Pancreatitis is an inflammation of the pancreas, an organ located behind the stomach. Although relatively rare, pancreatitis in children is more common than was previously thought, and it can progress in a surprisingly short timeframe.
The pancreas performs many important functions, including the secretion of insulin and other key hormones, as well as production of a fluid containing precursor forms of enzymes and bicarbonate that flows through ducts into the intestine, where the enzymes become activated and aid digestion of food. In pancreatitis, the digestive enzymes become activated too early—while still inside the pancreas. This causes inflammation and damage to the organ, leading to the symptoms of pancreatitis— the main one being abdominal pain that is often severe, as well as nausea and vomiting.
The disease can occur in three forms: acute, acute recurrent (two or more acute episodes), and chronic. Acute pancreatitis can progress to the chronic form, which carries with it an increased risk of pancreatic cancer. Once considered an uncommon disease in children, the incidence of pediatric acute pancreatitis has increased over the last 10 to 20 years and currently affects approximately 1 in 10,000 children. Chronic pediatric pancreatitis, in which children have diagnostic or functional evidence of irreversible pancreatic damage, is estimated to have an incidence of approximately 2 per 100,000 children per year.
Both acute recurrent and chronic forms of pediatric pancreatitis place a significant burden on children and their caregivers. Risk factors for pancreatitis differ for children compared to adults. In children, the main risk factors are inherited genetic variants, followed next by obstructed ducts caused by congenital abnormalities or gallstones. In adults, risk factors include genetics and gallstones, but environmental factors such as alcohol and tobacco use are the most predominant. Although diabetes is another risk factor for pancreatitis, it is not as common in children as adults. An insufficient production of pancreatic enzymes is found in both children and adults with pancreatitis.
Emergency room visits and hospitalizations are common in children and adults with the disease, as are missed days of school or work. Pain, whether it comes in discrete episodes or is constant, is frequently difficult to treat, leading to lost school time for children and increased utilization of health care and high medical costs. There are currently no drugs that effectively halt the progression of this potentially debilitating disease or that reverse the disease process.
Treatment options to manage the severe, often unremitting pain typically accompanying chronic pancreatitis include opioids, which carry the risk of addiction. If traditional pain management fails, a child with pancreatitis may need a surgical palled a total pancreatectomy-islet autotransplantation (TP-IAT), in which the pancreas is surgically removed and its insulin-producing islet cells, which regulate blood glucose (sugar), are collected and infused into the liver, where the cells implant and function.