL or greater poses an absolute risk for pancreatitis; persistent elevations of calcium are predisposing. Further research is necessary to determine whether end-stage renal disease leads to increased pancreatitis in children similar to adults. It is unknown whether cigarette smoking exposure, which clearly increases risk in adults, also increases risk in children. The role of alcohol in pediatric pancreatitis, whether direct or modifying, needs to be elucidated. The evidence supporting most cases of medication-induced pancreatitis is poor. Drug structure, improper handling of drug by host, and bystander status may be implicated. Other pancreatitis risk factors must be sought in all cases. The quality of evidence supporting causative role of various toxic and metabolic factors in pediatric pancreatitis is variable. Careful phenotyping is essential, including search for other etiologic risk factors. Directed therapy includes correction/removal of any agent identified, and general supportive measures. Further research is necessary to improve our understanding of these pancreatitis risk factors in children.

Background: Owing to the lack of data, we aimed to determine the etiology and outcome of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in children in Southeast Asia. Methods: This retrospective study was conducted at a university hospital in Bangkok, Thailand. We included patients aged <18 years who were diagnosed with pancreatitis from 2000 to 2021. Results: Among 155 patients with pancreatitis, 21 (13.5%) were diagnosed with either ARP (n = 7) or CP (n = 14). Clinical manifestations of CP included chronic abdominal pain (n = 10, 71.4%), steatorrhea (n = 8, 57.1%), and diabetes mellitus (n = 1, 7.1%). Positive radiological findings compatible with CP were detected from an abdominal ultrasound, computed tomography, magnetic resonance cholangiopancreatography in 70%, 90.9%, and 92.9% of patients, respectively. Genetic, metabolic, and pancreaticobiliary causes were the major causes of ARP/CP (23.8% each) and the etiologies were unidentified in one-fifth of the patients. Patients with metabolic diseases who had AP were at-risk of developing ARP (hazards ratio [HR], 4.7, 95% confidence interval [CI]: 1.5–13.9). Children with ARP or CP were younger than those with AP (P = 0.04). Approximately two-thirds of patients with CP had growth faltering and they had more episodes of hospitalization due to acute attacks when compared to patients with ARP ( 4 [interquartile range [IQR], 3–6] vs. 3 [IQR, 2–3]; P = 0.02). Conclusion: Genetic, metabolic, and pancreaticobiliary diseases were the common etiologies of ARP and CP among children living in a developing country in Southeast Asia. The burden of CP included malnutrition and frequent hospitalization. The findings emphasize the importance of an early etiological diagnosis and monitoring for pancreatic insufficiency in ARP/CP. [ABSTRACT FROM AUTHOR]

Objective: It was aimed to evaluate the etiology, clinical, laboratory and imaging findings and treatment methods of patients who have admitted with acute pancreatitis (AP) and progressed to chronic pancreatitis (CP) with ARP (acute recurrent pancreatitis). Methods: The data of children under the age of 18 years who were admitted to our hospital between January 2013-July 2020 and were diagnosed with acute, acute recurrent or chronic pancreatitis according to INSPPIRE diagnostic criteria were evaluated retrospectively. Results: There were 77 patients who were followed-up with the diagnosis of acute pancreatitis. Pancreatitis attack did not recur in 53/77 patients and no underlying cause was found in 35.84% (19/53) of the patients. The most common factor in those whose cause could be determined was gallstones (15.1%) (8/53). The pancreatitis attack recurred in 24 (31%) of the patients. Congenital anomalies (9/24) and hereditary pancreatitis (5/24) were the most common causes of pancreatitis in these patients and these factors were a risk factor for the recurrence of pancreatitis attack. There was no difference between the groups in terms of complications (p=0.423); however, chronicity was more common in the group with ARP (p=0.003). Conclusion: Beside the pancreatitis is a rare disease in childhood, with the increase of awareness and increased accessibility to diagnostic imaging methods, more and more pancreatitis is diagnosed day by day. Idiopathic acute pancreatitis cases still constitute the largest group. If other causes are excluded in these cases, it is important to investigate congenital anomalies, genetic and metabolic etiologies. [ABSTRACT FROM AUTHOR]

Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Retrospective study that include the patients admitted to hospital with diagnosis of acute pancreatitis, with at least one episode of acute pancreatitis in medical history, in General Surgery Clinic of the Bucharest Emergency Clinical Hospital during January 2016 – December 2018. From the total of 77 patients admitted to hospital with diagnosis of acute pancreatitis, with at least one episode of acute pancreatitis in medical history, from a ethiological point of view of the acute episode, dietary excces was found in 57% of cases, 30% being chronic consumers ethanol, 14% of patients were obese, 22% had diabetes (half of them with poor blood glucose control), 8% had severe complications during hospitalization, 5% requiring surgery. The mortality rate among patients with acute recurrent pancreatitis was 2.6%. In the study group, recurrent episodes of pancreatitis were more frequent in males (74%), especially associated with obesity and alcohol consumption. The success rate of conservative treatment was 95%, even in the presence of episodes of acute pancreatitis and comorbidities. Acute recurrent pancreatitis is a disease that affects decades of age 50-60 years. It mainly targets male patients in the context of obesity and alcohol consumption. Patients who had diabetes mellitus with poor control had a poor development. The main treatment remains conservative, with a positive response for 95%, of the patients included in the study.

Amaç: Bu çalışmada; akut pankreatit, akut tekrarlayan pankreatit ve kronik pankreatit tanısı ile izlenen çocukların klinik, laboratuvar ve etiyolojik farklılıklarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Ocak 2009 - Eylül 2018 tarihleri arasında pankreatit tanısı ile izlenen çocuklar geriye dönük olarak değerlendirilmiştir. Akut tekrarlayan pankreatit; ataklar arasında tüm bulguların tamamen normale döndüğü 2 veya daha fazla atak olarak tanımlanmıştır. Kronik pankreatit ise; tipik karın ağrısı ile birlikte görüntülemede karakteristik bulguların varlığı veya ekzokrin veya endokrin pankreas yetmezliği ile birlikte görüntülemede karakteristik bulgular ile koyulmuştur. Akut pankreatit (grup 1) ve akut tekrarlayan ve kronik pankreatit (grup 2) grupları arasında etiyoloji, demografik özellikler, laboratuvar ve radyolojik bulgular karşılaştırılmıştır.Bulgular: Akut pankreatit grubunda (grup 1) 21 hasta (%38,2) mevcuttur. Grup 2; akut tekrarlayan pankreatit tanısı alan 27 olgu ve kronik pankreatit tanısı ile izlenen 7 olgu içermektedir [toplam 34 olgu (%61,8)] . Pankreatitin sık görülen nedenleri grup 1’de idiyopatik (%61,9) ve ilaçlar (%19); grup 2’de ise idiyopatik (%47), herediter pankreatit (%17,6), pankreatikobiliyer bileşim anomalisi (%14,7) ve pankreatik kanalın konjenital anomalileridir (%8,8). Grup 2’deki gamma-glutamil transferaz yüksekliği dışında, iki grup arasında demografik, klinik ve laboratuvar bulguları açısından istatiksel bir fark bulunmamıştır.Sonuç: Çalışmamızda tüm gruplarda çoğunlukla pankreatitin nedeni tanımlanamamıştır yani idiyopatiktir. Akut pankreatit olgularında nedenler arasında ikinci sırada ilaçlar yer alırken, akut tekrarlayan pankreatit ve kronik pankreatitte sık görülen diğer nedenler pankreatikobiliyer bileşim anomalileri ve herediter nedenlerdir.

