While anyone who follows this blog knows that I like acronyms, I must say that many investigators have taken lessons from Krispy Kreme on spelling.  INSPPIRE is named for the International Study Group of Pediatric Pancreatitis: In Search for a Cure.  A study from this group reports on definitions of pediatric pancreatitis & surveys current practice (JPGN 2012; 55: 261-65).

The literature regarding acute recurrent pancreatitis and chronic pancreatitis in children is limited.  This consortium hopes to change this.  As a start, the authors assigned subcommittees to establish definitions, reviewed the literature, and assessed current practice.

Definitions:

• Acute pancreatitis (AP): requires at least 2 of 3 criteria:

1. Abdominal pain consistent with AP
2. Serum amylase and/or lipase activity at least 3 times ULN
3. Imaging findings compatible with AP

• Acute recurrent pancreatitis (ARP): requires at least two episodes of AP along with

Complete resolution of pain (≥ 1-month pain-free interval) OR complete normalization of pancreatic enzyme levels along with resolution of pain (can be shorter interval than 1 month)

• Chronic pancreatitis (CP): requires one of the following:

1. Abdominal pain and imaging suggestive of chronic pancreatic damage
2. Exocrine pancreatic insufficiency and imaging suggestive of chronic pancreatic damage
3. Endocrine  pancreatic insufficiency and imaging suggestive of chronic pancreatic damage
4. Surgical/histologic specimen consistent with chronic pancreatitis

Managing pancreatitis:

Typical tests for these three conditions are shown in figure 2 and vary widely.  For AP, most respondents (63%) routinely checked liver enzymes, triglycerides, calcium and abdominal ultrasound.  For ARP and CP, most respondents (69%) obtained additional imaging modalities (eg. MRCP), genetic testing, and sweat chloride. If ERCP was needed, 88% of practices relied on adult gastroenterology colleagues.

Related blog posts:

Recurrent pancreatitis and genetic underpinnings | gutsandgrowth

Does pancreas divisum cause pancreatitis? | gutsandgrowth

How helpful are antioxidants for chronic pancreatitis pain …