Pediatric Longitudinal Cohort Study of Chronic Pancreatitis

Inclusion Criteria:

1. All patients/parents must sign an informed consent and/or assent indicating that they
are aware of the investigational nature of this study.

2 Patients/parents must have signed an authorization for the release of their or their
child's protected health information.

3 All children providing samples should fit the ARP or CP inclusion criteria defined below.

4 All children must be under 18 years of age at the time of enrollment.

Acute pancreatitis (AP): AP is defined as requiring 2 of the following:

   1. Abdominal pain compatible with AP,

   2. Serum amylase and/or lipase values ≥3 times upper limits of normal,

   3. Imaging findings of AP, such as gland enlargement, acute inflammatory changes, and
   fluid collections.

ARP is defined as:

At least 2 episodes of acute pancreatitis with complete resolution of pain and a >1 month
pain-free interval between episodes.

Chronic Pancreatitis:

Children with at least:

1. One irreversible structural change* in the pancreas with or without abdominal pain +/-
exocrine pancreatic insufficiency +/- diabetes.

*irreversible structural changes:

   - Ductal calculi, dilated side branches, parenchymal calcifications found in any imaging
   (abdominal ultrasound (abd US), magnetic resonance imaging/magnetic resonance
   cholangiopancreatography (MRI/MRCP), computerized tomography (CT), endoscopic
   retrograde cholangiopancreatography (ERCP), endoscopic US (EUS).

   - Ductal obstruction or stricture/dilatation/irregularities that are persistent (for >2
   months) on any imaging.

   - Parenchymal atrophy, irregular contour, accentuated lobular architecture, cavities
   alone are not diagnostic findings for CP.

   - Surgical or pancreatic biopsy specimen demonstrating histopathologic features
   compatible with CP (acinar atrophy, fibrosis, protein plugs, infiltration with
   lymphocytes, plasma cells, macrophages).

Exclusion Criteria:

   - Patients must not have any significant medical illnesses that in the investigator's
   opinion cannot be adequately controlled with appropriate therapy or would compromise
   the patient's ability to tolerate study interventions.