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Chronic Pancreatitis

Year 2017, Volume: 9 Issue: 3, 17 - 23, 15.05.2017

Abstract

Abstract

Chronic pancreatitis (CP) is rare in childhood, butits incidence is increasing with age. CP and acute re-current pancreatitis (ARP) are regarded as different sta-ges of the same disease rather than two separate diseases. The main causes are genetic factors (most common),obstructive, toxicmetabolic, autoimmune and idiopathic conditions. The disease is characterized by severe episodes of recurrent pain. Deterioration of endocrineand exocrine functions of the pancreas may be seen.In most cases, amylase and lipase are normal or slightly elevated. Elevated levels of transaminases, direct bilirubin, alkaline phosphatase and gamma glutamyltransferase are detected in concomitant bile duct obstructions. It is suggested that the initial evaluation ofrecurrent pancreatitis should include aspirate aminotransferase, alanine aminotransferase, gammaglutamyltransferase, total bilirubin, fasting lipids and total serum calcium, if metabolic disease is suspected serumammonia and urine organic acids.Magnetic resonance cholangiopancreatography(MRCP), secretin-induced magnetic resonance cholan-giopancreatography (SMRCP), endoscopic retrogradecholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are the preferred imaging modalities. Sweat test and cationic trypsinogen (PRSS1) genemutation test should be performed during ARP or CPgenetic screening. If sweat testing is not possible, cysticfibrosis transmembrane regulator (CFTR) mutation should be examined.Functions in exocrine pancreatic insufficiency canbe assessed by indirect methods such as fecal fat analysis, fecal elastase-1, fecal chymotrypsin, serum immu-noreactive trypsinogen, levels of fat soluble vitamins or direct tests such as pancreas stimulation test withDreiling tube or endoscopic pancreas function test.All acute and acute recurrent pancreatitis cases, especially idiopathic cases, should be monitored regularly.Screening for Celiac disease is recommended in long-term follow-up of ARP or CP patients. Pediatric ARPand CP patients should be assessed at least once a yearfor fat-soluble vitamin deficiencies, pancreatic exocrine and endocrine deficiencies.

