Digestive and Gastrointestinal Conditions

Pancreatitis

What is pancreatitis?

Pancreatitis is inflammation of the pancreas, a large gland in the belly behind the stomach.

  • When it is healthy, the pancreas makes digestive juices (enzymes). These are released through a tube (called the pancreatic duct) into the upper part of the small intestine, where the enzymes become active. They break down fats, proteins and carbohydrates from food into smaller nutrients that your child’s body can absorb. A healthy pancreas also releases digestive hormones (insulin and glucagon) that control blood sugar.

  • In pancreatitis, the pancreas gets inflamed, and enzymes inside the pancreas irritate and damage the pancreas itself. Usually, pancreatitis is a brief, one-time illness. In some cases, it comes and goes or it does not clear up at all.

    • Most children with pancreatitis have only 1 attack that lasts less than 1 week, gets better with treatment and never returns (acute pancreatitis).
    • Some children have repeated acute attacks with periods of feeling normal in between (acute recurrent pancreatitis), or they have lasting inflammation with frequent or daily symptoms (chronic pancreatitis).

  • Pancreatitis happens when:

    • Cells in the pancreas that make enzymes are damaged
    • Ducts in the pancreas that should collect and drain the enzymes are blocked or disrupted

    In adults, these problems sometimes result from heavy alcohol use or from gallstones.

    In children, the common causes are different — though children may get gallstones too. Causes in children include:

    • Injury to the pancreas, like from being in a car accident or falling off a bicycle into the handlebars
    • Problems with how the pancreas and related ducts formed (pancreaticobiliary malformations)
    • Infections or other diseases that affect many body systems, including mumps and cystic fibrosis
    • Medicines that irritate the pancreas, including some medicines for seizures, chemotherapy drugs and antibiotics
    • Genes passed down in families (hereditary pancreatitis)
    • High levels of fats in the blood (hyperlipidemia or hypertriglyceridemia)

    In many cases — especially if a child has acute pancreatitis only 1 time — there is no clear cause.

Pancreatitis at Seattle Children’s

Seattle Children’s can offer expert diagnosis, monitoring and treatment by pediatric specialists to help your child recover from acute pancreatitis or live well with recurrent or chronic pancreatitis.

Our Gastroenterology and Hepatology Program brings together all the specialists your child needs during an acute attack. For children and teens with recurrent or chronic pancreatitis, our Pancreatitis Clinic provides comprehensive, team-based care over the long term. It is the only clinic of its kind in the Pacific Northwest.

  • Pancreatitis in children is not the same as in adults. Our experts understand how the causes, effects, diagnosis and treatments differ for children. Dr. Matthew Giefer is one of only a handful of doctors in the country who specialize in pediatric pancreatitis. He directs our Pancreatitis Clinic.

  • Seattle Children’s is the only pediatric hospital in the Pacific Northwest with the expertise to provide the full range of treatments your child may need — including pain relief, proper nutrition, endoscopic procedures and surgery. We also have the region’s only pediatric ERCP (endoscopic retrograde cholangiopancreatography)> and pediatric Therapeutic Endoscopy Program to treat pancreatitis.

  • We are a leader in evidence-based care for childhood pancreatitis. When research showed that it is safe to feed children early in an acute attack and that early feeding leads to better outcomes for children and shorter hospital stays, we developed pancreatitis nutrition guidelines to ensure all of our doctors provide the best care.

  • Our pancreatitis team takes part in the INSPPIRE Pediatric Pancreatitis Research Project, an international effort to better understand pancreatitis in children. INSPPIRE’s goal is to discover how to prevent repeat episodes of acute pancreatitis and keep acute disease from becoming chronic. By pooling data from their patients who volunteer, the 14 centers in the network hope to find answers more quickly than any one center could alone.

Symptoms of Pancreatitis

Most children with pancreatitis have pain in their upper belly.

  • The pain may:

    • Be mild to serious
    • Spread to the back
    • Get worse with eating
    • Become constant

    Your child’s belly may be tender if pressed on.

  • Other common symptoms include:

    • Nausea and vomiting
    • Diarrhea
    • Swollen belly, if fluid collects around the pancreas
    • Fever
    • Fast heartbeat and pulse

    If vomiting keeps your child from holding down enough fluids, your child may become dehydrated.

