Transcription:
Pancreatitis in kids

Caitlyn White: Although we don't hear about it often, pancreatitis is common even in children. So what exactly is it? What is the function of the pancreas and how do patients know when they need to seek medical attention for pancreatitis? Today, we'll go over the advanced methods experts at Children's Health use to treat pancreatitis in children with Dr. Megha Mehta, a pediatric gastroenterologist at Children's Health and Assistant Professor at UT Southwestern. This is Children’s Health Checkup where we answer parents’ most common questions about raising healthy and happy kids. I'm your host, Caitlyn White. So Dr. Mehta, what is pancreatitis?

Dr. Mehta: So, pancreatitis is injury and inflammation to the pancreas. So, a number of different things can cause it, but basically when your pancreas gets injured, inflammation starts and that can result in really severe pain.

Host: So what is the function of the pancreas and what are common causes for pancreatitis?

Dr. Mehta: So, the pancreas has two main functions. The first function is what we call an endocrine function. And this is where it releases important hormones into your body that helps to manage our blood sugar levels. So when you have problems with this function, you end up with a common condition called diabetes. The second important function of the pancreas is an exocrine function and this is where the pancreas releases important enzymes into the GI tract, which helps break down the fat and protein that we eat. If you have problems with the exocrine function of your pancreas, you can have issues with  malabsorption, poor weight gain, oily stools for example. There are a lot of different things that can cause pancreatitis to name a few injury to the pancreas. So if you're involved in a motor vehicle crash or if you're rough housing with your siblings and caused injury to the pancreas or trauma, this can trigger pancreatitis.

There are a number of different medications that we know that can cause pancreatitis. Common ones include antiepileptic medications, certain types of chemotherapy medications, and certain anti-inflammatory medications that we use to treat chronic medical conditions. Certain infections can cause pancreatitis, viral infections and bacterial infections. Gallstones is another major cause of pancreatitis. So, with gallstones you can have basically a problem with the plumbing. It can cause back up into your pancreas causing pancreatitis. And unfortunately, in pediatrics, the large majority of the time we just don't know what causes pancreatitis. And we call this idiopathic pancreatitis.

Host: So when would you say patients should seek out medical attention or how do they even know when they should seek out medical attention?

Dr. Mehta: Yeah, so when you have pancreatitis, the most common symptoms you have is really sharp, sudden onset abdominal pain. It's usually located at the top of the stomach and to the left of the stomach. And, oftentimes, we hear about how it radiates to the back, so it spreads from the left upper side of your abdomen to your back. I'll be honest, in kids we don't see the back pain complaint as often. It's more kind of top of the tummy and to the left side. And this happens all of the sudden. So you're usually fine one minute and the very next day you wake up with really sharp pain. Anytime you have really sharp unexplained pain, it's a good idea to talk to your pediatrician. The reasons sometimes for kids to have to come to the emergency room though is if that pain is not controlled with their over the counter pain medications like Tylenol and Motrin. I mean if they need something stronger. Another important reason to come to the emergency room for pancreatitis is if you're not able to keep any foods down. So oftentimes eating and drinking can worse than the pain, and if kids are not drinking enough to stay hydrated, this is an important reason to come and seek medical attention.

Host: How do you diagnose pancreatitis then?

Dr. Mehta: So usually we want to see the classic symptoms. Again, abdominal pain. In younger kids, I should mention who are not able to tell you they're in pain. Oftentimes they present more with fussiness, feeding intolerance, refusing to eat, maybe some vomiting, as well. So, you want to see the symptoms of pancreatitis. That gets us thinking about it. And then either seeing clinical symptoms, lab elevation, or concerning imaging findings can help tip us off that your child has pancreatitis.

Host: Now I know that the pancreas disease program at Children's Health is National Pancreas Foundation approved. Can you talk more about this distinction and how the team achieved this?

Dr. Mehta: Yeah, the National Pancreas Foundation is an important organization in the US that helps provide advocacy for chronic medical conditions involving the pancreas. This includes pancreatitis, pancreatic cancers and certain medical conditions that can form that affects your pancreas. We are privileged to be a National Pancreas Foundation Center of Excellence and in order to achieve this distinction we had to basically, you know, provide them with information about our center. And some of the things that the NPS foundation are looking for are centers that provide a complete multidisciplinary approach to care and provide all the unique resources to help provide comprehensive care for a child with pancreatitis.

