**1. Introduction**

Pediatric pancreatitis has increased in incidence during last decades and 1/10,000 children per year is affected by the acute form genetic mutations and congenital abnormalities represent the major risk factors for this disease but there is no agreement about a certain pathogenetic theory. The reasons of pancreatitis' burden in pediatric population may be multifactorial and it can be explained by an improved detection instead of a real increase [1].

In children, pancreatitis is categorized as acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Here we summarize recent advances in the field of pediatric pancreatitis with focus on etiologies, pathogenesis, diagnosis and therapy.

## **2. Acute pancreatitis**

Acute pancreatitis (AP), in children is increasingly recognized to be a challenge for affected patients and their families, their treating physicians and surgeons, and the health care system. The incidence of pediatric AP was estimated at 3.6–13.2 per

100,000 per children per year, which is within of the range of incidence reported for adult AP. Genetic contributions to the development of pancreatitis, especially in acute recurrent and chronic pancreatitis are now increasingly recognized. There are no evidence-based diagnostic guidelines for pancreatic disorders in children. The diagnosis criteria are based on symptoms, biochemical and imaging evidence of pancreatitis, with two of the three criteria required to diagnose AP. A multicenter effort led by INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE) defined AP as requiring 2 of: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP. Although abdominal pain is the most common clinical manifestation, it may be absent in up to one third of pediatric patients. The diagnostic yield and concordances for serum pancreatic enzymes and imaging for the diagnosis of pediatric AP will be discusses. Pediatric AP is associated with significant disease burden. There is currently no consensus on the definition for severity of AP in children. However, there are now predictors of severity for AP that has been developed and validated in children. The management of AP remains driven by adult studies and recommendations. Treatment is directed at the underlying etiologies as well as supportive measures.