  • Over time, acute recurrent pancreatitis or chronic pancreatitis can lead to nutrition and growth problems or cause other symptoms, especially without expert treatment.

Diagnosis of Pancreatitis

To diagnose pancreatitis, the doctor will ask about your child’s health history, do an exam and order blood tests to check for high levels of digestive enzymes (amylase and lipase) that increase when the pancreas is inflamed.

  • Your child will also need 1 or more of these imaging studies:

    • Ultrasound
    • MRI (magnetic resonance imaging)
    • CT (computed tomography) scan

    Usually, children do not need other tests and do not get pancreatitis again after treatment for the first attack.

  • If your child has acute recurrent pancreatitis or chronic pancreatitis, the doctor may ask for more tests, like these:

    • ERCP (endoscopic retrograde cholangiopancreatography) to look for abnormal ducts within or leading away from the pancreas, or to look for pseudocysts. ERCP is a tool to diagnose and treat pancreas problems without surgery. While your child is asleep (sedated), the doctor gently passes a long, flexible tube with a camera attached to it (endoscope) through your child’s mouth and stomach. ERCP combines images from the camera with X-rays so the doctor can look inside your child’s body. The doctor can also perform treatment using small instruments passed through the endoscope.
    • Stool studies to look for chemicals that show how well the pancreas is working.
    • Genetic tests to look for genes that can cause pancreatitis.

Treatment of Pancreatitis

Pancreatitis can be life threatening. Children with pancreatitis need treatment, whether they have:

  • Only 1 brief attack (acute pancreatitis)
  • Repeated acute attacks with normal periods in between (acute recurrent pancreatitis)
  • Lasting inflammation, damage and symptoms (chronic pancreatitis)

Seattle Children’s treats all types of childhood pancreatitis, using the latest methods — from evidence-based nutrition guidelines to advanced technologies, like therapeutic ERCP (endoscopic retrograde cholangiopancreatography).

Our Pancreatitis Clinic brings together gastroenterologists (doctors who specialize in digestive system diseases), dietitians, pain medicine doctors and others to take care of children with recurrent or chronic pancreatitis over the long term.

Acute Pancreatitis Treatment

If your child has an acute attack of pancreatitis, they will need to stay in the hospital for a couple of days to a week (whether it is their first attack or they have had attacks before). Most children with pancreatitis have only 1 attack of acute illness that gets better with treatment and never returns.

  • For acute pancreatitis, the treatment is designed to relieve symptoms and prevent complications. If there is a clear cause or if a complication develops, doctors will treat the cause or complication, too.

  • There is no medicine to cure pancreatitis. During an acute attack, children receive supportive care, meant to keep them safe and comfortable and to promote healing.

    Your child will likely need to stay in the hospital for a few days to get pain medicine and intravenous (IV) fluids (to replace what they have lost from vomiting and prevent or manage dehydration).

    We will tailor any other supportive care to your child’s needs — for example, giving medicine to control nausea if your child needs this.

  • Doctors used to believe that children with pancreatitis should not be fed during an acute attack so their pancreas and intestines could rest. However, recent research shows that early feeding is safe and leads to better results for children and shorter hospital stays.

    Seattle Children’s developed nutrition guidelines, based on this research, that are used by all of our doctors treating acute pancreatitis.

    During a mild attack, your child may be fed by mouth. During a moderate or severe attack, your child may be fed through a feeding tube placed through the nose — a nasogastric tube (NG tube) or a nasojejunal tube (NJ tube). Usually, children need a feeding tube for only a few days; in severe illness, children may need a feeding tube for several weeks.

  • Your child’s team at Seattle Children’s will watch closely for signs of other conditions linked to pancreatitis and will provide care to prevent or treat any complications.

    Pseudocysts are one possible complication of pancreatitis. Small pseudocysts (less than 5 centimeters) tend to clear up on their own, and they do not need treatment. Your child may need ERCP or surgery to drain a cyst that is larger, lasts longer or keeps the pancreas from healing.

    If your child has other complications, like bleeding in the pancreas or problems with their kidneys or lungs, we will treat these, bringing in other Seattle Children’s experts as needed.

