Pancreas Divisum in Pediatric Acute Recurrent and Chronic Pancreatitis: Report from INSPPIRE

Tom K. Lin, Maisam Abu-El-Haija, Jaimie D. Nathan, Joseph P. Palermo, Bradley Barth, Melena Bellin, Douglas S. Fishman, Steven D. Freedman, Cheryl E. Gariepy, Matthew J. Giefer, Tanja Gonska, Melvin B. Heyman, Ryan Himes, Sohail Z. Husain, Quin Liu, Asim Maqbool, Maria Mascarenhas, Brian McFerron, Veronique D. Morinville, Chee Y. Ooi & 11 others Emily Perito, John F. Pohl, Sue Rhee, Sarah Jane Schwarzenberg, Uzma Shah, David Troendle, Steven L. Werlin, Michael Wilschanski, M. Bridget Zimmerman, Mark E. Lowe, Aliye Uc

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Abstract

Introduction:The significance of pancreas divisum (PD) as a risk factor for pancreatitis is controversial. We analyzed the characteristics of children with PD associated with acute recurrent or chronic pancreatitis to better understand its impact.Patients and Methods:We compared children with or without PD in the well-phenotyped INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) cohort. Differences were analyzed using 2-sample t test or Wilcoxon rank sum test for continuous variables, Pearson χ2 or Fisher exact test for categorical variables.Results:PD was found in 52 of 359 (14.5%) subjects, a higher prevalence than the general population (∼7%). Females more commonly had PD (71% vs. 55%; P=0.02). Children with PD did not have a higher incidence of mutations in SPINK1, CFTR, CTRC compared with children with no PD. Children with PD were less likely to have PRSS1 mutations (10% vs. 34%; P<0.01) or a family history of pancreatitis (P<0.05), and more likely to have hypertriglyceridemia (11% vs. 3%; P=0.03). Children with PD underwent significantly more endoscopic procedures and pancreatic sphincterotomy. Patients with PD had fewer attacks of acute pancreatitis (P=0.03) and were less likely to develop exocrine pancreatic insufficiency (P=0.01). Therapeutic endoscopic retrograde cholangiopancreatography was considered most helpful if pancreatic duct was impacted with stones (83% helpful).Conclusions:PD is likely a risk factor for acute recurrent pancreatitis and chronic pancreatitis in children that appears to act independently of genetic risk factors. Patients with PD and stones obstructing the pancreatic duct benefit most from therapeutic endoscopic retrograde cholangiopancreatography.

Original languageEnglish (US)
Pages (from-to)E232-E238
JournalJournal of clinical gastroenterology
Volume53
Issue number6
DOIs
StatePublished - Jul 1 2019

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Chronic Pancreatitis
Pancreas
Pediatrics
Pancreatitis
Endoscopic Retrograde Cholangiopancreatography
Pancreatic Ducts
Nonparametric Statistics
Exocrine Pancreatic Insufficiency
Mutation
Hypertriglyceridemia

Keywords

  • ERCP
  • MRCP
  • children
  • endoscopy
  • pancreatitis

Cite this

Pancreas Divisum in Pediatric Acute Recurrent and Chronic Pancreatitis : Report from INSPPIRE. / Lin, Tom K.; Abu-El-Haija, Maisam; Nathan, Jaimie D.; Palermo, Joseph P.; Barth, Bradley; Bellin, Melena; Fishman, Douglas S.; Freedman, Steven D.; Gariepy, Cheryl E.; Giefer, Matthew J.; Gonska, Tanja; Heyman, Melvin B.; Himes, Ryan; Husain, Sohail Z.; Liu, Quin; Maqbool, Asim; Mascarenhas, Maria; McFerron, Brian; Morinville, Veronique D.; Ooi, Chee Y.; Perito, Emily; Pohl, John F.; Rhee, Sue; Schwarzenberg, Sarah Jane; Shah, Uzma; Troendle, David; Werlin, Steven L.; Wilschanski, Michael; Zimmerman, M. Bridget; Lowe, Mark E.; Uc, Aliye.

In: Journal of clinical gastroenterology, Vol. 53, No. 6, 01.07.2019, p. E232-E238.

