Çocukluk Çağı Pankreatı̇t Hastalarının Tanı, Tedavı̇ ve Klı̇nı̇k İzlem Sonuçları

Abstract

The number of patients diagnosed with pancreatitis has been increasing in recent years due to the understanding of the physiopathogenesis of pancreatic diseases, developments in diagnostic methods and the increased awareness of physicians. Acute pancreatitis (AP) cases usually resolve without complications but in some AP cases, recurrent pancreatitis episodes (acute recurrent pancreatitis-ARP) are seen and may cause chronic pancreatitis (CP). In this retrospective study, we aimed to identify the demographic, etiologic, clinical and laboratory features, clinical follow-up results and prognosis of patients with AP, ARP and KP who were admitted to Hacettepe University İhsan Doğramacı Children's Hospital, Pediatric Gastroenterology-Hepatology and Nutrition, Pediatric Surgery and Pediatric Emergency Clinics between 01.01.2016 and 01.09.2018 or who were diagnosed with pancreatitis while being followed at the General Pediatric Services. 52 patients (33 female (63,5%) and 19 male (36,5%)) were included in the study. 44.3% of the patients included in the study were AP, 38.4% were ARP and 17.3% were CP. The age at diagnosis varied between 1-17 years (mean 9.1 ± 4.9 years). Etiological causes were grouped according to the type of pancreatitis. In 30% of the patients with AP, drug use was found to cause pancreatitis attack. The most common cause of ARP was pancreaticobiliary system anomaly (pancreatic divisum, pancreaticobiliary junction anomaly) (45%) and the most common cause of CP was genetic mutations (44%). The most common complaint was abdominal pain (94%) and nausea/vomiting (67%). When evaluated according to age groups, the rate of nausea/vomiting, diarrhea and fever in the 1-5 year old age group was higher compared to the 6-17 age group, while there was no significant difference (p>0.05).

According to the laboratory findings, mean amylase level 656±663,2 U/L (136-2953 U/L), mean pancreatic amylase level 524,2±559,8 U/L (83-2764 U/L), mean lipase level 1182±1447,3 U/L (83-4932 U/L) were found to be. The mean value of C-reactive protein (CRP) was 3,24 ± 6,64 mg/dL and high in 33(63,5%) patients. It was found statistically significant that patients with CRP had longer hospital stay than those with normal CRP values (p = 0.01). The CRP values of the patients who developed complications were higher than those without complications and no significant difference was found (p> 0.05). Genetic tests were evaluated, genetic mutation analysis was performed in 10 (20%) patients. CFTR mutation was detected in four patients with CP and SPINK-1 mutation was detected in one patient with ARP. When radiological tests were evaluated, it was observed that 94% of the patients were examined with ultrasonography (US), 36.5% with computed tomography (CT), 82.6% with magnetic rezonance cholangiopancreatography (MRCP) and 30.7% with endoscopic retrograde cholangiopancreatography (ERCP). The frequency of MRCP and ERCP was found to be significantly higher in patients with ARP than in AP patients (p<0.05). Paracetamol was the most commonly used analgesic during the episode of pancreatitis and the frequency of opioid use was 9.6% in all patients. When the frequency of antibiotic administration was evaluated, it was seen that 61,5% of all patients received single or multiple and 42% of them received multiple antibiotic treatment. The most commonly used antibiotics were sulperazone (62%), amikacin (51.4%) and ornidazole (28.8%). When the amount of maintenance fluid given during the episode of pancreatitis was analyzed, it was seen that 54% of the patients were given 2000 cc/m2/day and more. Patients who received 1500 cc/m2/day and 2000 cc/m2/day and more fluid were not found to be significantly different in terms of duration of hospitalization, normalization times of amylase and lipase levels and the risk of developing complications (p<0.05). The mean follow-up period for stopped enteral nutrition (EN) was seven days (1-30 days) for all patients. The duration of hospitalization of the patients who started EN after the 72th hours was found to be significantly longer than those started before 72th hours (p=0.01). Pancreatitis may be diagnosed in all age groups and complaints may vary according to age group. Laboratory and radiologic findings important for the differential diagnosis and give some clues about prognosis of patients. It is important to diagnose and prevent recurrent attacks in patients with ARP and KP due to disease burden. Developing a standardized approach to the treatment of patients will improve the prognosis.