Health Library

Chronic Pancreatitis in Children

What Causes Chronic Pancreatitis?

Causes of chronic pancreatitis in children may include:

• Genetic conditions such as PRSS1, CFTR or SPINK1 mutations that make children more likely to get pancreatitis
• Structural problems in the pancreas ducts, like blockages or narrowing that prevent proper drainage and lead to longstanding inflammation
• Certain medications
• Very high levels of calcium in the blood
• Autoimmune pancreatitis where the immune system mistakenly attacks the pancreas

Other causes include an infection or another disease, such as cystic fibrosis. However, in many cases, the cause of chronic pancreatitis in children is unknown.

Problems Associated with Chronic Pancreatitis

The main problem for those with chronic pancreatitis is chronic pain. Chronic pancreatitis can cause serious complications, including:

• Ongoing abdominal pain that can become daily and long-lasting
• Poor digestion, where the pancreas is unable to make enough enzymes to break down food properly, leading to diarrhea, oily stools, weight loss, vitamin deficiencies
• Diabetes and pre-diabetes as the pancreas becomes unable to make enough insulin
• Fluid collections in the pancreas that can enlarge and cause pain or infection

What Are the Symptoms of Chronic Pancreatitis?

Chronic pancreatitis begins with multiple episodes of acute pancreatitis. These episodes typically involve intense upper abdominal pain, vomiting and nausea.

The most common symptom of chronic pancreatitis is pain in the upper belly that is much worse than a typical bellyache. A child may describe it as severe. The pain can be constant, come and go, and worsen after eating, especially after eating foods that are high in fat.

Another common symptom is weight loss. This is due in part to not being able to absorb nutrition. In some cases, children avoid eating because it aggravates painful symptoms. Sometimes, pancreatitis can cause a loss of appetite, which leads to weight loss.

How is Chronic Pancreatitis Diagnosed?

Because symptoms of chronic pancreatitis look like those of other illnesses, diagnosing it can be challenging.

To diagnose chronic pancreatitis, a doctor will do a thorough physical exam and ask questions about the child’s medical history. Tests may include:

• Imaging to check for damage to the pancreas. That can include an abdominal ultrasound to start, but your child would often need more specialized imaging that can include a CT scan or an MRI that show signs of damage to the ducts and the pancreas tissue better
• Labs to check for elevated pancreas enzyme levels in the blood, vitamin deficiencies, genetic abnormalities, autoimmune reasons for pancreatitis, and signs of diabetes
• Stool studies to check the digestive capacity of the pancreas
• Specialized interventions, including endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) that help diagnose pancreas abnormalities missed on imaging or allow for intervention to the ducts endoscopically

How is Chronic Pancreatitis Treated?

There is no cure for chronic pancreatitis, but treatment can ease the symptoms and improve a child’s quality of life. It is important to treat chronic pancreatitis as soon as possible because repeated inflammation can cause permanent damage. Treatment options include:

• Taking pancreatic enzymes to aid in digesting nutrients
• Following a special diet and/or taking vitamins to address the body’s inability to absorb certain nutrients
• Surgically removing the gallbladder or pancreas
• Taking medication to correct a metabolic imbalance
• Undergoing endoscopic retrograde cholangiopancreatography (ERCP) to relieve a blockage that is causing pancreatitis

Total pancreatectomy and islet cell autotransplantation

In rare cases, a child may undergo a surgery called a total pancreatectomy and islet autotransplantation (TPIAT). This involves removing the entire pancreas and reconstructing the gastrointestinal tract. After the pancreas is removed, it is taken to an islet laboratory where the islet cells are extracted. These cells are responsible for producing insulin and other hormones. The islets are then transplanted into the patient’s body, where they continue to perform essential functions of the pancreas.

Although TPIAT is a complex surgery, the operation can be life-changing for patients who haven’t found relief from the painful symptoms of pancreatitis with previous treatments.

Pain Management

Chronic pancreatitis can cause intense upper belly pain. Minimizing this pain and helping your child cope with it is a high priority. A pediatric pain specialist can offer medication and strategies to help your child cope with painful symptoms while also minimizing the use of narcotics. A pain psychologist can also help by providing coping strategies to deal with the pain.

Outlook for People with Chronic Pancreatitis

Not all children who experience acute episodes of pancreatitis will develop chronic pancreatitis, but some will.

Unfortunately, chronic pancreatitis is a lifelong condition, although symptoms sometimes come and go. Patients should see their doctor regularly to evaluate their condition, ensure that they are getting enough nutrition and discuss treatment options. The doctor will provide endocrine testing on a regular basis to identify any issues related to glucose tolerance or the development of diabetes.

Children with chronic pancreatitis may be at an increased risk of developing pancreatic cancer. The degree of risk depends on the underlying cause of pancreatitis, family history and the type of genetic involvement.