Central Journal of Family Medicine & Community Health Research Article *Corresponding author Karin N. Westlund, Department of Physiology, University of Kentucky, MS-508 Medical Science Building, 800 Prevalence of Pancreatitis in Rose, Lexington, KY, 40536-0298, USA, Tel: 859-323-0672 or -33668; Email: Submitted: 23 August 2016 Female and Male Pediatric Accepted: 10 November 2016 Published: 12 November 2016 Patients in Eastern Kentucky in ISSN: 2379-0547 Copyright the United States © 2016 Westlund et al. OPEN ACCESS Sabrina L. McIlwrath and Karin N. Westlund* Department of Physiology, University of Kentucky, USA Keywords • Epidemiology • Gender difference Abstract • Recurrent acute pancreatitis Background & aims: Studies in the past decade report worldwide increase of • Tobacco use pediatric pancreatitis. The present study focuses on aUnited States region where the • Obesity first genes associated with hereditary pancreatitis were identified. Aim of the study was to investigate incidences of acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis, collecting demographics, etiologies, and comorbid conditions using charted ICD-9-CM codes. Methods: Retrospective chart review was performed on de-identified patient records of hospitalizations at University of Kentucky hospitals between 2005 and 2013. Results: Of 234 children diagnosed during the 9 year time period, 69.2% (n=162) had a single episode of acute, 27.8% (65) recurrent acute, and 16.2% (38) chronic pancreatitis. Surprisingly, the annual incidence for first time diagnosis of acute pancreatitis was significantly higher for female patients (16.1, 95% CI: 13.5- 18.7 per 100,000, P<0.005) compared to males (9.1, 95% CI: 6.8-11.4). Comorbid conditions varied widely depending on patients’ age. Between 33.3-46.2% presented with digestive system symptoms, 12.8-26.3% with diseases of stomach and duodenum, and 10.6-31.6% with systemic diseases. Biliary disease was the most common etiology for single acute (28.4% of cases) and recurrent acute pancreatitis (16.9% of cases). Nineteen of 65 patients with recurrent acute pancreatitis developed chronic pancreatitis (29.2%), while only 3 of 162 with a single bout of acute pancreatitis returned with chronic pancreatitis (P<0.0001). Conclusions: These findings identify a prevalent disease progression from recurrent acute pancreatitis to chronic pancreatitis in the Kentucky pediatric patient population that could be due to hereditary predisposition and other geographically relevant health factors. ABBREVIATIONS AP: Acute Pancreatitis; BMI: Body Mass Index; CCTS: Center a mean age of 57 [1,2]. It is generally categorized into reversible for Clinical and Translational Science; CDC: Center For Disease acute (AP) and irreversible chronic pancreatitis (CP) [3-6]. Several Control; CFTR: Cystic Fibrosis Transmembrane Conductance recent studies have investigated the population-based incidence of pancreatitis in pediatric patients. Predominantly conducted in metropolitan areas, an incidence rise of pediatric cases has been Regulatory; CI: Confidence Interval; CLDN2: Claudin; CP: Chronic reported between 1990 and 2005 [6-10]. It has been speculated Pancreatitis; CPA1: Carboxypeptidase A1; CTRC: Chymotrypsin; that this increase may be due to an epidemiological increase or ICD-9-CM: International Classification of Diseases, Ninth Revision, improved clinical awareness. Clinical Modification; PRSS1: Protease, Serine 1; SPINK1: Serine PeptidaseINTRODUCTION Inhibitor, Kazal-type 1; UK: University of Kentucky The population of Kentucky is of special interest to the study of pancreatitis as the first gene mutations associated with hereditary pancreatitis were identified in a kindred living in eastern Pancreatitis is a progressive inflammatory disease of the Kentucky and western Virginia in the United States of America pancreas with the highest incidence in older male patients with [11,12]. These autosomal-dominant mutations are associated Cite this article: McIlwrath SL, Westlund KN (2016) Prevalence of Pancreatitis in Female and Male Pediatric Patients in Eastern Kentucky in the United States. J Family Med Community Health 3(5): 1092. Westlund et al. (2016) Email: Central with the onset of recurrent AP and CP in children by the age of Powell, Pulaski, Robertson, Rockcastle, Rowan, Russell, Wayne, 5-10 years [10,13-15]. The University of Kentucky, Lexington, Whitley, Wolfe). USA, hospitals and clinics serve a catchment area located in Data source eastern and central Kentucky. In contrast to previous studies, 2/3 of the population resides in rural Appalachian counties and Patient records from University of Kentucky HealthCare only 1/3 in urban counties. The aim of our retrospective chart review study of the 9-year period between 2005 and 