Rapid Progression of Acute Pancreatitis to Acute Recurrent Pancreatitis in Children

Objective: Research is lacking on the natural history of acute pancreatitis (AP) progression to acute recurrent pancreatitis (ARP). The aim of this project was to study the progression from AP to ARP among pediatric patients with pancreatitis to better understand the presentation and natural history of pancreatitis. Methods: Patients presenting with AP were included in a prospective database in Research Electronic Data Capture. We enrolled 115 AP patients from March 2013 – November 2016. Physicians completed surveys regarding clinical data for patients with first attack of AP. Patients were followed prospectively, with data on progression entered when patients presented with ARP. Results: The most common etiologies for the first attack of AP were idiopathic (31%), toxic/drug related (23%), and biliary/gallstone (18%). Twenty of the 115 patients (17%) developed ARP during the follow up period. Seventy percent (14/20) of ARP patients progressed from AP to ARP within 5 months from first diagnosis. A comparison of patients who rapidly progressed to ARP within 3 months (n = 12) to those followed for more than 3 months without progression in 3 months (n = 97) revealed associations with a higher weight percentile for age (p = 0.045), male gender (p = 0.03) and presence of pancreatic necrosis during first AP attack (p = 0.004). Progression to ARP significantly differed by etiology group with genetics having the highest risk for ARP progression over time and patients with gallstone/biliary, viral/systemic, and obstructive (non-gallstone) having the lowest risk for ARP progression over time (p = 0.02). Conclusions: Most patients who progressed from AP to ARP progressed within five months. The presence of a higher weight percentile for age, male gender and pancreatic necrosis during the first AP attack are associated with rapid progression to ARP. Address correspondence and reprint requests to Maisam Abu-El-Haija, MD, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039 (e-mail: Maisam.haija@cchmc.org). Received 15 March, 2018 Accepted 17 August, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Note: Katherine F. Sweeny, MD is now affiliated with the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts. Funding Source: No external funding for this manuscript Financial disclosure: All authors have indicated they have no financial relationships relevant to the article to disclose. Conflicts of interest: All authors have no potential conflicts of interest to disclose. Clinical Trial Registration: N/A. Contributors Statement: Dr. Sweeny: Assisted in data collection, drafted the initial manuscript and edited the final manuscript for submission. Dr. Lin, Dr. Nathan, Dr. Denson and Dr. Husain: assisted in conceptualization of study design, assisted in data collection, reviewed and revised the manuscript and approved the final manuscript once submitted. Ms. Hornung: assisted in development of the database survey, analyzed the data, assisted in drafting the initial manuscript and approved the final manuscript once submitted. Mr. Thompson: assisted in database design, assisted in data collection, reviewed and revised the manuscript and approved the final manuscript once submitted. Dr. Abu-El-Haija: conceptualized and designed the database, directed and assisted in data collection, drafted the initial manuscript and approved the final manuscript once submitted. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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