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Original Article
17 (
2
); 80-87
doi:
10.25259/BJKines_6_2025

Study of chronic pancreatitis in children

, , , , , ,
1Department of General Surgery, B.J. Medical College, Ahmedabad, Civil Hospital, Ahmedabad, India

*Corresponding author: Kadviben Bhojabhai Chavda, Department of General Surgery, B.J. Medical College, PG Hostel, Civil Hospital Campus, Ahmedabad, 380016, India. kavitachavda1281998@gmail.com

Received: , Accepted: ,
©2025 Published by BJKines - National Journal of Basic & Applied Sciences
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Chavda KB, Makwana RA, Chauhan HR, Parmar NM, Gadani RP, Kumar DM, et al. Study of chronic pancreatitis in children. Natl J Basic Appl Sci. 2025;17:80-7. doi: 10.25259/BJKines_6_2025

Abstract

Introduction:

Chronic pancreatitis (CP) in children and adolescents is an uncommon but increasingly recognized condition with etiological and clinical profiles distinct from adults.

Material and Methods:

This prospective observational study included 20 patients aged <18 years diagnosed with CP and admitted to a tertiary care center in Ahmedabad between May 2022 and May 2024. Clinical features, laboratory parameters, imaging findings, etiology, management strategies, complications, and short-term outcomes were analyzed descriptively.

Results:

The mean age was 12.4 years with a male predominance (70%). Abdominal pain was present in 100%, followed by weight loss (60%) and nausea/vomiting (55%). Etiology was idiopathic in 50%, post-traumatic in 20%, cholelithiasis and mumps infection in 10% each, and pancreatic divisum and choledochal cyst in 5% each. Elevated serum lipase and amylase were seen in 60% and 45%, respectively. Ultrasonography was abnormal in 100%, CT in 40%, and MRCP in 30%. Complications included parenchymal calcification (50%), ascites (20%), and pseudocyst (15%). Most patients were managed conservatively; 15% required surgical intervention.

Conclusion:

CP in children and adolescents shows a high burden of pain and complications, with a large proportion labeled idiopathic, highlighting the need for genetic evaluation and multidisciplinary care.

Keywords

Chronic pancreatitis
Children
Etiology
Pancreatic calcification
Pseudocyst
Peadiatric pancreatitis

INTRODUCTION

Chronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas, causing irreversible damage with pain and/or permanent exocrine or endocrine dysfunction, confirmed by imaging or histology.1-3

Relevance to the young population

In children, the most common causes of CP are trauma, heredity, systemic disease, and malformations of the pancreaticobiliary duct, such as pancreas divisum, annular pancreas, and choledocholithiasis. In addition, various unusual conditions, including metabolic disease, endocrine disorders, and inflammatory bowel disease 13, may cause the disorder.4-6

Certain congenital anomalies affect the pancreas and surrounding tissue, several of which are associated with CP. Obstruction of pancreatic flow caused by a stenotic papilla of Vater and bile reflux resulting from a common channel are believed to be responsible for the resultant inflammation, which may be reversible if the obstruction is relieved. A relatively common cause of relapsing pancreatitis is pancreas divisum, in which most of the pancreatic fluid flows through the minor duct of Santorini, with the possibility of a relative obstruction to flow because of anatomy and flow dynamics. Some series have reported an increased incidence of pancreas divisum in patients with idiopathic CP.1-3

Assessment in children

Assessment of malnutrition

  • Anthropometry: weight, height/length, BMI-for-age, weight-for-age, and height-for-age z-scores (WHO growth charts).

  • Clinical signs: muscle wasting, loss of subcutaneous fat, and edema.

  • Dietary assessment: dietary recall or food frequency history.

  • Laboratory parameters (if available): serum albumin, prealbumin, hemoglobin, micronutrient deficiencies (fat-soluble vitamins A, D, E).4-33

Annular pancreas, which results from an error of rotation or fixation of the embryologic pancreatic primordium, has also been associated with CP.

Pancreaticobiliary malunion with or without choledocholithiasis may likewise result in relapsing CP.

In the past few years, several genes have been identified as being associated with hereditary and idiopathic CP: PRSS1, CFTR, and SPINK1. SPINK1 mutations were found predominantly in patients without a family history. These mutations were most common in those with idiopathic CP, whereas patients with hereditary CP predominantly had PRSS1 mutations.30-32

Assessment of exocrine pancreatic insufficiency

  • Clinical features: steatorrhea, chronic diarrhea, bulky/ foul-smelling stools, poor weight gain or weight loss.

  • Stool tests: fecal elastase-1 (<200 μg/g suggestive of insufficiency; <100 μg/g severe).