Background: The diagnosis of pediatric pancreatitis has been increasing over the last 20 years. We aimed to compare the clinical characteristics for pediatric acute pancreatitis (AP) with adult AP, and investigate the risk factor for acute recurrent pancreatitis (ARP) in children.Method: From June 2013 to June 2019, a total of 130 pediatric patients with AP at the inpatient database were enrolled. Univariate analysis and multivariate Cox regression analysis were performed to identify the risk factors for ARP in children.Result: Major etiologic factors in 130 patients were biliary (31.5%), idiopathic (28.5%). The etiology of pancreatitis in children was markedly different from that in adults (p < 0.001). Compared with the adult patients, the pediatric patients had significantly lower severity (p = 0.018) and occurrence rate of pancreatic necrosis (p = 0.041), SIRS (p = 0.021), acute peripancreatic fluid collection (p = 0.014). Univariate and Multivariate Cox regression analysis showed that female (p = 0.020; OR 3.821; 95% CI 1.231-11.861), hypertriglyceridemia (p = 0.045; OR 3.111; 95% CI 1.024-9.447), pancreatic necrosis (p = 0.023; OR 5.768; 95% CI 1.278-26.034) were the independent risk factors of ARP. Hypertriglyceridemia AP had the highest risk of recurrence compared to other etiology (p = 0.035).Conclusion: Biliary and idiopathic disease were the major etiologies of AP in children. Children have simpler conditions than adults. Female, hypertriglyceridemia, and pancreatic necrosis were associated with the onset of ARP. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Pancreatitis (CP) is a progressive inflammatory disorder characterised by recurrent episodes of severe abdominal pain. Experimental studies demonstrated protective effects of statins in pancreatic fibrosis. Aim: To assess impact of simvastatin therapy on the severity of pain in patients with idiopathic CP or recurrent acute pancreatitis. Materials and Methods: This prospective, single centre and open-label study included patients with idiopathic CP and recurrent acute pancreatitis, depending upon inclusion and exclusion criteria. Patients were treated with either simvastatin (40 mg per day) (Group-A; n=25) or standard therapy (protonpump inhibitor and antioxidant therapy) (Group-B; n=25). Severity of the pain was assessed using a Visual Analogue Score (VAS) at the start of treatment and at 12-month of treatment. Results: Between June 2017 and August 2017, a total of 50 patients, age ranging from 18 years to 54 years, were included in the study. The study population predominantly included male patients (n=38). The intensity of pain in patients of Group-A reduced significantly (p=0.0001) from 8 (range 6-10) at baseline to 2 (range 0-9) after 12 months of the treatment. There was significant reduction in the intensity of pain in Group-B also {7 (range 6-10) at baseline vs. 5 (range 0-7); p=0.0001}. However, the reduction of VAS score was significantly higher in Group-A as compared to Group-B at 12-month follow-up {6 (range-1-8) vs. 3 (range 0-6); p=0.032}. Conclusion: Simvastatin treatment improved severity of pain in patients with CP or recurrent acute pancreatitis at 12-month follow-up. However, large randomised trials are needed to replicate these findings.

Background: Acute pancreatitis may increase the risk of pancreatic cancer, although this association remains unclear. Therefore, we aimed to investigate this association., Methods: We retrospectively analyzed the 2002-2019 Korean National Health Insurance Service-National Sample Cohort using 1:3 propensity score matching for sex and age (acute pancreatitis, n = 4,494; matched controls, n = 13,482). We calculated the hazard ratio (HR) for pancreatic cancer risk in patients with acute pancreatitis using Cox proportional hazards regression., Results: Acute pancreatitis was significantly associated with an increased risk of pancreatic cancer throughout the study period (adjusted HR, 7.56 [95% confidence interval, 5.00-11.41]), which persisted for 2, 2-5, and > 5 years post-diagnosis (19.11 [9.60-38.05], 3.46 [1.35-8.33], and 2.73 [1.21-6.15], respectively). This pancreatitis-related pancreatic cancer risk became insignificant beyond 10 years of follow-up (1.24 [0.24-6.49]). Furthermore, this risk notably increased as the number of recurrent acute pancreatitis episodes increased (1 episode: 5.25 [3.31-8.33], 2 episodes: 11.35 [6.38-20.19], ≥ 3 episodes: 24.58 [13.66-44.26])., Conclusion: Following an acute pancreatitis diagnosis, the risk of pancreatic cancer increases significantly in the initial years, with a rapid increase further accentuated with recurrent acute pancreatitis episodes. Additional study is needed to evaluate whether this increased risk of carcinogenesis is attributed to accumulated inflammation., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

