Chronic pancreatitis

• Published in: Nature reviews. Disease primers Vol. 3; no. 1; p. 17060
• Main Authors: Kleeff, Jorg, Whitcomb, David C., Shimosegawa, Tooru, Esposito, Irene, Lerch, Markus M., Gress, Thomas, Mayerle, Julia, Drewes, Asbjørn Mohr, Rebours, Vinciane, Akisik, Fatih, Muñoz, J. Enrique Domínguez, Neoptolemos, John P.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 07.09.2017; Nature Publishing Group
• Subjects: 692/4020/2741/416; 692/420/256/2515; 692/699/1503/1712/1714/2103; 692/700/1421; 692/700/565/2775; Cancer Research; Cysts; Epidemiology; Humans; Inflammation; Internal Medicine; Medical Microbiology; Medicine; Medicine & Public Health; Pancreas; Pancreatitis; Pancreatitis, Chronic - diagnosis; Pancreatitis, Chronic - epidemiology; Pancreatitis, Chronic - physiopathology; Pancreatitis, Chronic - therapy; Pathophysiology; primer; Quality of Life Research; Risk Factors
• ISSN: 2056-676X; 2056-676X
• DOI: 10.1038/nrdp.2017.60

Chronic pancreatitis is defined as a pathological fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathological responses to parenchymal injury or stress. Potential causes can include toxic factors (such as alcohol or smoking), metabolic abnormalities, idiopathic mechanisms, genetics, autoimmune responses and obstructive mechanisms. The pathophysiology of chronic pancreatitis is fairly complex and includes acinar cell injury, acinar stress responses, duct dysfunction, persistent or altered inflammation, and/or neuro-immune crosstalk, but these mechanisms are not completely understood. Chronic pancreatitis is characterized by ongoing inflammation of the pancreas that results in progressive loss of the endocrine and exocrine compartment owing to atrophy and/or replacement with fibrotic tissue. Functional consequences include recurrent or constant abdominal pain, diabetes mellitus (endocrine insufficiency) and maldigestion (exocrine insufficiency). Diagnosing early-stage chronic pancreatitis is challenging as changes are subtle, ill-defined and overlap those of other disorders. Later stages are characterized by variable fibrosis and calcification of the pancreatic parenchyma; dilatation, distortion and stricturing of the pancreatic ducts; pseudocysts; intrapancreatic bile duct stricturing; narrowing of the duodenum; and superior mesenteric, portal and/or splenic vein thrombosis. Treatment options comprise medical, radiological, endoscopic and surgical interventions, but evidence-based approaches are limited. This Primer highlights the major progress that has been made in understanding the pathophysiology, presentation, prevalence and management of chronic pancreatitis and its complications. Chronic pancreatitis is characterized by chronic inflammation of the pancreas that results in progressive scarring of the pancreatic tissue, pain and pancreatic gland dysfunction. In this Primer, Kleeff et al . describe the current understanding of chronic pancreatitis and its complications.