  • Indirect evidence: need for pancreatic enzyme replacement therapy (PERT).

  • Fat-soluble vitamin deficiency as supportive evidence.

Assessment of endocrine pancreatic insufficiency

  • Blood glucose testing: fasting plasma glucose.

  • HbA1c for chronic glycemic status.

  • Oral glucose tolerance test (OGTT) when indicated.

  • Diagnosis: diabetes mellitus defined according to standard paediatric criteria.

Assessment of pain

  • Pain history: frequency, duration, severity, and impact on daily activities.

  • Pain scales (age-appropriate):

    • FLACC scale [face, legs, activity, cry, consolability (infants and young children).

    • Wong-Baker FACES pain scale.

    • Visual analog scale (VAS) or Numeric rating scale in older children.

  • Analgesic requirement or hospital admissions as surrogate markers.

Malnutrition, pancreatic exocrine and endocrine insufficiency, and pain were assessed based on clinical records and available investigations; however, standardized assessment tools were not uniformly applied to all patients.

AIMS AND OBJECTIVES

  • To study the etiology and pathogenesis of CP in patients aged <18 years.

  • To study the clinical features, management, and complications of study group patients.

  • To assess the outcome.

METHODOLOGY

Study site: Department of General Surgery, B.J. Medical College & Civil Hospital, Ahmedabad.

Study type: Prospective and Interventional.

Study period: 5 May 2022 to 5 May 2024.

Sample size: 20 patients (All patients meeting the inclusion criteria from 5 May 2022 to 5 May 2024 were included).

Method of data collection

All of the patients’ records were prospectively collected from the patients and the indoor case records.

This was a prospective study conducted at a tertiary hospital in Ahmedabad as part of the author's thesis. Institutional ethical permission taken.

  1. All patients meeting the inclusion criteria and hospitalized for over 2 years were included in this study.

  2. The clinical, laboratory, and radiological data for all patients aged <18 years admitted to this Institution with a diagnosis of CP were prospectively collected for this study within 24 h of admission.

Inclusion criteria: All patients aged <18 years admitted to this hospital with a diagnosis of CP, irrespective of etiology.

Exclusion criteria:

  1. Age >18 years

  2. Acute pancreatitis

Follow up

Patients were followed up for 6 months after discharge from the institute or until death during the inpatient period.

OBSERVATION AND RESULTS

Figure 1 shows that there was male predominance with 70% males and 30% females.

Sex distribution of patients.
Figure 1:
Sex distribution of patients.

Figure 2 shows that most patients belonged to 13-18 years age group.

Age distribution.
Figure 2:
Age distribution.

Figure 3 shows that abdominal pain was present in all patients, followed by weight loss and nausea/vomiting.

Clinical presentatioonic panceratitis.
Figure 3
Clinical presentatioonic panceratitis.

Figure 4 shows Idiopathic etiology was the most common cause of chronic pancreatitis.

Etiological factors.
Figure 4:
Etiological factors.

Figure 5 shows that raised serum lipase and amylase levels were observed in 60% and 45% of patients respectively.

Laboratory findings.
Figure 5:
Laboratory findings.

Ultrasonography was abnormal in all patients, while CT and MRCP showed abnormalities in selected cases [Figure 6].

Imaging findings.
Figure 6:
Imaging findings.

All patients were managed with analgesics and pancreatic enzyme supplementation [Figure 7].

Management modalities.
Figure 7:
Management modalities.

Non-surgical interventions included pigtail insertion and coeliac plexus block [Figure 8].

Endoscopic interventions.
Figure 8:
Endoscopic interventions.

Surgical procedures performed included cystogastrostomy, Frey’s procedure, and Puestow procedure [Figure 9].

Surgical interventions.
Figure 9:
Surgical interventions.

Parenchymal calcification was the most common complication [Figure 10].

Complications.
Figure 10:
Complications.

Malnutrition was present in 25% of patients [Figure 11].

Nutritional status.
Figure 11:
Nutritional status.

Most patients responded to NSAIDs or opioids for pain control [Figure 12].

Pain management strategies.
Figure 12:
Pain management strategies.

Recurrent hospitalizations were noted in 40% of patients [Figure 13].

Hospitalization duration.
Figure 13:
Hospitalization duration.
Correlation between clinical presentation and complications is shown in [Figure 14]
Figure 14:
Correlation between clinical presentation and complications is shown in [Figure 14]
Association between etiological factors and laboratory findings is shown in [Figure 15].
Figure 15:
Association between etiological factors and laboratory findings is shown in [Figure 15].
Correlation between imaging findings and surgical interventions is presented in [Figure 16].
Figure 16:
Correlation between imaging findings and surgical interventions is presented in [Figure 16].

