Pediatric Acute and Chronic Pancreatitis: Increase in Incidence or Increasing Awareness?

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To the Editor:
We read with interest the article by Poddar et al.1 Pancreatitis is an increasingly recognized, although still rare, pediatric disease. Traditionally, acute pancreatitis (AP) and chronic pancreatitis (CP) were described as separate entities. According to current knowledge, AP, acute recurrent pancreatitis, and CP are seen as a continuation of the disease process. Authors reported that a number of hospitalizations due to pancreatitis, especially AP, are increasing. Poddar et al1 observed a fivefold increase in the number of AP cases from 2003 to 2014. In the recent years, we observed an increase in the number of children with AP and CP in our hospital and in the other pediatric centers in the world.2,3 The etiology of pediatric AP and CP is varied and includes gene mutations, anatomic anomalies, metabolic disorders, and others.2–7 The Children's Memorial Health Institute in Warsaw, a leading national pancreatic center, admits the majority of Polish children with CP. Our group of children with CP (340 patients) is one of the largest single-center cohorts in the world. According to article aims, we reviewed our database of children with AP and CP, with particular attention to the increase in the incidence of childhood pancreatitis. Since 1988 to 2016, 340 children with CP were hospitalized. For 29 years, we observed a statistically significant increase (15-fold; R2 = 0.73; P < 0.05) in the number of newly diagnosed children with CP [from 12 CP patients in the first decade (1988–1997) to 184 children with CP in the last decade (2008–2016)]. Since 2001 to 2015, 401 children with AP were hospitalized. For 15 years, we observed a statistically significant increase (2.7-fold; R2 = 0.59; P < 0.05) in the number of newly diagnosed children with AP [from 79 AP patients in 2000–2005 to 214 children with AP in the last 5 years (2005–2015)]. The number of hospitalizations due to AP and CP per year is shown in Figure 1. Our results are strongly consistent with those of Poddar et al1 and recent literature data, demonstrating a significant increase in the number of hospital visits because of pancreatitis in children.2,3,5,7 Because recurrent abdominal pain is relatively frequent in children, the diagnosis of AP and CP may be delayed. Because of the infrequent occurrence of pancreatitis in childhood, the clinician may be unfamiliar with optimal diagnostic and management strategies. It is not clear whether the significant difference in the number of newly diagnosed children with AP and CP during the last decades may be due to the increasing awareness of pediatricians concerning the disease, increase in the incidence of the disease, and better quality and reliability of the collected data in children, or possibly a combination of all. In our opinion, the increased number of children with pancreatitis is a result of increasing awareness of the pediatrician, which we can observe in Poland. Serum amylase and lipase are today one of the most common diagnostic tests of abdominal pain in Polish children.
The high prevalence of idiopathic pancreatitis in Indian children is related to the lack of genetic testing; therefore, conclusions that children with idiopathic etiology are significantly associated with disease progression of AP to CP are misinterpretations.1 The overall incidence of gene mutations observed among our patients was 48.8%.2 In available literature, we can find values ranging from 30% to 80%.2,6,8 Assuming the constant dynamic development of genetics and molecular techniques, the incidence of idiopathic pancreatitis will probably gradually decrease. For that reason, Poddar et al1 must perform genetic evaluation before suggesting this thesis.

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