Progression from acute to chronic pancreatitis

In the latter, the pathogenesis is less clear but a high intake of alcohol over several years results in toxic effects on pancreatic acinar and stellate cells, and biochemical changes in pancreatic secretions that facilitate the formation of pancreatic plugs. Chronic pancreatitis is the end result o...

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Bibliographic Details
Published in:JGH open 2021-12, Vol.5 (12), p.1321-1322
Main Author: Roberts‐Thomson, Ian C
Format: Article
Language:English
Subjects:
Alcohol
Bile ducts
Calcification
Cholecystectomy
Chronic illnesses
Diabetes
Endoscopy
Gallbladder diseases
Inflammation
Pancreatic cancer
Pancreatitis
Pathogenesis
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Summary:In the latter, the pathogenesis is less clear but a high intake of alcohol over several years results in toxic effects on pancreatic acinar and stellate cells, and biochemical changes in pancreatic secretions that facilitate the formation of pancreatic plugs. Chronic pancreatitis is the end result of continuing pancreatic inflammation and is characterized by extensive fibrosis that replaces exocrine cells and, to a lesser extent, endocrine cells in pancreatic islets. 4,5 Common clinical features are chronic pain, steatorrhea, nutritional deficiencies, analgesic addiction (particularly opiods) and diabetes. An exception is the reduced frequency of pancreatitis after ERCP in patients given non-steroidal, anti-inflammatory drugs or treated with pancreatic stents. 7 After acute alcoholic pancreatitis, cessation of alcohol and smoking reduce the risk of progression to recurrent acute and chronic disease. 8,9 In patients with mild biliary pancreatitis, same-admission cholecystectomy rather than later (interval) cholecystectomy (with or without ERCP) also reduces the risk of recurrence. 10 Longer-term treatment with corticosteroids may prevent progression to chronic pancreatitis in patients with autoimmune pancreatitis, although the natural history of this disorder is highly variable. 11 In idiopathic pancreatitis presumed to be caused by sphincter dysfunction, endoscopic or operative procedures to facilitate duct drainage continue to evoke debate and may not avoid progression to chronic pancreatitis. 12 Ongoing challenges include a better understanding of the pathogenesis of idiopathic pancreatitis, effective medication to avoid severe necrotizing pancreatitis and better ways to diagnose and treat the persistent inflammation that results in chronic disease.
ISSN:2397-9070
2397-9070
DOI:10.1002/jgh3.12698