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Diagnostic criteria for pancreatitis in children

Diagnostic criteria for pancreatitis in children
Entity Clinical definition
Acute pancreatitis Requires at least 2 of the following 3 criteria:
  • Abdominal pain suggestive of or compatible with acute pancreatitis (ie, abdominal pain of acute onset, especially in the epigastric region)
  • Serum amylase and/or lipase activity at least 3 times greater than the upper limit of normal
  • Imaging findings characteristic of or compatible with acute pancreatitis (eg, using U/S, CECT, EUS, MRI/MRCP)
Pediatric onset First episode of acute pancreatitis occurring before the patient's 19th birthday
Acute recurrent pancreatitis Requires at least 2 distinct episodes of acute pancreatitis (each as defined above), along with:
  • Complete resolution of pain (≥1-month pain-free interval between the diagnoses of acute pancreatitis)
or
  • Complete normalization of serum pancreatic enzyme levels (amylase and lipase) before the subsequent episode of acute pancreatitis is diagnosed, along with complete resolution of pain symptoms, irrespective of a specific time interval between acute pancreatitis episodes
Chronic pancreatitis Requires either at least 1 of the following 3 criteria:
  • Abdominal pain consistent with pancreatic origin and imaging findings suggestive of chronic pancreatic damage*
  • Evidence of exocrine pancreatic insufficiency and suggestive pancreatic imaging findings*
  • Evidence of endocrine pancreatic insufficiencyΔ and suggestive pancreatic imaging findings*
or
  • Surgical or pancreatic biopsy specimen demonstrating histopathologic features compatible with chronic pancreatitis
U/S: transabdominal ultrasonography; CECT: contrast-enhanced computerized tomography; EUS: endoscopic ultrasonography; MRI: magnetic resonance imaging; MRCP: magnetic resonance cholangiopancreatography; ERCP: endoscopic retrograde cholangio-pancreatography.
* Suggestive imaging findings of chronic pancreatitis/chronic pancreatic damage including: Ductal changes (irregular contour of the main pancreatic duct or its radicles; intraductal filling defects; calculi, stricture, or dilation) and parenchymal changes (generalized or focal enlargement, irregular contour [accentuated lobular architecture], cavities, calcifications, heterogeneous echotexture). Imaging modalities may include CECT, MRI/ MRCP, ERCP; U/S; EUS (in which at least five EUS features [as defined by the Rosemont classification[1]] must be fulfilled).
¶ Exocrine pancreatic insufficiency to be diagnosed via fecal elastase-1 monoclonal assay <100 micrograms/g stool (two separate samples done one month apart); or coefficient of dietary fat absorption <90% on a 72-hour fecal fat collection. Neither test should be performed during an acute pancreatitis episode because the results may be temporarily low. Children with classic cystic fibrosis, exhibiting early-onset pancreatic insufficiency without earlier evidence of any meaningful pancreas sufficiency, typically should not be diagnosed as having chronic pancreatitis. They do not have chronic abdominal pain and pancreatic imaging findings described in the chronic pancreatitis criteria.
Δ Endocrine pancreatic insufficiency to be diagnosed via 2006 World Health Organization criteria for the diagnosis of diabetes mellitus: Fasting glucose ≥7.0 mmol/L (126 mg/dL) or plasma glucose ≥11.1 mmol/L (200 mg/dL) two hours after glucose load 1.75 g/kg children (to maximum 75-g glucose load).[2]
References:
  1. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 2009; 69:1251.
  2. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003; 26(suppl 1):S5.
From: Morinville VD, Husain SZ, Bai H, et al. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr 2012; 55:261. DOI: 10.1097/MPG.0b013e31824f1516. Copyright © 2012 ESPGHN and NASPGHN. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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