Acute pancreatitis in childhood – a comparative international study and tale of two cities
Adeline Salim, Ampaipan Boonthai, Pornthep Tanpowpong, Paul D. Losty- General Medicine
- Surgery
Abstract
Backgrounds
To compare factor(s) contributing to aetiology, management and clinical outcome(s) of paediatric patients acquiring acute pancreatitis (AP) at two major university paediatric surgical centres in Liverpool and Bangkok.
Methods
All patients (<18 years) with an index diagnosis of AP (ICD 10 coding) during 2006–2016 were studied.
Results
121 patients included n = 79 (65.3%) in Thailand versus n = 42 (34.7%) in the UK centre with no difference(s) in age at diagnosis at 10.4 ± 4.5 and 11.7 ± 6 years. (P = 0.12). Major AP aetiology(s) in Thailand were medications (39.2%) and choledochal cysts (8.9%). In the UK—gallstone disease (21.4%), and medications (16.7%) were leading factors (P < 0.01). Ultrasonography was deployed more frequently in the UK versus Thai centre (74.3% vs. 49.1%; P < 0.01). Pancreatitis was confirmed by imaging in 67.9% (Thai) and 62.9% (UK) patients (P = 0.47). Most patients at both centres had a mild‐grade pancreatitis illness (95% Thai vs. 90.5% UK; P = 0.28) while 12.7% of Thai and 19% of UK children developed pancreatitis‐related complication (P = 0.37). Overall mortality rate (%) was significantly higher in the Thai versus UK centre (27.8% vs. 9.5%; P = 0.02).
Conclusions
Aetiology of acute pancreatitis appears to vary between UK and Thailand children. Timely early diagnosis and healthcare pathways may be driven by local patient‐related factor(s). The higher mortality (%) observed in Thailand versus UK in this comparative study was linked to underlying co‐existent chronic medical condition(s) in vulnerable patient cohorts.