References

  • Kaynaklar 1.Spanier B, Bruno MJ, Dijkgraaf MG. Incidence andmortality of acute and chronic pancreatitis in the Net-herlands: a nationwide record-linked cohort studyfor the years 1995-2005. World J Gastroenterol 2013;19 (20): 3018-26. 2.Mullady DK, Yadav D, Amann ST, et al; NAPS2 Con-sortium. Type of pain, pain-associated complicati-ons, quality of life, disability and resource utilisati-on in chronic pancreatitis: a prospective cohort study.Gut 2011; 60 (1): 77-84. 3.Morinville VD, Husain SZ, Bai H, et al; INSPPIRE Gro-up. Definitions of pediatric pancreatitis and survey ofpresent clinical practices. J Pediatr Gastroenterol Nutr2012; 55 (3): 261-65. 4.Gariepy CE, Heyman MB, Lowe ME, et al. CausalEvaluation of Acute Recurrent and Chronic Pancrea-titis in Children: Consensus From the INSPPIRE Gro-up. J Pediatr Gastroenterol Nutr 2017; 64: 95-103.doi: 10.1097/MPG.000000000000 1446 5.Poddar U, Yachha SK, Borkar V, Srivastava A, Ku-mar S. A report of 320 cases of childhood pancrea-titis: Increasing incidence, etiologic categorization,dynamics, severity assessment, and outcome. Pan-creas 2017; 46 (1): 110-15. 6.Pohl JF, Uc A. Paediatric pancreatitis. Curr OpinGastroenterol 2015; 31 (5): 380-86. 7.Ooi CY, Dorfman R, Cipolli M, et al. Type of CFTRmutation determines risk of pancreatitis in patientswith cystic fibrosis. Gastroenterology 2011; 140 (1):153-61. 8.Bertin C, Pelletier AL, Vullierme MP, et al. Pancre-as divisum is not a cause of pancreatitis by itself butacts as a partner of genetic mutations. Am J Gastro-enterol 2012; 107 (2): 311-17. 9.O'Reilly DA, Malde DJ, Duncan T, Rao M, FilobbosR. Review of the diagnosis, classification and mana-gement of autoimmune pancreatitis. World J Gastro-intest Pathophysiol 2014; 5 (2): 71-81. 10.Husain SZ, Morinville V, Pohl J, et al. Toxic-meta-bolic risk factors in pediatric pancreatitis: Recom-mendations for diagnosis, management, and futureresearch. J Pediatr Gastroenterol Nutr 2016; 62 (4):609-17. doi: 10.1097/MPG.000000 0000001035. 11.Wejnarska K, Kolodziejczyk E, Wertheim-Tysa-rowska K, et al. The etiology and clinical course ofchronic pancreatitis in children with early onset ofthe disease. J Pediatr Gastroenterol Nutr 2016; 63(6): 665-70. 12.Schwarzenberg SJ, Bellin M, Husain SZ, et al. Pe-diatric chronic pancreatitis is associated with gene-tic risk factors and substantial disease burden. J Pe-diatr 2015; 166 (4): 890-96. e1. 13.Kandula L, Whitcomb DC, Lowe ME. Genetic issu-es in pediatric pancreatitis. Curr Gastroenterol Rep2006; 8 (3): 248-53. 14.Singhi AD, Pai RK, Kant JA, et al. The histopathologyof PRSS1 hereditary pancreatitis. Am J Surg Pathol2014; 38 (3): 346-53. 15.Taylor CJ, Chen K, Horvath K, et al. ESPGHAN andNASPGHAN report on the assessment of exocrinepancreatic function and Pediatr Gastroenterol Nutr 2015; 61 (1): 144-53. 16.Sojo Aguirre A, Martínez Ezquerra N, Bousoño Gar-cía C, et al. Pancreatitis in cystic fibrosis: associati-on with genotype and pancreatic status. An Pediatr(Barc) 2011; 75 (6): 401-408. 17.CubranićA, Dintinjana RD, Vanis N. Endoscopic di-agnostic of chronic pancreatitis. Coll Antropol2014; 38 (4): 1265-69. 18.Pezzilli R. Pancreatitis. Secretin increases the diag-nostic yield of MRCP. Nat Rev Gastroenterol Hepa-tol 2014; 11 (9): 519-20. 19.Stevens T, Parsi MA. Update on endoscopic pancrea-tic function testing. World J Gastroenterol 2011; 17(35): 3957-61. 20.Ewald N, Hardt PD. Diagnosis and treatment of dia-betes mellitus in chronic pancreatitis. World J Gas-troenterol 2013; 19 (42): 7276-81. 21.Raimondi S, Lowenfels AB, Morselli-Labate AM, Mai-sonneuve P, Pezzilli R. Pancreatic cancer in chro-nic pancreatitis; aetiology, incidence, and early de-tection. Best Pract Res Clin Gastroenterol 2010; 24(3): 349-58. 22.Gachago C, Draganov PV. Pain management in chro-nic pancreatitis. World J Gastroenterol 2008; 14 (20):3137-48. 23.Shafiq N, Rana S, Bhasin D, et al. Pancreatic enzy-mes for chronic pancreatitis. Cochrane Database SystRev 2009; (4): CD006302. 24.Saito N, Suzuki M, Sakurai Y, et al. Genetic analy-sis of Japanese children with acute recurrent andchronic pancreatitis. J Pediatr Gastroenterol Nutr2016; 63 (4): 431-36. doi: 10.1097/MPG.0000000000001320. 25.Agarwal J, Nageshwar Reddy D, Talukdar R, et al.ERCP in the management of pancreatic diseases inchildren. Gastrointest Endosc 2014; 79 (2): 271-78. 26.Andersen DK, Frey CF. The evolution of the surgi-cal treatment of chronic pancreatitis. Ann Surg 2010;251 (1): 18-32. 27.Azhari H, Rahhal R, Uc A. Is total pancreatectomywith islet autotransplantation a reasonable choice forpediatric pancreatitis? JOP 2015; 16 (4): 335-41. 28.Uc A, Andersen DK, Bellin MD, et al. Chronic pan-creatitis in the 21st century - Research challenges andopportunities: Summary of a National Institute of Dia-betes and Digestive and Kidney Diseases Workshop.Pancreas 2016; 45: 1365-75.pancreatitis in children. J

