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.
- Acute pancreatitis (AP): requires at least 2 of 3 criteria:
- Abdominal pain consistent with AP
- Serum amylase and/or lipase activity at least 3 times ULN
- 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:
- Abdominal pain and imaging suggestive of chronic pancreatic damage
- Exocrine pancreatic insufficiency and imaging suggestive of chronic pancreatic damage
- Endocrine pancreatic insufficiency and imaging suggestive of chronic pancreatic damage
- Surgical/histologic specimen consistent with chronic 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.
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