Spectrum of pancreatitis in children and adolescents.

BACKGROUND: Very little is known about the early stages of tropical chronic pancreatitis except that many patients give history of childhood abdominal pain.

AIM: To examine whether tropical chronic pancreatitis may initially present clinically as recurrent acute pancreatitis.

METHODS: Children and adolescents with acute, recurrent acute and chronic pancreatitis were prospectively followed up from 2003 to 2010. Seventy-three consecutive patients were analyzed for progression from acute to recurrent and recurrent acute to chronic pancreatitis.

RESULTS: Of the 36 acute, 28 were recurrent acute pancreatitis patients. Similarly of the 37 chronic pancreatitis patients 27 were de novo and 10 had progressed to chronicity from recurrent acute. The mean age of patients was not significantly different between the different groups. Majority of patients in all groups were of idiopathic etiology. The progression of recurrent acute to chronic took 1 to 5 years. Minimum number of episodes of acute pancreatitis before progression to chronicity was 2 and minimum period was 1 year. In 11 of the 27 de novo chronic pancreatitis patients, the age of first pain and diagnosis were identical, in the remaining 16, there were varying intervals between the first pain and diagnosis (1-12 years).

DISCUSSION: There was a continuum of acute pancreatitis to recurrent acute pancreatitis, some of the recurrent acute pancreatitis patients further progressed to chronic.

CONCLUSION: In some instances tropical chronic pancreatitis may initially present clinically as recurrent acute pancreatitis.