Kronik Pankreatitler

Year 2017, Volume: 9 Issue: 3, 17 - 23, 15.05.2017

Abstract

Öz

Kronik pankreatit (KP)çocukluk çağında nadir görülen ancak insidansı yaşla artan bir hastalıktır. Akut tekrarlayıcı pankreatit (ARP) ile KP iki ayrı hastalık yerine bir hastalığın farklı aşamaları olarak kabul edilmektedir. Başlıca nedenler genetik faktörler (en sık), obstrüktif, toksik-metabolik, otoimmün ve idiyopatik durumlardır. Hastalık şiddetli tekrarlayıcı ağrı epizotları ile karakterizedir. Pankreasın endokrin ve ekzokrin fonksiyonlarında bozulma görülebilmektedir.Olguların çoğunda amilaz ve lipaz normal veya hafif yüksektir. Eşlik eden safra yolları obstrüksiyonlarında, transaminazlar, direkt bilirubin, alkalen fosfatazve gamma glutamil transferaz düzeylerinde yükselme saptanır. Tekrarlayan pankreatitin ilk değerlendirmesinin aspartat aminotransferaz, alanin aminotransferaz, gamaglutamiltransferaz, total bilirubin, açlık lipidleri ve total serum kalsiyumu, metabolik hastalık şüphesi varsa serum amonyak ve idrar organik asitleri tetkiklerini içermesi önerilmektedir. Manyetik rezonans kolanjiyopankreatografi (MRCP), sekretinli manyetik rezonans kolanjiyopankreatografi (SMRCP),endoskopik retrograd kolanjiopankreatografi (ERCP) ve endoskopik ultrasonografi (EUS) tercih edilen görüntüleme yöntemleridir. ARP veya KP'nin genetikaçıdan taraması sırasında ter testi ve katyonik tripsinojen (PRSS1) gen mutasyontesti yapılmalı, ter testi yapılamıyorsa, kistik fibroz transmembran regülatör (CFTR)mutasyonu bakılmalıdır.Ekzokrin pankreas yetmezliğinde fonksiyonlar fekal yağ analizi, fekal elastaz-1, dışkıda kimotripsin, serum immün reaktif tripsinojen, yağda eriyen vitamin düzeyleri gibi indirekt testler veya Dreiling tüpü ile pankreas stimülasyon testi veya endoskopik pankreas fonksiyon testi gibi direkt yöntemlerle değerlendirilebilir. Tüm akut ve akut tekrarlayan pankreatit vakalarının, özellikle idiyopatik olguların, düzenli olarak izlenmesi gereklidir. Uzun vadeli izlemde ARP veya KP hastalarının Çölyak hastalığı için araştırılması önerilmektedir. Pediatrik ARP ve KP hastaları yağda çözünen vitamin eksiklikleri, pankreatik ekzokrin ve endokrin yetmezlikler açısından yılda en az bir kez değerlendirilmelidir.