Host: How do you treat pancreatitis once it's diagnosed? And, specifically, can you talk about the state-of-the-art endoscopy procedure you offer at Children's Health and how it sets you apart from other systems in the nation?

Dr. Mehta: Yeah, so this is sort of a two-part answer. When your child has acute pancreatitis, the main things that we do to manage pancreatitis are fluids, pain control, and nutrition. So, in milder episodes of acute pancreatitis, it could be managed at home. And the most important thing for parents to know is to make sure that their child is staying hydrated. So, it's okay if they don't want to eat much, but as long as you're drinking enough fluids to stay hydrated, this is really important and can help their pancreas heal faster. Making sure to address pain needs is also important. So sometimes you need to schedule the pain medications around the clock. And then again, I mentioned nutrition. So sometimes if your pain is really bad, you may not want to eat. Allowing the child to eat what they're able to tolerate. If you're not able to manage this at home, if the episode is too severe and you have to come to the hospital and get admitted, then we're doing versions of the same thing, but at a hospital level.

So instead of having the child drink fluids if they're not able to drink them, we'll give them fluids through an IV. We can provide alternative forms of nutrition if we need to, and then stronger pain medications if we need it. So, this is how we treat an acute episode of pancreatitis. Sometimes based on what is causing the pancreatitis, we may need to do additional interventions, either through an acute episode or kind of subsequently if your child is having repeat episodes, then we might need to do additional intervention. And this is where our center can be really helpful because we have certain resources here that are not available at most pediatric centers in the country. So, we have a therapeutic endoscopy available here through two of my colleagues, Dr. Barth and Dr. Troendle who perform specific forms of endoscopy therapy called endoscopic retrograde cholangiopancreatography or ERCP and endoscopic ultrasound. And through these we're able to help three very specific pancreatic conditions to try to help make kids feel better.

Host: Now that we know how it's diagnosed after being treated for pancreatitis, what's the likelihood that a child will get it again? And what kind of follow-up care do you have at Children's Health to monitor this chance of recurrence?

Dr. Mehta: Oh, this is a great question and one that I get asked often. So, we know that in kids about 13 in a hundred thousand pediatric patients will have acute pancreatitis. And of these patients, about a third or so may have a second episode. So the vast majority might have a single episode of pancreatitis and then never have it again. But sometimes in the third of patients who might have repeat episodes, this is what we call acute recurrent pancreatitis, and of these patients who have multiple episodes of pancreatitis, about one sixth will go on to develop chronic pancreatitis, which is where you have more permanent damage to your pancreas causing scarring and affecting the function of the pancreas. So oftentimes because your episode of pancreatitis may be a one and done type of a deal, you may not need to seek care here at our pediatric center. However, if you've had a single episode that was really severe, causing complications, or if you're starting to have more than one episode of pancreatitis, that's a good reason to come and see us so that we can make sure that we're doing a complete evaluation and we're able to manage whatever we can and try to help prevent future episodes.

Host: I know you participate in large international research studies. Can you tell us more about those and why it's important to participate in those studies as a center?

Dr. Mehta: So, I mentioned earlier that a lot of times we don't have an explanation for what causes your child's episode of pancreatitis. So sometimes we can pick up on causes and other times, even though we look for all these things, there are a lot of times we just don't know what's causing it. This is why research is really important. We also know that children are not little adults. So, while we have a lot of information about pancreatitis in adults, we don't have that much in pediatric patients. This is what got me really interested and why I'm a pancreatologist. So, participating in large international studies is really helpful so we can get more information about pancreatitis and kids and what we can do to try and make it better.

Host: Great. Is there anything else that you'd like to share about the pancreas disease program at Children's Health?

Dr. Mehta: We have a really large and robust pediatric pancreas disease program here at Children's Health, and we're excited and available to treat anyone with pancreas problems, big or small. So, you can always reach out to us and we'll try to help take good care of your child.

Host: Thank you so much for your time and your insight, Dr. Mehta. That was Dr. Megha Mehta, a pediatric gastroenterologist at Children's Health and Assistant Professor at UT Southwestern. Find more information about this topic at childrens.com/pancreas. This has been Children’s Health Checkup. I'm Caitlin Whyte. Thank you for joining us.