Toxic-metabolic risk factors in pediatric pancreatitis: Recommendations for diagnosis, management, and future research

Sohail Z. Husain, Veronique Morinville, John Pohl, Maisam Abu-El-Haija, Melena D. Bellin, Steve Freedman, Peter Hegyi, Melvin B. Heyman, Ryan Himes, Chee Y. Ooi, Sarah J. Schwarzenberg, Danielle Usatin, Aliye Uc

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)609-617
Number of pages9
JournalJournal of pediatric gastroenterology and nutrition
Issue number4
StatePublished - 2016

Bibliographical note

Funding Information:
This work was supported by the NIH (grant nos. DK096327, DK097820 to A.U.).

Publisher Copyright:
© 2016 by ESPGHAN and NASPGHAN.


  • Acute pancreatitis
  • Acute recurrent pancreatitis
  • Alcohol
  • Chronic pancreatitis
  • Chronic renal failure
  • Hypercalcemia
  • Hypertriglyceridemia
  • Medications
  • Smoking


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