References

  • Kaynaklar 1.Spanier B, Bruno MJ, Dijkgraaf MG. Incidence andmortality of acute and chronic pancreatitis in the Net-herlands: a nationwide record-linked cohort studyfor the years 1995-2005. World J Gastroenterol 2013;19 (20): 3018-26. 2.Mullady DK, Yadav D, Amann ST, et al; NAPS2 Con-sortium. Type of pain, pain-associated complicati-ons, quality of life, disability and resource utilisati-on in chronic pancreatitis: a prospective cohort study.Gut 2011; 60 (1): 77-84. 3.Morinville VD, Husain SZ, Bai H, et al; INSPPIRE Gro-up. Definitions of pediatric pancreatitis and survey ofpresent clinical practices. J Pediatr Gastroenterol Nutr2012; 55 (3): 261-65. 4.Gariepy CE, Heyman MB, Lowe ME, et al. CausalEvaluation of Acute Recurrent and Chronic Pancrea-titis in Children: Consensus From the INSPPIRE Gro-up. J Pediatr Gastroenterol Nutr 2017; 64: 95-103.doi: 10.1097/MPG.000000000000 1446 5.Poddar U, Yachha SK, Borkar V, Srivastava A, Ku-mar S. A report of 320 cases of childhood pancrea-titis: Increasing incidence, etiologic categorization,dynamics, severity assessment, and outcome. Pan-creas 2017; 46 (1): 110-15. 6.Pohl JF, Uc A. Paediatric pancreatitis. Curr OpinGastroenterol 2015; 31 (5): 380-86. 7.Ooi CY, Dorfman R, Cipolli M, et al. Type of CFTRmutation determines risk of pancreatitis in patientswith cystic fibrosis. Gastroenterology 2011; 140 (1):153-61. 8.Bertin C, Pelletier AL, Vullierme MP, et al. Pancre-as divisum is not a cause of pancreatitis by itself butacts as a partner of genetic mutations. Am J Gastro-enterol 2012; 107 (2): 311-17. 9.O'Reilly DA, Malde DJ, Duncan T, Rao M, FilobbosR. Review of the diagnosis, classification and mana-gement of autoimmune pancreatitis. World J Gastro-intest Pathophysiol 2014; 5 (2): 71-81. 10.Husain SZ, Morinville V, Pohl J, et al. Toxic-meta-bolic risk factors in pediatric pancreatitis: Recom-mendations for diagnosis, management, and futureresearch. J Pediatr Gastroenterol Nutr 2016; 62 (4):609-17. doi: 10.1097/MPG.000000 0000001035. 11.Wejnarska K, Kolodziejczyk E, Wertheim-Tysa-rowska K, et al. The etiology and clinical course ofchronic pancreatitis in children with early onset ofthe disease. J Pediatr Gastroenterol Nutr 2016; 63(6): 665-70. 12.Schwarzenberg SJ, Bellin M, Husain SZ, et al. Pe-diatric chronic pancreatitis is associated with gene-tic risk factors and substantial disease burden. J Pe-diatr 2015; 166 (4): 890-96. e1. 13.Kandula L, Whitcomb DC, Lowe ME. Genetic issu-es in pediatric pancreatitis. Curr Gastroenterol Rep2006; 8 (3): 248-53. 14.Singhi AD, Pai RK, Kant JA, et al. The histopathologyof PRSS1 hereditary pancreatitis. Am J Surg Pathol2014; 38 (3): 346-53. 15.Taylor CJ, Chen K, Horvath K, et al. ESPGHAN andNASPGHAN report on the assessment of exocrinepancreatic function and Pediatr Gastroenterol Nutr 2015; 61 (1): 144-53. 16.Sojo Aguirre A, Martínez Ezquerra N, Bousoño Gar-cía C, et al. Pancreatitis in cystic fibrosis: associati-on with genotype and pancreatic status. An Pediatr(Barc) 2011; 75 (6): 401-408. 17.CubranićA, Dintinjana RD, Vanis N. Endoscopic di-agnostic of chronic pancreatitis. Coll Antropol2014; 38 (4): 1265-69. 18.Pezzilli R. Pancreatitis. Secretin increases the diag-nostic yield of MRCP. Nat Rev Gastroenterol Hepa-tol 2014; 11 (9): 519-20. 19.Stevens T, Parsi MA. Update on endoscopic pancrea-tic function testing. World J Gastroenterol 2011; 17(35): 3957-61. 20.Ewald N, Hardt PD. Diagnosis and treatment of dia-betes mellitus in chronic pancreatitis. World J Gas-troenterol 2013; 19 (42): 7276-81. 21.Raimondi S, Lowenfels AB, Morselli-Labate AM, Mai-sonneuve P, Pezzilli R. Pancreatic cancer in chro-nic pancreatitis; aetiology, incidence, and early de-tection. Best Pract Res Clin Gastroenterol 2010; 24(3): 349-58. 22.Gachago C, Draganov PV. Pain management in chro-nic pancreatitis. World J Gastroenterol 2008; 14 (20):3137-48. 23.Shafiq N, Rana S, Bhasin D, et al. Pancreatic enzy-mes for chronic pancreatitis. Cochrane Database SystRev 2009; (4): CD006302. 24.Saito N, Suzuki M, Sakurai Y, et al. Genetic analy-sis of Japanese children with acute recurrent andchronic pancreatitis. J Pediatr Gastroenterol Nutr2016; 63 (4): 431-36. doi: 10.1097/MPG.0000000000001320. 25.Agarwal J, Nageshwar Reddy D, Talukdar R, et al.ERCP in the management of pancreatic diseases inchildren. Gastrointest Endosc 2014; 79 (2): 271-78. 26.Andersen DK, Frey CF. The evolution of the surgi-cal treatment of chronic pancreatitis. Ann Surg 2010;251 (1): 18-32. 27.Azhari H, Rahhal R, Uc A. Is total pancreatectomywith islet autotransplantation a reasonable choice forpediatric pancreatitis? JOP 2015; 16 (4): 335-41. 28.Uc A, Andersen DK, Bellin MD, et al. Chronic pan-creatitis in the 21st century - Research challenges andopportunities: Summary of a National Institute of Dia-betes and Digestive and Kidney Diseases Workshop.Pancreas 2016; 45: 1365-75.pancreatitis in children. J
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Primary Language Turkish
Journal Section makale
Authors

