Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2017 Jun 1.
Published in final edited form as: J Pediatr Gastroenterol Nutr. 2016 Jun;62(6):e66–e67. doi: 10.1097/MPG.0000000000001156

Toxic-Metabolic Risk Factors Are Uncommon In Pediatric Chronic Pancreatitis

John Pohl 1, Veronique Morinville 2, Sohail Z Husain 3, Aliye Uc 4
PMCID: PMC4880405  NIHMSID: NIHMS757987  PMID: 27213250

To the Editor

We appreciated the comments by Oracz, et al (1) regarding their experience in childhood chronic pancreatitis (CP) and specifically toxic-metabolic risk factors. We previously reported toxic-metabolic factors only in 11% of children with CP in our INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search For a CuRE) cohort, similar to the frequency reported by Oracz, et al (14%) (2). Genetic risk factors were most common in our study, similar to other pediatric studies (3-6). Medications, alcohol, smoking, chronic renal failure, hypercalcemia were uncommon in both cohorts (0-4%) (1, 2), but lipid disorders was much higher in the Polish cohort (7.2%) compared to ours (1% with hypertriglyceridemia). Because hypertriglyceridemia is associated with acute pancreatitis, acute recurrent pancreatitis and possibly CP (7, 8), we recommend defining the lipid disturbances and specifically serum triglyceride levels in their cohort. Multiple risk factors may be found in children with CP (2), therefore it would be of interest whether Polish children with CP and lipid disturbances had other risk factors including genetic mutations, obstructive/anatomical problems or other toxic-metabolic risk factors.

The study by Oracz, et al, along with our work emphasizes that toxic-metabolic risk factors are relatively uncommon in childhood CP. In children, genetic risk factors predominate (2); in adults toxic-metabolic risk factors (mostly alcohol) (9) are most common. Studies on carefully phenotyped and longitudinally followed cohorts such as INSPPIRE have the potential to shed light into the risk factors and pathogenesis of pediatric pancreatitis with improved diagnostics and therapeutics.

Acknowledgments

Sources of funding: This work was supported by DK096327 (AU); DK108334 (AU).

Footnotes

Conflicts of interest: Conflicts reported: Editorial Board, Practical Gastroenterology (JP), Speaker's Bureau for Medical Education Resources, Inc. (JP). No relevant conflicts: VM, SZH, AU.

References

  • 1.Oracz G, Kolodziejczyk E, Wejnarska K, et al. Toxic-Metabolic Risk Factors in Pediatric Chronic Pancreatitis - Single Center Experience. J Pediatr Gastroenterol Nutr. 2015 doi: 10.1097/MPG.0000000000001083. PAP. [DOI] [PubMed] [Google Scholar]
  • 2.Schwarzenberg SJ, Bellin M, Husain SZ, et al. Pediatric chronic pancreatitis is associated with genetic risk factors and substantial disease burden. J Pediatr. 2015;166:890–6. e1. doi: 10.1016/j.jpeds.2014.11.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Lee YJ, Kim KM, Choi JH, et al. High incidence of PRSS1 and SPINK1 mutations in Korean children with acute recurrent and chronic pancreatitis. J Pediatr Gastroenterol Nutr. 2011;52:478–81. doi: 10.1097/MPG.0b013e31820e2126. [DOI] [PubMed] [Google Scholar]
  • 4.Lucidi V, Alghisi F, Dall'Oglio L, et al. The etiology of acute recurrent pancreatitis in children: a challenge for pediatricians. Pancreas. 2011;40:517–21. doi: 10.1097/MPA.0b013e318214fe42. [DOI] [PubMed] [Google Scholar]
  • 5.Sobczynska-Tomaszewska A, Bak D, Oralewska B, et al. Analysis of CFTR, SPINK1, PRSS1 and AAT mutations in children with acute or chronic pancreatitis. J Pediatr Gastroenterol Nutr. 2006;43:299–306. doi: 10.1097/01.mpg.0000232570.48773.df. [DOI] [PubMed] [Google Scholar]
  • 6.Sultan M, Werlin S, Venkatasubramani N. Genetic prevalence and characteristics in children with recurrent pancreatitis. J Pediatr Gastroenterol Nutr. 2012;54:645–50. doi: 10.1097/MPG.0b013e31823f0269. [DOI] [PubMed] [Google Scholar]
  • 7.Husain SZ, Morinville V, Pohl J, et al. Toxic-Metabolic Risk Factors in Pediatric Pancreatitis: Recommendations for Diagnosis, Management and Future Research. J Pediatr Gastroenterol Nutr. 2015 doi: 10.1097/MPG.0000000000001035. PAP. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Ahmed Ali U, Issa Y, Hagenaars JC, et al. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis. Clin Gastroenterol Hepatol. 2016 doi: 10.1016/j.cgh.2015.12.040. PAP. [DOI] [PubMed] [Google Scholar]
  • 9.Yadav D, Timmons L, Benson JT, et al. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol. 2011;106:2192–9. doi: 10.1038/ajg.2011.328. [DOI] [PubMed] [Google Scholar]

RESOURCES