Faculty Collaboration Database

Clinical and Practice Variations in Pediatric Acute Recurrent or Chronic Pancreatitis: Report From the INSPPIRE Study. J Pediatr Gastroenterol Nutr 2020 Jul;71(1):112-118

Date

02/23/2020

Pubmed ID

32079978

Pubmed Central ID

PMC7305964

DOI

10.1097/MPG.0000000000002661

Scopus ID

2-s2.0-85086792951 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

OBJECTIVE: The aim of the study was to determine whether clinical characteristics and management of pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) differ across INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a cuRE) sites.

STUDY DESIGN: Data were collected from INSPPIRE and analyzed per US regions and "non-US" sites. Between-group differences were compared by Pearson chi-square test. Differences in disease burden were compared by Kruskal-Wallis test.

RESULTS: Out of the 479 subjects, 121 (25%) were enrolled in West, 151 (32%) Midwest, 45 Northeast (9%), 78 (16%) South, and 84 (18%) at non-US sites. Hispanic ethnicity was more common in South (P < 0.0001); white race in Northeast (P = 0.009). CP was less common and time from diagnosis of first acute pancreatitis to CP was longer in children at non-US sites (P = 0.0002 and P = 0.011, respectively). Genetic mutations were most common among all groups; PRSS1 variants predominated in Midwest (P = 0.002). Gallstones were more frequent in South (P = 0.002). Endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) imaging were more commonly utilized in United States compared with non-United States (P < 0.0001), but there were no differences in the use of MRI/MRCP. Disease burden was highest in the West and Midwest, possibly as total pancreatectomy and islet autotransplantation (TPIAT) referral sites were located in these regions. All therapies were less commonly administered in non-US sites (P < 0.0001).

CONCLUSIONS: This is the first study to describe geographical variations in the INSPPIRE cohort, which possibly reflect variations in practice and referral patterns. The underlying reason behind the lower frequency of CP and fewer treatments in non-United States sites need to be further explored.

Author List

Dike CR, Zimmerman B, Zheng Y, Wilschanski M, Werlin SL, Troendle D, Shah U, Schwarzenberg SJ, Pohl J, Perito ER, Ooi CY, Nathan JD, Morinville VD, McFerron B, Mascarenhas M, Maqbool A, Liu Q, Lin TK, Husain SZ, Heyman MB, Gonska T, Giefer MJ, Gariepy CE, Fishman DS, Bellin M, Barth B, Abu-El-Haija M, Lowe ME, Uc A

Author

Steven L. Werlin MD Emeritus Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Child
Cholangiopancreatography, Endoscopic Retrograde
Humans
Pancreatitis, Chronic
Recurrence