3.4　Clinical Manifestations

The main clinical symptom from CP in children is pain that ranges from mild to severe，episodic to constant（Schwarzenberg et al.2015）.In the INSPPIRE population，36%of children with ARP and 72%with CP received pain medications.Acetaminophen and ibuprofen were the leading pain medications for ARP while patients with CP utilized acetaminophen and hydrocodone for pain（Kumar et al.2016）.The disease burden was higher in CP compared with ARP（more emergency department visits，hospitalizations，missed school days，medical，endoscopic and surgical interventions）.(https://www.daowen.com)

Children with CP also report other gastrointestinal symptoms including indigestion，nausea，vomiting，weight loss，diarrhea，steatorrhea，symptoms related to diabetes.In general，GI symptoms are attributed to impaired pancreatic duct drainage caused by duct strictures，fibrosis，calcification，etc.（Troendle and Barth 2016）.In a subset of patients，pancreatic duct is of normal caliber and symptoms are attributed to small duct or“minimal change”disease（Wilson et al.2015）.The management is based on the underlying etiology，disease course and whether CP is manifesting as small or large duct disease（Troendle and Barth 2016）.