Journal Article

Chronic pancreatitis

McMahon, Michael J, Braganza, Joan M, McCloy, Rory F, Lee, Stephen H

2011

Overview

Chronic pancreatitis is a progressive fibroinflammatory disease that exists in large-duct (often with intraductal calculi) or small-duct form. In many patients this disease results from a complex mix of environmental (eg, alcohol, cigarettes, and occupational chemicals) and genetic factors (eg, mutation in a trypsin-controlling gene or the cystic fibrosis transmembrane conductance regulator); a few patients have hereditary or autoimmune disease. Pain in the form of recurrent attacks of pancreatitis (representing paralysis of apical exocytosis in acinar cells) or constant and disabling pain is usually the main symptom. Management of the pain is mainly empirical, involving potent analgesics, duct drainage by endoscopic or surgical means, and partial or total pancreatectomy. However, steroids rapidly reduce symptoms in patients with autoimmune pancreatitis, and micronutrient therapy to correct electrophilic stress is emerging as a promising treatment in the other patients. Steatorrhoea, diabetes, local complications, and psychosocial issues associated with the disease are additional therapeutic challenges.

• Publisher: Elsevier Ltd,Elsevier,Elsevier Limited
• Subject: Abdominal Pain - etiology / Abdominal Pain - therapy / acinar cells / alcohols / Algorithms / analgesics / Animals / Anti-Inflammatory Agents - therapeutic use / Autoimmunity / Biological and medical sciences / Biomarkers - blood / calculi / Cholangiopancreatography, Endoscopic Retrograde / cigarettes / cystic fibrosis / Cysts / diabetes / Diabetes Mellitus - etiology / Diabetes Mellitus - therapy / Disease Models, Animal / Disease Progression / Drainage / Endoscopy, Digestive System / Enzymes / exocytosis / Fibrosis / Free radicals / Gastroenterology. Liver. Pancreas. Abdomen / General aspects / genes / Genetic factors / Genetic Predisposition to Disease / Histology / Humans / Internal Medicine / Ischemia - complications / Liver. Biliary tract. Portal circulation. Exocrine pancreas / Magnetic Resonance Imaging / Medical sciences / Micronutrients - therapeutic use / Mortality / Mutation / Other diseases. Semiology / Pain / Pancreas / Pancreas - blood supply / Pancreas - metabolism / Pancreas - pathology / Pancreatectomy / Pancreaticojejunostomy / pancreatitis / Pancreatitis, Acute Necrotizing / Pancreatitis, Alcoholic / Pancreatitis, Chronic - classification / Pancreatitis, Chronic - complications / Pancreatitis, Chronic - diagnosis / Pancreatitis, Chronic - etiology / Pancreatitis, Chronic - metabolism / Pancreatitis, Chronic - pathology / Pancreatitis, Chronic - therapy / paralysis / patients / Prednisolone - therapeutic use / Risk Factors / Rodents / Signal transduction / Smoking - adverse effects / Steatorrhea - etiology / Steatorrhea - therapy / steroids / Surgery / therapeutics