Non-Alcohol-Related Etiologies in Chronic Pancreatitis

Despite numerous experimental and clinical investigations there is no consensus on the evolution of chronic pancreatitis (CP). In the 1970s and 1980s, Sarles persistently emphasised the de novo evolution of CP due to pancreatolithiasis. In recent years, however, clinical and morphological studies have provided strong evidence for the initial proposal of acute pancreatitis progressing to chronic pancreatitis. The so-called necrosis-fibrosis-sequence theory is supported by immunohistochemical work suggesting that inflammatory mediators primarily contribute to tissue destruction and that infiltration of pancreatic nerves by immune cells is a pathogenetic factor for the generation of pain in CP. While Sarles postulates that acinar hypersecretion and an imbalance of pancreatic stone promoting and inhibiting factors trigger the evaluation of CP, the necrosis-fibrosis-sequence theory also involves other pathomechanisms (e.g. changes in ductal permeability, ischemia, oxidative stress) which have been shown to cause (acute) pancreatic injury. Despite this unifying template, which also lessens the need to identify independent mechanisms for the pathogenesis of acute and chronic alcoholic pancreatitis, there are still open questions, e.g. on genetic factors that (like in hereditary CP) may explain the different susceptibility of the pancreas to injury and the individual immunological response.

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“…CP auf dem Boden anderer Ursachen sind selten [35,54]. Die hereditäre CP manifestiert sich typischerweise zwischen dem 5. und 15.…”

Section: ä Tiologieunclassified

Neue Aspekte in der Pathophysiologie der chronischen Pankreatitis

Foitzik

Buhr

1997

Chirurg

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confidence: 99%

“…The next most frequent type is so called idiopathic chronic pancreatitis (ICP), which comprises 10–40% of all cases and has no known cause 2. In rare cases factors such as heredity, hypercalcaemia, or an autoimmune background may play a role 2. Moreover, in some parts of India and Africa there is a particular type of chronic pancreatitis that is not associated with any of the factors known in Western countries 2.…”

mentioning

confidence: 99%

“…In rare cases factors such as heredity, hypercalcaemia, or an autoimmune background may play a role 2. Moreover, in some parts of India and Africa there is a particular type of chronic pancreatitis that is not associated with any of the factors known in Western countries 2. This type of chronic pancreatitis occurs in children and adolescents and is thought to be caused by malnutrition.…”

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confidence: 99%

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Non-alcoholic duct destructive chronic pancreatitis

Ectors

Maillet

Aerts

et al. 1997

Gut

277

176

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Background-The pathology of nonalcoholic chronic pancreatitis has not yet been suYciently studied. Aims-To identify the major changes of pancreatic tissue in patients surgically treated for non-alcoholic chronic pancreatitis. Patients-Pancreatectomy specimens from 12 patients with non-alcoholic chronic pancreatitis, including four patients with autoimmune or related diseases (Sjögren's syndrome, primary sclerosing cholangitis, ulcerative colitis, and Crohn's disease), were reviewed. Methods-Morphological changes were studied histologically and immunohistochemically (to type inflammatory cells) and compared with the pancreatic alterations found in 12 patients with alcoholic chronic pancreatitis. Results-In patients with non-alcoholic chronic pancreatitis, with or without associated autoimmune or related diseases, pancreatic inflammation particularly involved the ducts, commonly resulting in duct obstruction and occasionally duct destruction. None of these features was seen in alcoholic chronic pancreatitis which, however, showed pseudocysts and calcifications. Conclusion-The pancreatic changes in patients with non-alcoholic chronic pancreatitis clearly diVer from those with alcoholic chronic pancreatitis. The term chronic duct destructive pancreatitis is suggested for this type of pancreatic disease.

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