CHRONIC-PANCREATITIS

The aim of this review is to highlight the new developments from the past year regarding pathogenesis, epidemiology, diagnosis, and treatment of chronic pancreatitis. Chronic pancreatitis is a disease of many causes. Although the term chronic calcific pancreatitis has become popular, it is not useful because it describes only one feature of chronic pancreatitis and suggests a single underlying cause of chronic pancreatitis. The pancreatic stone protein (lithostatin) hypothesis to explain the pathogenesis of calcific pancreatitis has received much attention, but remains controversial. Alcohol and diet important to the development of chronic pancreatitis. Decreasing alcohol consumption and ingesting a diet high in carbohydrates and low in fat and protein may prevent chronic pancreatitis. It is unclear whether immune mechanisms also may be important to the pathogenesis of chronic pancreatitis. Two promising new tests of pancreatic function have been introduced (amino acid consumption test and the cholesteryl octanoate breath test), but their accuracy is uncertain. Several studies have been published regarding treatment of pain, including the results of medical (pancreatic enzymes), surgical, and other procedures (endoscopic stents, celiac ganglion blocks). The results of these studies are not comparable because of selection biases and the uncontrolled design of the studies. Treatment of exocrine insufficiency may undergo changes in the near future because of an increasing understanding of the factors that are related to survival of lipolytic activity intraluminally, including nutrients and development of sturdier lipases.