Hereditary pancreatitis: An updated review in pediatrics

Abstract

Hereditary Pancreatitis (HP) has emerged as a significant cause of acute, acute recurrent and chronic pancreatitis in the pediatric population. Given that it presents similarly to other causes of pancreatitis, a positive family history and/or isolation of a gene mutation are vital in its designation. Inheritance patterns remain complex, but mutations involving the PRSS1, SPINK1, CFTR and CTRC genes are commonly implicated. Since being first described in 1952, dozens of genetic alterations that modify the action of pancreatic enzymes have been identified. Among children, these variants have been isolated in more than 50% of patients with chronic pancreatitis. Recent research has noted that such mutations in PRSS1, SPINK1 and CFTR genes are also associated with a faster progression from acute pancreatitis to chronic pancreatitis. Patients with HP are at increased risk of developing diabetes mellitus, exocrine pancreatic insufficiency, and pancreatic adenocarcinoma. Management follows a multi-disciplinary approach with avoidance of triggers, surveillance of associated conditions, treatment of pancreatic insufficiency and use of endoscopic and surgical interventions for complications. With significant sequela, morbidity and a progressive nature, a thorough understanding of the etiology, pathophysiologic mechanisms, diagnostic evaluation, current management strategies and future research considerations for this evolving disease entity in pediatrics is warranted.

Keywords: Acute pancreatitis; Acute recurrent pancreatitis; Chronic pancreatitis; Hereditary pancreatitis; Pancreatitis; Pediatrics.

Figure 1

Radial endoscopic ultrasound in a 13 year old male with SPINK1 and CTRC gene mutations demonstrating pancreatic duct dilatation (arrow) in addition to chronic parenchymal changes: Honeycombing with lobularity, non-shadowing hyperechoic foci, cystic changes and hyperechoic duct margins.

Figure 2

Endoscopic retrograde cholangiopancreatography in a 10 year old male with a CFTR gene mutation and pancreas divisum demonstrating contrast entering the dorsal pancreatic duct (arrows) from the common bile duct during a balloon occlusion cholangiogram. This occurred due to a fistula between the common bile duct and pancreatic duct secondary to repeated episodes of acute pancreatitis.