Pathophysiology of chronic pancreatitis

Abstract

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterized by progressive fibrotic destruction of the pancreatic secretory parenchyma. Despite the heterogeneity in pathogenesis and involved risk factors, processes such as necrosis/apoptosis, inflammation or duct obstruction are involved. This fibrosing process ultimately leads to progressive loss of the lobular morphology and structure of the pancreas, deformation of the large ducts and severe changes in the arrangement and composition of the islets. These conditions lead to irreversible morphological and structural changes resulting in impairment of both exocrine and endocrine functions. The prevalence of the disease is largely dependent on culture and geography. The etiological risk-factors associated with CP are multiple and involve both genetic and environmental factors. Throughout this review the M-ANNHEIM classification system will be used, comprising a detailed description of risk factors such as: alcohol-consumption, nicotine-consumption, nutritional factors, hereditary factors, efferent duct factors, immunological factors and miscellaneous and rare metabolic factors. Increased knowledge of the different etiological factors may encourage the use of further advanced diagnostic tools, which potentially will help clinicians to diagnose CP at an earlier stage. However, in view of the multi factorial disease and the complex clinical picture, it is not surprising that treatment of patients with CP is challenging and often unsuccessful.

Extensive Molecular Analysis Suggested the Strong Genetic Heterogeneity of Idiopathic Chronic Pancreatitis

“…Valentina Maria Sofia, 1 Letizia Da Sacco, 2 Cecilia Surace, 1 Anna Cristina Tomaiuolo, 1 Silvia Genovese,…”

“…Furthermore, in the last decade, hereditary pancreatitis (HP), pancreatitis with no other etiology that appears in more members of the family (5), has been described and is frequently associated iNTRoDUCTioN Chronic pancreatitis (CP) is a persistent inflammatory disease in which exocrine acinar tissue is gradually replaced by fibrotic tissue (1). The annual incidence of CP in adults is estimated to be 5-12 per 100,000 inhabitants each year in Japan, Europe and the United States (2).…”

Pancreatic Acinar and Island Vascular Apparatus Associated with Acute and Chronic Inflammatory Processes

“…However, a molecular study has referred to important role of genetic polymorphism in the pathobiology of pancreatic diseases. [8] Several studies proved that the prevalence of chronic pancreatitis tends toward 0.6% in several countries of Europe and United States [8,9], with an annual incidence of 10 cases for 100000 persons [10]. The most frequent factors that may lead to the appearance of chronic pancreatitis are: the obstruction of main excretory ducts, autoimmunity or individual risk factors (working and life conditions, alcohol consumption, smoking, different drugs, etc.)…”

Systematic review and meta-analysis of islet autotransplantation after total pancreatectomy in chronic pancreatitis patients [Review]

“…Its pathological features are atrophy and damage of pancreatic acinar and interstitial fibrosis [1]. The main clinical symptoms are recurrent abdominal pain and (or) endocrine dysfunction of the pancreas, these can be accompanied with pancreatic parenchyma calcify, dilated pancreatic duct and pancreatic pseudocyst, etc.…”