Research output: Contribution to journalArticle

Lin, TK, Abu-El-Haija, M, Nathan, JD, Palermo, JP, Barth, B, Bellin, M, Fishman, DS, Freedman, SD, Gariepy, CE, Giefer, MJ, Gonska, T, Heyman, MB, Himes, R, Husain, SZ, Liu, Q, Maqbool, A, Mascarenhas, M, McFerron, B, Morinville, VD, Ooi, CY, Perito, E, Pohl, JF, Rhee, S, Schwarzenberg, SJ, Shah, U, Troendle, D, Werlin, SL, Wilschanski, M, Zimmerman, MB, Lowe, ME & Uc, A 2019, 'Pancreas Divisum in Pediatric Acute Recurrent and Chronic Pancreatitis: Report from INSPPIRE' Journal of clinical gastroenterology, vol. 53, no. 6, pp. E232-E238. https://doi.org/10.1097/MCG.0000000000001063
Lin, Tom K. ; Abu-El-Haija, Maisam ; Nathan, Jaimie D. ; Palermo, Joseph P. ; Barth, Bradley ; Bellin, Melena ; Fishman, Douglas S. ; Freedman, Steven D. ; Gariepy, Cheryl E. ; Giefer, Matthew J. ; Gonska, Tanja ; Heyman, Melvin B. ; Himes, Ryan ; Husain, Sohail Z. ; Liu, Quin ; Maqbool, Asim ; Mascarenhas, Maria ; McFerron, Brian ; Morinville, Veronique D. ; Ooi, Chee Y. ; Perito, Emily ; Pohl, John F. ; Rhee, Sue ; Schwarzenberg, Sarah Jane ; Shah, Uzma ; Troendle, David ; Werlin, Steven L. ; Wilschanski, Michael ; Zimmerman, M. Bridget ; Lowe, Mark E. ; Uc, Aliye. / Pancreas Divisum in Pediatric Acute Recurrent and Chronic Pancreatitis : Report from INSPPIRE. In: Journal of clinical gastroenterology. 2019 ; Vol. 53, No. 6. pp. E232-E238.
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abstract = "Introduction:The significance of pancreas divisum (PD) as a risk factor for pancreatitis is controversial. We analyzed the characteristics of children with PD associated with acute recurrent or chronic pancreatitis to better understand its impact.Patients and Methods:We compared children with or without PD in the well-phenotyped INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) cohort. Differences were analyzed using 2-sample t test or Wilcoxon rank sum test for continuous variables, Pearson χ2 or Fisher exact test for categorical variables.Results:PD was found in 52 of 359 (14.5{\%}) subjects, a higher prevalence than the general population (∼7{\%}). Females more commonly had PD (71{\%} vs. 55{\%}; P=0.02). Children with PD did not have a higher incidence of mutations in SPINK1, CFTR, CTRC compared with children with no PD. Children with PD were less likely to have PRSS1 mutations (10{\%} vs. 34{\%}; P<0.01) or a family history of pancreatitis (P<0.05), and more likely to have hypertriglyceridemia (11{\%} vs. 3{\%}; P=0.03). Children with PD underwent significantly more endoscopic procedures and pancreatic sphincterotomy. Patients with PD had fewer attacks of acute pancreatitis (P=0.03) and were less likely to develop exocrine pancreatic insufficiency (P=0.01). Therapeutic endoscopic retrograde cholangiopancreatography was considered most helpful if pancreatic duct was impacted with stones (83{\%} helpful).Conclusions:PD is likely a risk factor for acute recurrent pancreatitis and chronic pancreatitis in children that appears to act independently of genetic risk factors. Patients with PD and stones obstructing the pancreatic duct benefit most from therapeutic endoscopic retrograde cholangiopancreatography.",
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author = "Lin, {Tom K.} and Maisam Abu-El-Haija and Nathan, {Jaimie D.} and Palermo, {Joseph P.} and Bradley Barth and Melena Bellin and Fishman, {Douglas S.} and Freedman, {Steven D.} and Gariepy, {Cheryl E.} and Giefer, {Matthew J.} and Tanja Gonska and Heyman, {Melvin B.} and Ryan Himes and Husain, {Sohail Z.} and Quin Liu and Asim Maqbool and Maria Mascarenhas and Brian McFerron and Morinville, {Veronique D.} and Ooi, {Chee Y.} and Emily Perito and Pohl, {John F.} and Sue Rhee and Schwarzenberg, {Sarah Jane} and Uzma Shah and David Troendle and Werlin, {Steven L.} and Michael Wilschanski and Zimmerman, {M. Bridget} and Lowe, {Mark E.} and Aliye Uc",
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T1 - Pancreas Divisum in Pediatric Acute Recurrent and Chronic Pancreatitis

T2 - Report from INSPPIRE

AU - Lin, Tom K.

