Etiology and pathogenesis of chronic pancreatitis in adults
- Steven D Freedman, MD, PhD
Steven D Freedman, MD, PhD
- Professor of Medicine
- Harvard Medical School
- Michele D Lewis, MD, MSSc
Michele D Lewis, MD, MSSc
- Assistant Professor of Medicine
- Mayo Clinic Jacksonville
Chronic pancreatitis is a challenging disease that typically presents as chronic unrelenting pain with episodic flares. Although it is sometimes stated that chronic pancreatitis "burns out" over time, the duration of time over which this may occur is highly variable, if it occurs at all [1-4]. In addition, pancreatic endocrine and exocrine dysfunction may develop as the disease progresses, and a variety of complications can occur, including pseudocysts, bile duct or duodenal obstruction, pancreatic ascites, splenic vein thrombosis, and pseudoaneurysms.
The etiology and pathogenesis of chronic pancreatitis will be reviewed here. The clinical manifestations, diagnosis, and treatment of this disorder in adults are discussed separately. (See "Clinical manifestations and diagnosis of chronic pancreatitis in adults" and "Treatment of chronic pancreatitis".)
Chronic pancreatitis is a progressive fibroinflammatory process of the pancreas that results in permanent structural damage, which leads to impairment of exocrine and endocrine function .
Chronic pancreatitis may be divided based on underlying morphology into the following: a large-duct type and a small-duct type with or without calcification.
DIFFERENCES BETWEEN ACUTE AND CHRONIC PANCREATITIS
Acute pancreatitis is an acute inflammatory response to pancreatic injury and is usually nonprogressive. Recurrent episodes of acute pancreatitis may lead to chronic pancreatitis over time. Chronic and acute pancreatitis can be distinguished by several features.
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- DIFFERENCES BETWEEN ACUTE AND CHRONIC PANCREATITIS
- Alcohol abuse
- Cigarette smoking
- Hereditary pancreatitis
- Ductal obstruction
- Tropical pancreatitis
- Systemic disease
- Idiopathic pancreatitis
- Mutations of the cystic fibrosis gene
- Pancreatitis susceptibility genes
- Proteinaceous ductal plugs
- Autoimmune disorders
- INFORMATION FOR PATIENTS