Medical Management of Chronic Pancreatitis in Children

1. Patients with CP are at risk for macro- and micronutrient deficiencies. Patients should be monitored for growth and pubertal delay, dietary intake, and fat-soluble vitamin deficiencies. Growth and intake should be reviewed at every clinic visit, a minimum of every 6 to 12 months. Fat-soluble vitamin laboratory analysis should occur every 12 to 18 months or as clinically indicated. (1B)

2. A multidisciplinary approach that includes a clinical pediatric dietitian is needed to adequately monitor nutritional status, evaluate nutrient intake and provide education and recommendations to help prevent both malnutrition and obesity. (1C)

3. There is a clear role for PERT in children with CP who have EPI with steatorrhea, poor growth and/or nutritional deficiencies. PERT dosing for CP-associated EPI is similar to that used in patients with CF. (1B)

4. Children with CP should be screened yearly for pancreatogenic DM with a fasting glucose and HbA1c level. (1C)

5. Consider OGTT if pre-diabetes is present based on abnormal fasting glucose (100–125 mg/ dL) and/or HbA1c level (5.7%–6.4%). OGTT should be performed annually once a patient is considered to have pre-diabetes. (1C)

6. Chronic pancreatitis patients with diabetes should be referred to a pediatric endocrinologist to optimize glucose management and determine if evaluation for other forms of DM should be considered. (1B)

7. It is important to address clinical symptoms of malabsorption and PERT in children with CP and DM to improve glycemic control. (1C)

8. Insufficient data exists to recommend the use of antioxidants as a treatment to prevent EPI or other disease progression in children with CP. (2C)