# Clinical Spectrum and Management of Paediatric Chronic Pancreatitis

## TL;DR

This study examines the clinical features and treatment of chronic pancreatitis in children, emphasizing the need for early diagnosis and a multidisciplinary approach for better outcomes.

## Contribution

The study provides insights into the clinical spectrum and management strategies for paediatric chronic pancreatitis in a resource-limited setting.

## Key findings

- Epigastric pain was reported in all patients, with idiopathic causes in 71.4% of cases.
- Medical management was the initial treatment, but 47.6% required surgical intervention for persistent symptoms.
- Parental consanguinity was present in 85.7% of cases, suggesting a possible genetic component.

## Abstract

Objective

Chronic pancreatitis is a long-standing inflammatory condition of the pancreas that leads to progressive damage and impaired pancreatic function, resulting in various complications. Although historically considered uncommon in children, its incidence is increasing. This study aimed to describe the clinical spectrum, diagnostic findings, and management approaches of paediatric chronic pancreatitis and the importance of multidisciplinary team management to optimise patients in a tertiary care setting.

Method

This retrospective observational cohort study was conducted in the Department of Paediatric Gastroenterology and Hepatology at the Pakistan Kidney and Liver Institute and Research Centre (PKLI&RC), Lahore. Medical records of children diagnosed with chronic pancreatitis between September 2021 and September 2023 were reviewed. Demographic characteristics, clinical presentation, laboratory findings, imaging results, and treatment modalities were analysed using SPSS (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY).

Results

A total of 23 children met the inclusion criteria; two were lost to follow-up, leaving 21 patients for analysis. There were 11 males and 10 females, and the mean age of the children was 10.52 years. In terms of residence, the largest proportion (57.2%) resided in Punjab. Epigastric pain was reported in all patients. Parental consanguinity was present in 85.7% of cases, and the aetiology was idiopathic in 71.4%. Pancreatic amylase was elevated in the majority of patients (90.5%), and lipase levels were raised in 81.0% of cases. The CT scan findings varied, with 38.1% of patients exhibiting a moderately dilated pancreatic duct. Magnetic resonance cholangiopancreatography (MRCP) findings revealed minimal prominence of the pancreatic duct in 42.9% of cases. Endoscopic retrograde cholangiopancreatography-guided stent placement was required in 23.8% of patients. Medical management was the initial treatment approach, while 47.6% of patients required surgical intervention for persistent or refractory symptoms.

Conclusion

Early diagnosis of paediatric chronic pancreatitis by clinical assessment, biochemical and genetic testing, and radiological evaluation is essential for effective management. While medical therapy is the keystone of initial treatment, endoscopic and surgical interventions play an important role in selected patients with refractory symptoms. A tailored, multidisciplinary approach is especially crucial in resource-limited settings to improve patient outcomes.