Causes and contributing risk factors for chronic pancreatitis in children and adolescents
- Sarah Jane Schwarzenberg, MD
Sarah Jane Schwarzenberg, MD
- Associate Professor of Pediatrics
- Director, Pediatric Gastroenterology, Hepatology and Nutrition
- University of Minnesota Masonic Children's Hospital
- Section Editors
- Melvin B Heyman, MD, MPH
Melvin B Heyman, MD, MPH
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- University of California, San Francisco
- David C Whitcomb, MD, PhD
David C Whitcomb, MD, PhD
- Section Editor — Pancreatic Diseases
- Professor of Medicine
- University of Pittsburgh School of Medicine
The contemporary, international definition of chronic pancreatitis is "a pathologic fibroinflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress." The definition includes a description of the common characteristics of chronic pancreatitis, including structural changes that result in pain syndromes, sometimes progressing to irreversible exocrine, and/or endocrine pancreatic insufficiency [1-4]. The structural changes include diffuse or focal destruction, sclerosis, acinar cell loss, fatty replacement, islet cell loss, inflammatory cell infiltrate, and pancreatic duct abnormalities. Intraductal obstruction may be caused by protein-plugs and/or calculi. Extraductal lesions such as trauma, pancreatic or hepatobiliary tumors, or surgical procedures may also lead to chronic inflammatory responses in the pancreas.
Because the pancreas has a large reserve capacity, symptoms of pancreatic failure do not develop until there is loss of over 90 percent of pancreatic exocrine function . Most patients with chronic pancreatitis initially experience recurrent abdominal pain, which may progress to persistent pain. Less commonly, patients are asymptomatic or have minimal symptoms until developing signs of advanced disease, such as diabetes mellitus or fat and protein malabsorption. With advances in diagnostic methods, the diagnosis of chronic pancreatitis is becoming more common in children. (See "Clinical manifestations and diagnosis of chronic and acute recurrent pancreatitis in children".)
This topic review will outline the risk factors for chronic pancreatitis in children, which become contributing etiologic factors once the disease is established. Related information is available in the following topic reviews:
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