CHRONIC-PANCREATITIS

The pathophysiology of the common forms of chronic pancreatitis (alcoholic and idiopathic) remains unknown but newer molecular techniques may provide insight into the mechanisms of injury. Not all patients with chronic pancreatitis due to alcohol will follow a progressive downhill course but disease progression to end-stage chronic pancreatitis is associated with significant morbidity, mortality, and use of substantial societal resources. Patients with idiopathic chronic pancreatitis appear to have a natural history that is much more benign, with late development of exocrine and endocrine insufficiency. Many patients with chronic pancreatitis will develop progressive injury to acinar cells and small ducts, without any obvious abnormality of the main pancreatic duct. Standard diagnostic tests for chronic pancreatitis are generally unable to diagnose these patients and are also inaccurate in earlier stages of chronic pancreatitis. Treatment of exocrine insufficiency is effective; however, clinicians should be aware of the development of colonic strictures in patients with cystic fibrosis treated with very large doses of high-potency formulations. Treatment of pain is less satisfactory and long-term studies after surgical therapy suggest continued medical and social problems. Endoscopic treatments remain experimental and are associated with substantial short-term and long-term risks. This review focuses on recent observations concerning the pathophysiology, clinical course, and treatment of patients with chronic pancreatitis.