Pancreas divisum is the most common congenital variant of the pancreatic ductal system and a potential cause of acute recurrent pancreatitis. Here, we report a middle-aged woman with acute recurrent pancreatitis due to pancreas divisum. [ABSTRACT FROM AUTHOR]

Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Retrospective study that include the patients admitted to hospital with diagnosis of acute pancreatitis, with at least one episode of acute pancreatitis in medical history, in General Surgery Clinic of the Bucharest Emergency Clinical Hospital during January 2016 - December 2018. From the total of 77 patients admitted to hospital with diagnosis of acute pancreatitis, with at least one episode of acute pancreatitis in medical history, from a ethiological point of view of the acute episode, dietary excces was found in 57% of cases, 30% being chronic consumers ethanol, 14% of patients were obese, 22% had diabetes (half of them with poor blood glucose control), 8% had severe complications during hospitalization, 5% requiring surgery. The mortality rate among patients with acute recurrent pancreatitis was 2.6%. In the study group, recurrent episodes of pancreatitis were more frequent in males (74%), especially associated with obesity and alcohol consumption. The success rate of conservative treatment was 95%, even in the presence of episodes of acute pancreatitis and comorbidities. Acute recurrent pancreatitis is a disease that affects decades of age 50-60 years. It mainly targets male patients in the context of obesity and alcohol consumption. Patients who had diabetes mellitus with poor control had a poor development. The main treatment remains conservative, with a positive response for 95%, of the patients included in the study. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to describe the clinical, laboratory and etiologic differences between acute pancreatitis and acute recurrent and chronic pancreatitis in children. Materials and Methods: We retrospectively evaluated the children with pancreatitis who had been followed between January 2009 and September 2018. Acute recurrent pancreatitis was defined as 2 or more episodes of AP with a return to baseline in the intervals. Chronic pancreatitis was diagnosed in the presence of typical abdominal pain plus characteristic imaging findings or evidence of endocrine or exocrine pancreatic deficiency. The etiologies, demographic features, and laboratory and imaging findings were compared in children with acute pancreatitis (group 1) and acute recurrent and chronic pancreatitis (group 2). Results: Twenty-one patients (38.2%) were in acute pancreatitis group (group 1). Group 2 included 27 patients in acute recurrent pancreatitis and 7 patients in chronic pancreatitis [34 patients (61.8%)]. The most common etiologies were idiopathic (61.9%) and drugs (19%) in group 1; idiopathic (47%), hereditary pancreatitis (17.6%), pancreaticobiliary maljunction (14.7%), and congenital anomalies of the pancreatic duct (8.8%) in group 2. There was no statistical difference between the two groups regarding demographic, clinical and laboratory findings except higher gamma-glutamyl transferase in group 2. Conclusion: The etiology of pancreatitis in children was mostly idiopathic in two groups in our study. Drugs were the second common cause in acute pancreatitis whereas the other common causes were pancreaticobiliary maljunction and hereditary disorders in acute recurrent pancreatitis or chronic pancreatitis. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the long-term outcomes of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for pediatric patients with pancreas divisum (PD) presenting with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Between May 2008 and August 2017, pediatric patients with PD who received endotherapy at Ruijin Hospital were identified and grouped according to clinical presentation, namely ARP and CP. Primary success was defined as patients' improvement in symptoms after index ERCPs, without further intervention or any analgesic. A total of 74 ERCPs were performed in 38 pediatric patients. The frequency of at least 1 genetic mutation identified in patients with ARP and CP was 44.4% and 68.4%, respectively. Patients with CP required more ERCPs than those with ARP (2.4 ± 1.7 vs. 1.1 ± 0.4, P = 0.005). The incidence of post-ERCP complications was 14.9%, including pancreatitis of 13.5% and hemorrhage of 1.4%. During a median follow-up duration of 41 months (range, 12–123 months), the frequency of pancreatitis episodes decreased significantly from 2.31 to 0.45 (P < 0.0001). The 25% recurrence and reintervention rates were estimated at 25 and 48 months, respectively, without significant difference between patients with ARP or CP. There was a nonsignificant trend towards a higher rate of primary success in patients with ARP than those with CP (92.9% vs. 69.6%, P = 0.123). After further endotherapy, 91.3% patients with CP improved clinically. Therapeutic ERCP is an effective and safe intervention for pediatric patients with symptomatic PD. Patients presenting with CP seem to achieve improvement after additional ERCPs. [ABSTRACT FROM AUTHOR]

