RESUMO
Recurrent acute and chronic pancreatitis are increasingly recognized in childhood. Etiologies are vastly different in children compared with adults and mostly involve genetic and anatomical factors with negligible contribution of environmental risks. Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have significant impact on quality of life with high healthcare costs. Children with these conditions suffer from recurrent acute or chronic abdominal pain and they endure multiple emergency room visits, hospitalizations, procedures, and surgeries. Diagnostic methods are being developed; treatment options are limited. This review summarizes the most recent developments in pediatric ARP and CP. These discoveries will help physicians provide optimal care for children with these conditions.
Assuntos
Pancreatite Crônica , Qualidade de Vida , Doença Aguda , Criança , Humanos , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/terapia , RecidivaRESUMO
OBJECTIVE: The objective of this study was to determine if infants carrying 1 cystic fibrosis transmembrane receptor (CFTR) mutation demonstrate pancreatic inflammation in response to tobacco exposure. METHODS: Cystic fibrosis carrier infants aged 4 to 16 weeks were prospectively enrolled. Tobacco exposure was assessed by survey and maternal hair nicotine analysis. Serum immunoreactive trypsinogen (IRT) levels at birth and at the time of recruitment were analyzed relative to the presence or absence of tobacco exposure. The effect of the severity of the CFTR mutation carried by the infant on the tobacco-IRT relationship was also analyzed. RESULTS: Forty-eight infants completed the study. Newborn screen and follow-up IRT levels were not different between exposed infants (19 by hair analysis) and nonexposed infants (29 by hair analysis). Follow-up IRT levels were lower in infants with more severe CFTR mutations (P = 0.005). There was no difference in follow-up IRT based on CFTR mutation severity in exposed infants. Nonexposed infants with milder CFTR mutations had higher median IRT values on follow-up testing than those with more severe CFTR mutations (P < 0.05). CONCLUSIONS: The pancreas of cystic fibrosis carrier infants is affected by tobacco exposure, and those carrying less severe CFTR mutations may be more susceptible to tobacco effects.
Assuntos
Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística/genética , Mutação , Poluição por Fumaça de Tabaco/efeitos adversos , Tripsinogênio/sangue , Fibrose Cística/sangue , Fibrose Cística/diagnóstico , Feminino , Testes Genéticos/métodos , Cabelo/química , Heterozigoto , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal/métodos , Nicotina/análise , Pancreatite/diagnóstico , Pancreatite/etiologia , Projetos Piloto , Gravidez , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Estudos Prospectivos , Fumar/efeitos adversosAssuntos
Estado Nutricional , Pancreatite , Doença Aguda , Adolescente , Criança , Doença Crônica , Humanos , Medição de RiscoRESUMO
OBJECTIVE: To determine whether early patient-directed oral nutrition in children with mild acute pancreatitis decreases the length of hospitalization without increasing complications. STUDY DESIGN: Hospitalized patients aged 2-21 years of age who met the criteria for acute pancreatitis based on the Revised Atlanta Classification were enrolled prospectively and allowed to eat by mouth at their discretion (patient-directed nutrition [PDN]). These patients were compared with a retrospective cohort of children who were allowed to eat based on traditional practices (treatment team-directed nutrition [TTDN]). Outcomes included length of hospitalization, time nil per os (NPO), and complications within 30 days of discharge. RESULTS: The study included 30 patients in the PDN group and 92 patients in the TTDN group. Patients in the PDN group had a median length of stay of 48.5 hours (IQR 37-70 hours) compared with 93 hours (IQR 52-145 hours) in the TTDN group (P < .0001). Patients were NPO for a median of 14 hours (IQR 7-19.5 hours) in the PDN group compared with 34 hours (IQR 19.3-55 hours) in the TTDN group (P < .0001). No patients in the PDN group developed complications within 30 days of discharge. CONCLUSION: Early patient-directed oral nutrition in mild acute pancreatitis was well tolerated and resulted in decreased length of NPO status and hospitalization with no obvious complications. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT01423786.