Author

Michael Ma

Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Sohail Z. Husain

Subject Area(s)

Medicine

Abstract

Little is known about risk factors for biliary pancreatitis in children. We hypothesized that ethnicity, obesity, and elevated pancreatic and hepatic biomarkers distinguish biliary from non-biliary and gallstone- from sludge-induced pancreatitis. We aimed to (1) characterize pediatric cases of biliary pancreatitis, (2) compare biliary with non-biliary cases, (3) examine differences between younger and older children, and (4) study features that distinguish gallstone- from sludge-induced pancreatitis.

We evaluated 76 episodes of biliary pancreatitis from 271 cases of acute pancreatitis in children admitted to Yale-New Haven hospital from 1994 to 2007. Of the 76 cases, 55% had gallstones, 21% had sludge, and 24% had structural defects. Hispanic children had a 2.85 (p=0.01) and 5.59 (p=0.003) higher probability of being diagnosed with biliary pancreatitis than white and black children, respectively. Median serum amylase and lipase in children with biliary pancreatitis were 64% and 49% higher, respectively, compared to other etiologies (p<0.05). In multiple logistic regression, aspartate aminotransferase (AST) was an independent predictor of biliary pancreatitis (OR=6.69, p=0.001). When comparing gallstone- with sludge-induced etiologies, obesity was an independent predictor (38% more prevalent, p<0.01) of gallstone cases.

Hispanic ethnicity was found to be a risk factor and AST a biomarker for biliary pancreatitis over other etiologies. Furthermore, obesity can distinguish gallstone- from sludge-induced pancreatitis. These findings may spur prospective studies to determine the optimal evaluation and management of children with biliary pancreatitis.

Comments

This is an Open Access Thesis.

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