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OBJECTIVE: To determine if mild-moderate hypertriglyceridemia is associated with increased development of chronic pancreatitis or pancreatitis-associated complications in children with acute recurrent or chronic pancreatitis. STUDY DESIGN: Longitudinal data from the INSPPIRE-2 (INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2) cohort of children with acute recurrent or chronic pancreatitis (n=559) were analyzed. Subjects were divided into normal triglycerides (<150 mg/dL; 1.7 mmol/L), any hypertriglyceridemia (≥150 mg/dL; ≥1.7 mmol/L), mild-moderate hypertriglyceridemia (150-499 mg/dL; 1.7-5.6 mmol/L), moderate hypertriglyceridemia (500-999 mg/dL; 5.6-11.3 mmol/L), and severe hypertriglyceridemia groups (≥1,000 mg/dL; ≥11.3 mmol/L), based on highest serum triglyceride value. Laboratory, imaging, pancreatitis and hospital events, complications, and quality of life data were analyzed. RESULTS: In children with acute recurrent or chronic pancreatitis and hypertriglyceridemia, there was no increase in the number of pancreatitis attacks per person-years, nor an increase in chronic pancreatitis prevalence. However, hypertriglyceridemia severity was associated with increased pancreatic inflammation, pancreatic cysts, pain, hospital days, number of hospitalizations, intensive care, and missed school days. CONCLUSIONS: Mild-moderate hypertriglyceridemia in children with acute recurrent or chronic pancreatitis was not associated with increased pancreatitis frequency, nor increased development of chronic pancreatitis, but was associated with increased pancreatitis complications and disease burden. As a treatable condition, treatment of mild-moderate hypertriglyceridemia may be considered to reduce pancreatitis-associated complications and medical burden in children with acute recurrent or chronic pancreatitis.
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INTRODUCTION: Among children who suffer from acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), acute pancreatitis (AP) episodes are painful, often require hospitalization, and contribute to disease complications and progression. Despite this recognition, there are currently no interventions to prevent AP episodes. In this retrospective cohort study, we assessed the impact of pancreatic enzyme therapy (PERT) use on clinical outcomes among children with pancreatic-sufficient ARP or CP. METHODS: Children with pancreatic-sufficient ARP or CP in the INSPPIRE-2 cohort were included. Clinical outcomes were compared for those receiving vs not receiving PERT, as well as frequency of AP before and after PERT. Logistic regression was used to study the association between development of AP episodes after starting PERT and response predictors. RESULTS: Among 356 pancreatic-sufficient participants, 270 (76%) had ARP, and 60 (17%) received PERT. Among those on PERT, 42% did not have a subsequent AP episode, during a mean 2.1 years of follow-up. Children with a SPINK1 mutation ( P = 0.005) and those with ARP (compared with CP, P = 0.008) were less likely to have an AP episode after starting PERT. After initiation of PERT, the mean AP annual incidence rate decreased from 3.14 down to 0.71 ( P < 0.001). DISCUSSION: In a retrospective analysis, use of PERT was associated with a reduction in the incidence rate of AP among children with pancreatic-sufficient ARP or CP. These results support the need for a clinical trial to evaluate the efficacy of PERT to improve clinical outcomes among children with ARP or CP.
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BACKGROUND/OBJECTIVES: Bone health of children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) is not well studied. METHODS: This retrospective study was performed at three sites and included data from INSPPIRE-2. RESULTS: Of the 87 children in the study: 46 had ARP (53%), 41 had CP (47%). Mean age was 13.6 ± 3.9 years at last DXA scan. The prevalence of low height-for-age (Z-score < -2) (13%, 10/78) and low bone mineral density (BMD) adjusted for height (Z-score < -2) (6.4%, 5/78) were higher than a healthy reference sample (2.5%, p < 0.0001 and p = 0.03, respectively). CONCLUSION: Children with ARP or CP have lower height and BMD than healthy peers. Attention to deficits in growth and bone mineral accrual in children with pancreatic disease is warranted.