The Pediatrics journal featured an article titled "A Better Understanding of Pediatric Autoimmune Pancreatitis: Over 13 Years of Experience," authored by Tirado et al., in its May 2023 issue. This article aimed to compare the efficacy of the 2011 International Consensus Diagnostic Criteria (ICDC) for Autoimmune Pancreatitis with the 2018 INSPPIRE criteria (International Study Group of Pediatric Pancreatitis: In search for a cuRE) in diagnosing pediatric autoimmune pancreatitis (P-AIP).
The research team conducted a retrospective analysis of 11 children diagnosed with AIP between 2008 and 2021, admitted to two tertiary hospitals. The analysis encompassed the patients' demographic information, along with clinical, laboratory, radiological, and histological findings.
Among the 11 children, six were girls, and the median age at diagnosis was 12.5 years (ranging from 2.8 to 15.7 years). Abdominal pain emerged as the most prevalent symptom, and pancreatic enzyme elevation was observed in 10 patients. In one patient, serum immunoglobulin G4 levels were elevated. Magnetic resonance imaging revealed pancreatic head enlargement in 10 patients, while one patient exhibited general pancreatic enlargement. Tissue samples from the pancreas and papilla were collected from nine patients. All patients received corticosteroids (prednisolone), and four patients also received azathioprine. Applying the ICDC, all patients were categorized as probable or non-otherwise specified AIP. However, based on the INSPPIRE criteria, all patients were classified as having AIP. By utilizing the INSPPIRE criteria, unnecessary biopsies could have been avoided in six patients who positively responded to corticosteroid treatment.
The findings from this study indicate that the implementation of the INSPPIRE criteria contributed to the accurate diagnosis of P-AIP. Relying solely on the ICDC in pediatric cases might cause delays in diagnosis and unnecessary invasive tests. The use of the INSPPIRE criteria enables a prompt diagnosis of P-AIP, thereby helping to prevent unnecessary procedures in children suspected of having autoimmune pancreatitis.
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