Chronic pancreatitis is rare in children. It can be diagnosed at any age, but is more common after the age of 10. Pediatric specialists at Cincinnati Children’s care for patients with chronic pancreatitis who are as young as three years of age.

Chronic pancreatitis in children can be caused by:

• Gallstones or an obstruction in the pancreatic duct
• A metabolic abnormality, such as high levels of calcium in the blood
• A hereditary (genetic) disposition
• Trauma to the pancreas

Other causes include medication, an infection or another disease, such as cystic fibrosis. However, in many cases, the cause of chronic pancreatitis in children is unknown.

Chronic pancreatitis begins with multiple episodes of acute pancreatitis. These episodes typically involve intense upper abdominal pain, vomiting and nausea.

The most common symptom of chronic pancreatitis is upper abdominal pain that is much worse than a typical bellyache. The pain can be constant, come and go unpredictably, and worsen after eating, especially after eating foods that are high in fat.

Another common symptom is unintentional weight loss, due in part to the fact that pancreatitis interferes with the body’s ability to absorb nutrition.

Other symptoms of chronic pancreatitis include:

• Nausea
• Vomiting
• Diarrhea and oily bowel movements
• Difficulty digesting food and poor growth
• Diabetes mellitus
• Jaundice (yellow discoloration of the skin)
• In some cases, back pain or left shoulder pain

Chronic pancreatitis can cause serious complications, including:

• Dehydration or low blood pressure
• Bleeding, tissue damage and infection
• Pseudocysts (fluid-filled cavities) in the pancreas, which can cause vomiting and fever
• Diabetes mellitus caused by the loss of pancreatic tissue and cells that produce insulin
• Fatty stools and fat malabsorption caused by a lack of digestive enzymes
• Diarrhea, gastrointestinal discomfort, bloating and distension (a protruding belly)

Because symptoms of chronic pancreatitis resemble those of other illnesses, diagnosing it can be challenging. Pancreatitis is sometimes misdiagnosed as constipation, heartburn, inflammatory bowel disease or irritable bowel syndrome.

To diagnose chronic pancreatitis, a physician will perform a thorough physical exam and ask questions about the child’s medical history. Tests may include:

• Blood tests to see whether the enzymes made by the pancreas are elevated
• Endoscopic retrograde cholangiopancreatography (ERCP), an imaging procedure used to examine the small intestine, pancreatic duct and other parts of the gastrointestinal tract
• An abdominal computed tomography scan (CT) scan, which uses X-rays and computer technology to reveal signs of damage
• Magnetic resonance imaging, which can show abnormalities in the pancreatic duct
• Pancreatic function testing
• Stool tests
• Genetic tests to help identify a possible hereditary cause
• Endocrine testing to assess insulin production

Although there is no cure for chronic pancreatitis, treatment can ease the symptoms and improve a child’s quality of life. It is important to treat chronic pancreatitis as soon as possible, as repeated inflammation can cause irreversible damage.

Treatment options include:

• Taking pancreatic enzymes to aid in digesting nutrients
• Following a specialized diet and/or taking vitamins to address the body’s inability to absorb certain nutrients
• Surgically removing the gallbladder or pancreas
• Taking medication to correct a metabolic imbalance
• Undergoing endoscopic retrograde cholangiopancreatography (ERCP) to relieve blockage that is causing pancreatitis
• Rarely, undergoing a total pancreatectomy and islet cell transplantation to remove the pancreas and transplanting the islet cells to another area of the body to continue performing essential functions

For more information, contact the Cincinnati Children’s Hospital Medical Center’s Pancreas Care Center at (877) 859-5395 or fill out a form.