Abdominal pain was the most common presenting complaint of patients with CP. The most common etiological factor was idiopathic, followed by blunt abdominal trauma and mumps (viral) infection. The most common complication following post-traumatic cause was pseudocyst, and the non-traumatic cause was calcification and its sequelae. USG and MRCP are investigations of choice in the paediatric age group of patients. CECT is advisable in case of acute exacerbation of CP and post-traumatic sequelae. Most of the patients were managed conservatively. Surgical intervention is required for complications like pseudocyst, calcification, and its sequelae, like MPD calculus. A longer duration of follow-up is required for assessment of complications, management, and outcomes.

DISCUSSION

In the present study, 20 patients with CP were studied.

In our study, the mean age of presentation was 12.4 years, and in the study by Schwarzenberg et al.,30 was 13 years. In the study by Choudhary et al.,23 from Vellore, it was 15.3 years, and in the study by Das et al.,21 from AIIMS Delhi, it was 12.5 years. In our study, males (70%) were affected more than females (30%). Similar results were found in another study. In a study by Schwarzenberg et al.,30 males (57%) and females (43%) were studied. In a study by Choudhary et al.,23 males (60%) and females (40%), and in a study by Das et al.,21 males (66%) and females (34%) [Table 1].

Table 1: Comparison of age and sex with other studies
Parameter Present study Schwarzenberg et al.30 Das et al.21 Choudhary et al.23
Mean age 12.4 13 15.3 15.3
Male 70% 57% 66% 60%
Female 30% 43% 34% 40%

Etiological factors in our study were idiopathic (50%), post-traumatic (blunt trauma)(20%), cholelithiasis (10%), viral infection (mumps) (10%), choledochal cyst(5%), and pancreatic divisum (5%).In a study by Schwarzenberg et al.,30 genetic (67%), pancreatic divisum (20%), cholelithiasis (4%), and drug (1%). In a study by Choudhary et al.,23 idiopathic (95.9%). In a study by Das et al.,21 idiopathic (60%), cholelithiasis (6.7%), blunt trauma (13.3%), drugs (12.5%), and mumps (0%) [Table 2].

Table 2: Comparison of etiological factors with other studies
Etiological factors Present
study (%)		 Schwarzenberg
et al.30(%)		 Das
et al.21(%)
Idiopathic 50 8 60
Blunt trauma 20 0 13.3
Cholelithiasis 10 4 6.7
Mumps 10 0 0
Pancreatic divisum 5 20 0
Choledochal cyst 5 0 0
Drugs 0 1 12.5
Genetic 0 67 7.5

In our study, abdominal pain was present in all patients (100%). Other symptoms like nausea/vomiting (55%), weight loss (60%), fever (25%), jaundice (15%), abdominal distension (30%) of patients suggest complication like pseudocysts or ascites .in study by Das et al.,21 abdominal pain (100%), nausea/vomiting (75%), abdominal distention (13.3%), fever (26%), jaundice (6.7%), weight loss (33%) [Table 3].

Table 3: Comparison of symptoms with other studies
Symptoms Present study (%) Das et al.21(%)
Abdominal pain 100 100
Nausea/vomiting 55 75
Fever 25 26
Jaundice 15 6.7
Weight loss 60 33
Abdominal distension 30 13.3
Drugs 0 1
Genetic 0 67

Laboratory findings in our study, such as elevated serum amylase and lipase in 45% and 60% respectively. A study by Werlin et al.6 found similar elevation in serum lipase and amylase. A study by Das et al.21 serum lipase 100% and serum amylase 66.7% [Table 4].

Table 4: Comparison of laboratory findings with other studies
Parameter Present
study (%)		 Werlin et al.6
(%)		 Srikant das et al.21(%)
Serum lipase 60 60 100
Serum amylase 45 45 66.7

Imaging findings in our study showed that all patients had positive USG findings (100%), abnormal CT findings in 40% of patients, and MRCP results in 60% patients. In a study by Das et al.,21 positive USG, CT, MRCP, and ERCP findings were 92.9%, 100%, 100%, and 100%, respectively. In a study by Choudhary et al.,23 positive USG findings were found in 100% patients [Table 5].

Table 5: Comparison of imaging findings with other studies
Imaging finding Present
study (%)		 Das et al.21
(%)		 Choudhary et al.23(%)
Positive USG 100 92.9 10
Positive CT 40 100 -
Positive MRCP 60 100 -
Positive ERCP Not done 100 -

In our study, management strategies were used where 100% patients received analgesics, dietary modification, and pancreatic enzyme supplementation. Similar management patterns were reported by Kumar et al.32 (2016) and others. Study by Husain SZ et al.34, Gariepy et al.31, and Morinville et al.33 for pain management in children with CP [Table 6].

