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Incomplete functional and morphological recovery after acute and acute recurrent pancreatitis in children
Author(s) -
Puttaiah Kadyada Srikanth,
Thapa Babu Ram,
Kaushal Karanvir,
Walia Rama,
Rana S V,
Dhaka Narendra,
Lal Sadhna B,
Prasad Rajendra,
Das Subhamoy,
Thakur Rajini,
Kamal Kishore
Publication year - 2019
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14288
Subject(s) - medicine , acute pancreatitis , pancreatitis , intensive care medicine
Abstract Background and Aim There is lack of data on functional and morphological recovery after an attack of acute pancreatitis (AP) or acute recurrent pancreatitis (ARP) in children. This study aims to evaluate the functional impairment and morphological changes in the pancreas after recovery. Methods All consecutive patients presenting with AP ( n = 61) or ARP ( n = 35), as per standard diagnostic criteria, were enrolled. After 2 months of pancreatitis, fecal elastase‐1 (FE‐1) (μg/g) and 2‐h oral glucose tolerance test to calculate oral disposition index (DI o ) (mmol/L) (β‐cell function) were performed. Morphological changes were assessed by endoscopic ultrasound and transabdominal ultrasound. Patients with chronic pancreatitis (CP) ( n = 27) and healthy children (HC) ( n = 26) were included as controls for functional parameters. Results At a median follow up of 12 (4–44) and 11 (2–108) months, 66.7% and 75.9% ( P = 0.57) of AP and ARP demonstrated exocrine insufficiency (FE‐1 < 200), respectively. Mean (SD) FE‐1 was 183.64 ± 150.94 (AP), 135.70 ± 103.80 (ARP), 46.56 ± 30.20 (CP), and 240.00 ± 181.83 (HC) ( P < 0.001; anova ) (AP vs CP, ARP vs CP, and CP vs HC; P < 0.001). Prediabetes due to insulin resistance was seen in 16.6% and 22.6% ( P = 0.56) of AP and ARP. Median (interquartile range) DI o (mmol/L) was comparable between AP (4.20 [2.36, 8.3]) and HC (5.20 [2.89, 8.68]), but was low in ARP (2.97 [1.80, 5.12]), which was comparable with CP (1.91 [1.20, 2.83]). Endoscopic ultrasound demonstrated morphological changes in 25% and 37% ( P = 0.34) of AP and ARP, respectively. Conclusion There was high frequency of biochemical evidence of exocrine insufficiency. β‐Cell function (DI o ) was preserved among AP but was poor in ARP. Nearly one‐third showed morphological changes in imaging.