Yrd. Doç. Dr. Selçuk Yazıcı This is me

Publication Date May 15, 2017
Published in Issue Year 2017 Volume: 9 Issue: 3

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APA Yazıcı, Y. D. D. S. (2017). Kronik Pankreatitler. Klinik Tıp Pediatri Dergisi, 9(3), 17-23.
AMA Yazıcı YDDS. Kronik Pankreatitler. Pediatri. May 2017;9(3):17-23.
Chicago Yazıcı, Yrd. Doç. Dr. Selçuk. “Kronik Pankreatitler”. Klinik Tıp Pediatri Dergisi 9, no. 3 (May 2017): 17-23.
EndNote Yazıcı YDDS (May 1, 2017) Kronik Pankreatitler. Klinik Tıp Pediatri Dergisi 9 3 17–23.
IEEE Y. D. D. S. Yazıcı, “Kronik Pankreatitler”, Pediatri, vol. 9, no. 3, pp. 17–23, 2017.
ISNAD Yazıcı, Yrd. Doç. Dr. Selçuk. “Kronik Pankreatitler”. Klinik Tıp Pediatri Dergisi 9/3 (May 2017), 17-23.
JAMA Yazıcı YDDS. Kronik Pankreatitler. Pediatri. 2017;9:17–23.
MLA Yazıcı, Yrd. Doç. Dr. Selçuk. “Kronik Pankreatitler”. Klinik Tıp Pediatri Dergisi, vol. 9, no. 3, 2017, pp. 17-23.
Vancouver Yazıcı YDDS. Kronik Pankreatitler. Pediatri. 2017;9(3):17-23.