2013 was to examine the frequency and clinical characteristics of pancreatitis coreClinical facility data of were the Universityextracted and of Kentucky de-identified Center by forthe Clinical biomedical and in this pediatric population. Translationalintelligence reporting Science (CCTS)officers center.within theData Biomedical from patients Informatics treated at the University of Kentucky hospitals in Lexington, Kentucky, METHODS were available starting January 2005 onward. Patient data sets contained demographic information (age, sex, race, county of for hospitalizations was approved by the Institutional Review residence, marital and employment status, payment source), data BoardThe of retrospective the University chart of review Kentucky of de-identified (protocol No. patient 14-0061- data of admission, discharge (date, discharge disposition, inpatient X2B). It was conducted using archival database information for mortality), diagnoses codes. admissions at the University of Kentucky (UK) hospitals and Inclusion criteria clinics in Lexington, the second largest city in Kentucky. The Patients with pancreatitis were diagnosed by the treating of the population sought treatment at the University of Kentucky physician. To identify and characterize incidence and prevalence catchment area was defined as counties from which at least 5% of comorbid diseases, disorders, and symptoms, ICD-9-CM accordance with the US census bureau [16]. Within the catchment codes were investigated in accordance with the International areahospitals there and are clinics. 10 urban Counties counties were classified(Anderson, as urbanBourbon, or rural Boyle, in Fayette, Franklin, Harrison, Jessamine, Mercer, Scott, Woodford) (ICD-9-CM), as listed in (Table 1). All patients under the age of 20 Classification of Diseases, Ninth Revision, Clinical Modification and 45 rural Appalachian counties (Bath, Bell, Breathitt, Carter, treated between January 2005 to December 2013, who received Casey, Clark, Clay, Clinton, Elliott, Fleming, Floyd, Garrard, Harlan, a charted diagnosis of either acute pancreatitis (ICD-9-CM 577.0) Jackson, Johnson, Knott, Knox, Laurel, Lawrence, Lee, Leslie, or chronic pancreatitis (ICD-9-CM 577.1), were included in this study. Recurrent acute pancreatitis does not have a separate Menifee, Montgomery, Morgan, Nicholas, Owsley, Perry, Pike, ICD-9-CM code. Typically it is described as the incidence of two Letcher, Lewis, Lincoln, Madison, Magoffin, Mason, McCreary, Table 1: ICD-9-CM codes of diseases, disorders, and symptoms investigated in the pediatric patients. Generalized disease/disorder name ICD-9-CM codes Acute pancreatitis 577.0 Chronic pancreatitis 577.1 Abdominal pain 789.00-789.09, 789.60-789.69 Anemia 280-285 Anxiety and depression 300, 311 Biliary disease (cholelithiasis & disorders of the gallbladder and biliary tract) 574-576 780.79, 783.21, 783.22, 783.40, 783.41, 783.7, 799.3, Cachexia (malaise, fatigue, cachexia) 799.4 Cardiovascular symptoms (congenital symptoms & abnormal heartbeat) 745, 746, 747, 780.2, 785.0-785.3, 785.9 V83.81, 277.0, 753.10-753.19 Diabetes mellitus 249- 250 Cystic fibrosis (cystic fibrosis & polycystic kidney disease) Disease of stomach & duodenum (gastritis &duodenitis, stomach, stomach & duodenum) 535-537 Disease of the lung (chronic bronchitis, emphysema, asthma) 491-493 Disorder of the kidneys (chronic kidney disease, hydronephrosis, calculus of kidney & 585, 591-593 ureter) 530.18 Hepatitis 070 Gastroesophageal reflux disease V08, 042 Hyperlipidemia 272.0-272.4 Human immunodeficiency virus infection 555-556, 564.1 Liver disease (non-alcoholic liver disease& necrosis) 570, 571.40-571.9, 572-573 Inflammatory bowel disease Lupus 710.0 Obesity V85.30-V85.54, 278.00-278.01 Other pancreatic disease (cysts & other diseases of the pancreas) 577.2, 577.8, 577.9 038, 995.90-995.94 Digestive system symptoms (diarrhea, vomiting, nausea) 787.01-787.03, 787.60, 787.7, 787.91, 787.99 Sepsis (septicimia& systemic inflammatory response syndrome) Tobacco use disorder V15.82, 305.1 J Family Med Community Health 3(5): 1092 (2016) 2/7 Westlund et al. (2016) Email: Central or more episodes of AP with a documented resolution of pain and normalization of enzymes. As this cannot be assessed in acute pancreatitis separated by a minimum of 2 months. All other patientsthe present under study, the weage defined of 20 were recurrent combined AP asin theat least control 2 bouts group. of Race of the patients in this study was not a factor considered since rural counties are over 90% white and urban counties are ~80%Statistical white. analysis All normally distributed data are presented as mean ± Data were compared using Student’s t-test or Chi square test whenstandard appropriate. error or mean Analysis