1. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Dóra Mosztbacher on behalf of the Hungarian Pancreatic Study Group SZEKSZÁRD, HUNGARY Pain IN EArly phase of Pediatric Pancreatitis Pain in early phase of pediatric pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE

2. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE 1.The protocols have been discussed in our latest international meeting held in Szeged in November 2014, where expert pediatric pancreatologists attended. ( http://pancreas.hu/sites/info/files/conferences/ALPD2014-Program.pdf ) http://pancreas.hu/sites/info/files/conferences/ALPD2014-Program.pdf 2.The studies have received the relevant ethical approval (No. ad.52499-3/2014) issued by the National Hungarian Ethical Authority (ETT TUKEB). 3.The trials have been registered at the ISRCTN registry (ISRCTN35618458, ISRCTN89664974) which is a primary clinical trial registry recognized by WHO and ICMJE. 4.The studies are open for all pediatric centers throughout the world. 5. Electronic CRF has been developed. 6.The IAP Scientific Committee has approved the studies and advertised worldwide among its 4000 members (16.06.2015) 7.The TRIAL articles (prestudy protocol) are under review

3. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE appendicitis invagination trauma malrotation inguinal hernia adhesio NEC Hirschprung ectopic pregnancy peptic ulcus uroinfection PID ruptured ovarial cyst menstruation DKA HUS myocarditis obstipation gastroenteritis Streptococcus pharyngitis pneumonia mesenterial lymphadenitis IBD pancreatitis cholecystitis IBD abd. abscess malabsorption HSP nutritiv allergy hepatitis Meckel diverticulum urolythiasis tumor ovarial/testicle torsion Sickle cell anaemia

4. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE 1. In case of abdominal pain we should think about it 2/3 rule 2. Diagnosis: 2/3 rule (Under 3 years old just 30% of patients have complains) Pancreatic oedema by abdominal imaging (Morinville VD, Pancreas 2010; 39:5-8) (INSPPIRE, JPGN 2012;55:261-265) Abdominal pain Elevated pancreatic enzyme levels (3 times upper than the normal)

5. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE Rising incidence Rising incidence in the last 15 years (3.6 and 13.2 cases per 100,000 children). is NOT a rare Pancreatitis is NOT a rare disease in childhood! the cause is not clearly understood, probably multifactorial

6. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE RARELY DIAGNOSED The pediatric pancreatitis is a RARELY DIAGNOSED disease in Central- and Eastern Europe Reasons: The incidence of the disease rises from Eastern- to Western Europe. Financial difficulties We do not think about pancreatitis There are no EBM guidelines available The number of serum amylase/ lipase measurement correlates with the incidence of the disease! (Morinville VD, JPGN; 2012) The number of serum amylase/ lipase measurement correlates with the incidence of the disease! (Morinville VD, JPGN; 2012)

7. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE-R RETROSPECTIVELY RETROSPECTIVELY look into our diagnostic practice by overviewing 1-month patient flows of medical and surgical emergency units. The number of serum amylase and lipase measurement correlates with the incidence of the disease. It will decrease from Western to Eastern Europe

8. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups According to patients data, the PINEAPPLE-R excel table PINEAPPLE-R excel table should be filled in and sent. Diagnosis Abdominal pain Nausea Vomiting Pancreatic enzyme measurements Imaging Yes or No PINEAPPLE-R

9. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE

10. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE To provide a fast, simple and authentic scoring system that helps to evaluate (in a reliable and cost efficient way) the necessity of pancreatic enzyme test and abdominal ultrasonography or CT when a child has abdominal pain. WE HOPEFULLY WILL BE ABLE WE HOPEFULLY WILL BE ABLE to draft the score system PINEAPPLE-P

11. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups “PINEAPPLE-P Informed consent form” The patient needs to be informed and the “PINEAPPLE-P Informed consent form” needs to be signed. “PINEAPPLE-P ENG FORM-A” questionnaire PINEAPPLEPINEAPPLE-P

12. Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLEPINEAPPLE-P Thank you for joining to us! We are waiting for more centres!!!

13. THE HUNGARIAN PANCREATIC STUDY GROUP IS COMMITTED TO IMPROVING THE LIVE OF PATIENTS SUFFERING FROM PANCREATIC DISEASES! www.pancreas.hu Hungarian Pancreatic Study Group – Magyar Hasnyálmirigy Munkacsoport Pain IN EArly phase of Pediatric Pancreatitis 4 th Conference of the Hungarian & 2 nd Conference of the Eastern and Central European Pancreatic Study Groups PINEAPPLE