Table 6: Comparison of conservative management with other studies
Management Present study (%) Kumar et al.32(%) Choudhary et al.23(%)
Analgesics 100 100 100
Dietary
modifi-cation		 100 100 100
Pancreatic
enzyme
supplementation		 100 100 100

The complications observed in our study included calcification (50%), ascites (20%), and pseudocyst (15%), while in the study by Choudhary et al.,23 complications were observed: calcification (71.6%), pseudocyst (17.1%), and ascites (9.1%) [Table 7].

Table 7: Comparison of conservative management with other studies
Complication Present study (%) Choudhary et al.23
(%)
Calcification 50 71.6
pseudocyst 15 17.1
Ascites 20 9.1

In our study, endoscopic procedure use in the management of CP (0%), pigtail insertion (5%), and surgical intervention was done in (15%), and the rest were managed conservatively in the study by Morinville et al.33 for endoscopic and surgical management of CP [Table 8].

Table 8: Comparison of management
Parameter Present study (%) Morinville et al.33 (%)
Surgical intervention 15 39
ERCP 0 62
Ascites 20 9.1

Study limitation

This study has several limitations that must be acknowledged. Firstly, the relatively small sample size of 20 patients limits the generalizability of the findings. A larger cohort would provide more robust data and allow for more comprehensive statistical analysis. Secondly, this study was conducted at a single tertiary care center, which may limit the applicability of the results to other settings, particularly in regions with different healthcare resources and practices.

Another limitation is the lack of genetic testing, which could provide insights into the hereditary factors contributing to CP. Additionally, the absence of a control group prevents a direct comparison with other populations, such as those with acute pancreatitis or other gastrointestinal conditions, which could help delineate the specific characteristics of CP.

The study also lacked long-term follow-up data, which is crucial in chronic conditions like pancreatitis to assess outcomes such as the progression of the disease, long-term complications, and the effectiveness of different management strategies. Finally, the limited use of advanced imaging modalities, such as endoscopic ultrasound (EUS), genetic study, and ERCP, in all patients may have led to an underestimation of certain etiological factors and complications.

Study strengths

Despite its limitations, this study has several strengths. the comprehensive analysis of multiple clinical parameters, including laboratory and imaging findings, management modalities, and complications, allows for a holistic understanding of the disease's presentation and progression. The study's findings also highlight the importance of a multidisciplinary approach to managing CP, which includes medical, nutritional, and surgical interventions. Additionally, the use of correlation analysis provides valuable information on the relationships between clinical symptoms, etiological factors, and complications, which can guide future research and clinical practice.

CONCLUSION

CP is a known entity in the paediatric age group of patients. In the present study, 20 patients with CP were studied. Among 20 patients, males (70%) were more commonly affected than females (30%). The mean age of presentation was 12.4 years. Abdominal pain was present in all of the patients (100%), 12 patients (60%) had weight loss, 11 patients (55%) had nausea/ vomiting, five patients (25%) had fever, and three patients (15%) had jaundice. 60% of patients had elevated serum lipase levels, and 45% had elevated serum amylase levels. All patients (100%) had positive USG findings, and CECT(A+P) was done in 8 patients (40% of patients). All eight patients (100%) had positive CT findings, and MRCP was done in 6 patients (30% of patients); all six patients (100%) had positive MRCP findings. Out of 20 patients, four patients (20%) had blunt trauma, two patients (10%) had cholelithiasis, two patients (10%) had mumps infection, one patient (5%) had pancreatic divisum, and one patient (5%) had choledochal cyst as an etiological factor. Out of 20 patients, 10 patients (50%) had no identifiable cause and were classified as idiopathic etiology [as a genetic study was not done in this study]. All patients were receiving dietary modifications, analgesics, and pancreatic enzyme supplementation. Among 20 patients, only three patients (15%) were managed with surgical intervention[cystogastrostomy, Frey`s procedure, Puestow procedure]. 01 patients managed with pigtail insertion. While the rest of the patients were managed conservatively.

Author contributions:

KC: Contributed to study design, data collection, analysis, and manuscript preparation; RM and HC: Assisted in data analysis and manuscript drafting; NP and RG: Contributed to patient management and data interpretation. DK and PD: Provided critical review and final approval of the manuscript.

Ethical approval:

The research/study was approved by the Institutional Review Board at B.J. Medical College, Ahemdabad, number 139/2024, dated 05/08/2024.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest:

Dinesh M. Kumar is on the editorial board.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.

Financial support and sponsorship: Nil

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