  • In many cases — especially if a child has only 1 short-term attack of pancreatitis — there is no clear cause. If doctors do find a cause, your child may need treatment for that condition.

    For example, Seattle Children’s doctors may use ERCP:

    • To remove a gallstone that blocks the tube leading from the pancreas to the intestine (pancreatic duct)
    • To stretch a narrowed duct by inflating a small balloon inside (balloon dilation)
    • To place a stent to hold open a narrowed duct

    Most children with pancreatitis do not need surgery. A very small number of children need surgery to correct a problem with the way the pancreas formed. Seattle Children’s surgeons are experienced with this type of surgery.

Recurrent or Chronic Pancreatitis Treatment

When they are having a flare-up, children with recurrent or chronic pancreatitis often need similar treatment to children with a single attack of acute pancreatitis:

  • Supportive care in the hospital, including pain medicine and IV fluids
  • Early feeding, sometimes with a tube placed through the nose (NG or NJ tube), to provide nutrition
  • Careful monitoring and treatment of complications

If your child has recurrent or chronic pancreatitis, they will also need ongoing care from a team of pediatric experts to ensure proper nutrition, promote healthy growth, limit further damage to the pancreas, and prevent or treat complications.

Repeated or ongoing inflammation and damage to the pancreas can lead to frequent, even daily, symptoms and serious health effects — which may be different in children than in adults. Seattle Children’s Pancreatitis Clinic brings together a team of pediatric experts to address the many healthcare needs your child may have.

  • Your child’s team at the Pancreatitis Clinic will focus on:

    • Making sure your child gets the nutrition they need to grow well
    • Controlling any pain your child has
    • Checking how well your child’s pancreas is working
    • Preventing, watching for and treating any long-term effects of pancreas damage
    • If possible, finding and treating any condition that led to pancreatitis

  • Recurrent or chronic pancreatitis may make it hard for your child to take in food or to digest it well and absorb the nutrients they need. This may lead to problems with growth or even weight loss.

    Your child’s team will include Dr. Matthew Giefer, who directs the Pancreatitis Clinic; Kimberly Braly, RDN, a registered dietitian who specializes in gastrointestinal conditions; and Doris Taylor, RN. They will work with each other and with your family to ensure your child gets the best possible nutrition to support their growing body.

    • The team can guide you to adjust your child’s diet for the best results — for example, your child may do better with small, frequent meals that are low in fat.
    • If your child needs a feeding tube placed through the nose (NG or NJ tube), the team will teach you how to use the tube for feedings and how to take care of it.
    • If your child’s pancreas no longer releases enough digestive enzymes because the organ is damaged, your child may need to take replacement enzymes with each meal.

  • Members of Seattle Children’s Pain Medicine Clinic take part in the Pancreatitis Clinic to help provide effective pain control for children who need it. They use a range of treatment approaches, including medicines and strategies that help children cope with pain or change their pain experience.

  • Your child’s team will use blood tests and stool tests to check the function of your child’s pancreas and tell whether it is changing over time. This will help guide treatment decisions. These tests also give the team information about your child’s risk of long-term effects like diabetes, which may develop if there is damage to cells in the pancreas that produce insulin.

  • When pancreatitis recurs or becomes chronic, it is important that doctors look carefully for the cause and, when possible, treat the underlying condition. For some causes, like genetic changes, there are no treatments at this time. For other causes, like gallstones or problems with the way the pancreas or ducts formed, ERCP or surgery may improve your child’s condition.

    Seattle Children’s has the only pediatric ERCP and pediatric Therapeutic Endoscopy Program in the Pacific Northwest. Giefer is one of the few pediatric providers nationwide who does these specialized endoscopic procedures himself.

    Our surgeons are all board certified in pediatric surgery. They are specially trained to treat children of every age and developmental stage.

  • Seattle Children’s is 1 of 14 pediatric hospitals in the world taking part in the INSPPIRE Pediatric Pancreatitis Research Project to better understand recurrent and chronic pancreatitis in children and develop better treatments.

Contact Us

To make an appointment with Seattle Children’s Gastroenterology and Hepatology, which includes our Pancreatitis Clinic for recurrent or chronic pancreatitis, ask your child’s primary care doctor or another specialist for a referral.

If you have a referral or would like a second opinion, call 206-987-2521.