This paper reviews the current status of our understanding of the epidemiology, diagnosis, and management of the continuum of pancreatic diseases from acute and recurrent acute pancreatitis to chronic pancreatitis and the diseases that are often linked with pancreatitis including diabetes mellitus and pancreatic cancer. In addition to reviewing the current state of the field, we identify gaps in knowledge that are necessary to address to improve patient outcomes in these conditions. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Pancreatitis (CP) is a progressive inflammatory disorder characterised by recurrent episodes of severe abdominal pain. Experimental studies demonstrated protective effects of statins in pancreatic fibrosis. Aim: To assess impact of simvastatin therapy on the severity of pain in patients with idiopathic CP or recurrent acute pancreatitis. Materials and Methods: This prospective, single centre and open-label study included patients with idiopathic CP and recurrent acute pancreatitis, depending upon inclusion and exclusion criteria. Patients were treated with either simvastatin (40 mg per day) (Group-A; n=25) or standard therapy (protonpump inhibitor and antioxidant therapy) (Group-B; n=25). Severity of the pain was assessed using a Visual Analogue Score (VAS) at the start of treatment and at 12-month of treatment. Results: Between June 2017 and August 2017, a total of 50 patients, age ranging from 18 years to 54 years, were included in the study. The study population predominantly included male patients (n=38). The intensity of pain in patients of Group-A reduced significantly (p=0.0001) from 8 (range 6-10) at baseline to 2 (range 0-9) after 12 months of the treatment. There was significant reduction in the intensity of pain in Group-B also {7 (range 6-10) at baseline vs. 5 (range 0-7); p=0.0001}. However, the reduction of VAS score was significantly higher in Group-A as compared to Group-B at 12-month follow-up {6 (range-1-8) vs. 3 (range 0-6); p=0.032}. Conclusion: Simvastatin treatment improved severity of pain in patients with CP or recurrent acute pancreatitis at 12-month follow-up. However, large randomised trials are needed to replicate these findings. [ABSTRACT FROM AUTHOR]

Children with acute pancreatitis may experience abdominal pain; the causes of which include anatomical abnormalities and medications. The rare anatomical etiology of duodenal duplication cyst is typically asymptomatic and discovered incidentally. The authors present a unique case of a Whipple-operated duodenal duplication cyst., Case Presentation: The authors present the case of a 12-year-old Arab male who was admitted to our hospital with worsening, severe epigastric pain, stabbing in nature, and radiating to the back, suggestive of acute pancreatitis. Serum lipase levels were significantly elevated. The patient received appropriate care. His medical history is notable for multiple bouts of pancreatitis in the last 18 months. Previous investigations at other hospitals were mostly unrevealing. A more extensive workup was performed, revealing a duodenal cystic structure. This led to the diagnosis of a duodenal duplication cyst. The Whipple procedure was decided upon due to his recurrent pancreatitis, which caused fibrotic adhesions and anatomic region distortion. The patient underwent surgery and recovered uneventfully., Discussion: Acute pancreatitis in children is frequent and can be caused by unrecognized duodenal duplication cysts. When symptomatic, the majority present with vague abdominal pain. Despite using ultrasound as an adjunctive for diagnosis, the cyst might not become apparent until the condition has progressed to an advanced stage. A delayed diagnosis may result in complications necessitating risky surgeries., Conclusion: Children with recurrent pancreatitis should be evaluated for a duodenal duplication cyst. Early use of computed tomography scans may be necessary to identify the cause and spare the patient from risky procedures like Whipple surgery., Competing Interests: NA., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)