Professor of Pediatrics Aliye Uc, MD seeks to improve the lives of children and families affected by pancreatitis by better understanding this disease. She is the chair and the founding member of INSPPIRE (International Study Group of Pediatric Pancreatitis: In search for a cure) with the task of studying the epidemiology, natural history and outcomes of pediatric pancreatitis, a disease without clear diagnostic parameters and treatment alternatives in children.
Pancreatitis is inflammation of the pancreas. A triggering event (for example, trauma, certain viral infections, some medications, or ingestion of a toxin) results in damage to the pancreas. Patients with pancreatitis often have severe abdominal pain, nausea and vomiting. Pancreatitis may be a mild disease or may be life-threatening.
There are three categories of pancreatitis:
- Acute (the pancreas is injured but returns to normal after a short time)
- Acute recurrent (there are multiple episodes of acute pancreatitis, but each time the pancreas returns to normal)
- Chronic (episodes occur, but the pancreas does not return to normal and scarring takes place)
Below, you will see answers to some of the more frequently asked questions regarding these categories. There is also a wealth of good information available on Mission:Cure's website for patients.
Frequently Asked Questions - Acute Pancreatitis
What causes acute pancreatitis?
We know that injury to the pancreas (for example, a strong blow to the belly over the pancreas) can cause pancreatitis. Some viruses, and toxins (alcohol, for example) can also cause pancreatitis. Some people get pancreatitis from certain medications (for example, certain seizure medicines or immune suppression medicines). At this time, we do not have a way to predict who will be affected. Sometimes the cause is unknown.
How do I know if my child has acute pancreatitis?
Children with acute pancreatitis have severe abdominal pain, usually above the navel and sometimes to the right or left of the upper abdomen. They stop eating and may be vomiting.
What should I do if my child has these symptoms?
Your child needs immediate medical attention if you suspect pancreatitis. Call your regular doctor and have your child seen right away, or go to the urgent care center or emergency room near you.
How is acute pancreatitis diagnosed?
Your doctors will look for many causes of your child’s abdominal pain. Amylase and lipase are enzymes produced by the pancreas and can be measured in a blood test. If your doctor finds high levels of amylase and/or lipase in your child’s blood (usually levels at least 3 times the upper limit of normal), then there is suspicion of pancreatitis. Your doctors may order imaging studies (ultrasound, MRI, or CT scan) to confirm the diagnosis.
What is done for a child with acute pancreatitis?
Children are usually admitted to the hospital to manage the pain and to provide intravenous fluids to keep them hydrated. If a child vomits persistently, a tube may be place through the child’s nose and down to the stomach to keep his/her stomach empty. This may reduce vomiting and overall make your child more comfortable. A small tube may also be placed through a child’s nose to his/her stomach or intestine to provide nutrition. Occasionally, children can become quite ill with pancreatitis and need to be admitted to the intensive care unit for monitoring. Thankfully, the pancreas usually heals in a few days. Good general medical care for a child is important during this time.
After my child has acute pancreatitis, will s/he have another attack?
Most of the time, children have a single episode of acute pancreatitis and never have another attack. However, depending on the cause of the pancreatitis, there is a chance of recurrence. If a child develops more than one episode of pancreatitis, doctors will often do more tests for obstructive, metabolic and genetic causes of pancreatitis. Rarely, the first attack of pancreatitis is the start of many attacks (acute recurrent pancreatitis) or chronic pancreatitis. Children with acute recurrent pancreatitis can develop chronic pancreatitis.
Frequently Asked Questions - Acute Recurrent (ARP) or Chronic Pancreatitis (CP)
What causes acute recurrent or chronic pancreatitis?
Many children who have acute recurrent or chronic pancreatitis have a genetic risk factor or an anatomic abnormality of their bile ducts or pancreas that predisposes them to pancreatitis. Sometimes the cause is unknown.
How do I know if my child has acute recurrent or chronic pancreatitis?
People with acute recurrent pancreatitis have multiple episodes of acute pancreatitis. Chronic pancreatitis is diagnosed when the child does not recover between episodes, when typical changes of chronic pancreatitis are seen on imaging studies, or when the pancreas begins to fail in its primary jobs, which includes production of enzymes important for digestion of food, and production of insulin so blood sugar remains normal.
Are special tests done for acute recurrent or chronic pancreatitis?
Although many primary care doctors take care of acute pancreatitis, children with chronic or acute recurrent pancreatitis should be seen by a pediatric gastroenterologist. A careful history may identify a medication or other toxin that is injuring the child’s pancreas. It is important to tell your doctor everything your child is taking, even therapies provided by other health care providers or labeled as “natural” or “organic”. Just because something is “natural” or “organic”, it does not mean that a child could not get pancreatitis from using it. Your doctor will likely do testing for genes associated with pancreatitis and special radiology test called magnetic resonance imaging (MRI) or a magnetic resonance cholangiopancreaticogram (MRCP). This imaging tests allow the doctor to get a good look at the tissue and the ducts in the pancreas and make sure they are not abnormal or blocked. MRI studies give a very good image of the pancreas and involve no radiation, so they are very safe. Your child may be sedated for these studies because they take a long time and your child must hold very still. The pancreas produces digestive enzymes important for digestion of food and also produces insulin so that blood sugar remains normal. Doctors may also test your child for diabetes and do stool testing to be sure your child is making enough enzymes to digest food; these tests check the functions of the pancreas.
How do you treat ARP and CP?
If there is evidence that your child has an obstruction to his/her pancreatic ducts, a procedure called an endoscopic retrograde cholangiopancreatography (ERCP) may be done to try to remove/lessen the obstruction. If gallstones are found, your child’s gallbladder may need to be removed. Some episodes of pancreatitis may be so bad that the child will need admission to the hospital, while some will be mild, and your child can be treated at home with liquids by mouth and pain medication by mouth.
Will my child become addicted to pain medications?
It is hard to balance the very real need for good pain medications against the fear of addiction and misuse of narcotics. Children with pancreatitis have real pain and need to have good relief. Parents can help by helping their child develop “pain scale” to allow them to tell the doctors how bad the pain is. Children should not hide pain when they feel it, but they need to learn to not exaggerate the pain either. Doctors should treat pain aggressively, so the child does not feel he/she has to exaggerate pain to get the medicine he/she needs. Children should attend school and have normal activities as much as possible. Isolation from school and friends allows the child to focus on their pain and may make them inappropriately demand more medicine. A good, child-friendly pain management program and/or a good pediatric psychologist in your area can be of great value to help your child learn to manage pain with less narcotics.
Is there any way to stop pain in ARP or CP?
For a very small number of children, the pain of recurrent or chronic pancreatitis is relentless. It affects their lives in many ways, including reduction of participation in sports or other activities, inability to concentrate in school, and a development of a constant fear of a “bad attack”. Chronic or recurrent pain has negative psychological effects. Some pediatric gastroenterologists may explore more aggressive options to reduce pain by reducing the number of attacks. Celiac blocks are not recommended for children. However, ERCP and surgical procedures may help by increasing drainage from the pancreas or even by removing the pancreas to relieve pain. Deciding to have one of the procedures for your child is a complex decision. It requires research and thought. Your can start by discussing the impact pancreatitis is having on your child with your pediatric gastroenterologist.