AU - Abu-El-Haija, Maisam

AU - Nathan, Jaimie D.

AU - Palermo, Joseph P.

AU - Barth, Bradley

AU - Bellin, Melena

AU - Fishman, Douglas S.

AU - Freedman, Steven D.

AU - Gariepy, Cheryl E.

AU - Giefer, Matthew J.

AU - Gonska, Tanja

AU - Heyman, Melvin B.

AU - Himes, Ryan

AU - Husain, Sohail Z.

AU - Liu, Quin

AU - Maqbool, Asim

AU - Mascarenhas, Maria

AU - McFerron, Brian

AU - Morinville, Veronique D.

AU - Ooi, Chee Y.

AU - Perito, Emily

AU - Pohl, John F.

AU - Rhee, Sue

AU - Schwarzenberg, Sarah Jane

AU - Shah, Uzma

AU - Troendle, David

AU - Werlin, Steven L.

AU - Wilschanski, Michael

AU - Zimmerman, M. Bridget

AU - Lowe, Mark E.

AU - Uc, Aliye

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Introduction:The significance of pancreas divisum (PD) as a risk factor for pancreatitis is controversial. We analyzed the characteristics of children with PD associated with acute recurrent or chronic pancreatitis to better understand its impact.Patients and Methods:We compared children with or without PD in the well-phenotyped INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) cohort. Differences were analyzed using 2-sample t test or Wilcoxon rank sum test for continuous variables, Pearson χ2 or Fisher exact test for categorical variables.Results:PD was found in 52 of 359 (14.5%) subjects, a higher prevalence than the general population (∼7%). Females more commonly had PD (71% vs. 55%; P=0.02). Children with PD did not have a higher incidence of mutations in SPINK1, CFTR, CTRC compared with children with no PD. Children with PD were less likely to have PRSS1 mutations (10% vs. 34%; P<0.01) or a family history of pancreatitis (P<0.05), and more likely to have hypertriglyceridemia (11% vs. 3%; P=0.03). Children with PD underwent significantly more endoscopic procedures and pancreatic sphincterotomy. Patients with PD had fewer attacks of acute pancreatitis (P=0.03) and were less likely to develop exocrine pancreatic insufficiency (P=0.01). Therapeutic endoscopic retrograde cholangiopancreatography was considered most helpful if pancreatic duct was impacted with stones (83% helpful).Conclusions:PD is likely a risk factor for acute recurrent pancreatitis and chronic pancreatitis in children that appears to act independently of genetic risk factors. Patients with PD and stones obstructing the pancreatic duct benefit most from therapeutic endoscopic retrograde cholangiopancreatography.

AB - Introduction:The significance of pancreas divisum (PD) as a risk factor for pancreatitis is controversial. We analyzed the characteristics of children with PD associated with acute recurrent or chronic pancreatitis to better understand its impact.Patients and Methods:We compared children with or without PD in the well-phenotyped INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) cohort. Differences were analyzed using 2-sample t test or Wilcoxon rank sum test for continuous variables, Pearson χ2 or Fisher exact test for categorical variables.Results:PD was found in 52 of 359 (14.5%) subjects, a higher prevalence than the general population (∼7%). Females more commonly had PD (71% vs. 55%; P=0.02). Children with PD did not have a higher incidence of mutations in SPINK1, CFTR, CTRC compared with children with no PD. Children with PD were less likely to have PRSS1 mutations (10% vs. 34%; P<0.01) or a family history of pancreatitis (P<0.05), and more likely to have hypertriglyceridemia (11% vs. 3%; P=0.03). Children with PD underwent significantly more endoscopic procedures and pancreatic sphincterotomy. Patients with PD had fewer attacks of acute pancreatitis (P=0.03) and were less likely to develop exocrine pancreatic insufficiency (P=0.01). Therapeutic endoscopic retrograde cholangiopancreatography was considered most helpful if pancreatic duct was impacted with stones (83% helpful).Conclusions:PD is likely a risk factor for acute recurrent pancreatitis and chronic pancreatitis in children that appears to act independently of genetic risk factors. Patients with PD and stones obstructing the pancreatic duct benefit most from therapeutic endoscopic retrograde cholangiopancreatography.

KW - ERCP

KW - MRCP

KW - children

KW - endoscopy

KW - pancreatitis

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