Understanding the Causes of Chronic Pancreatitis

What is Chronic Pancreatitis?

Chronic pancreatitis is a persistent inflammatory disease affecting the pancreas. It's characterized by the progressive fibrotic replacement of pancreatic gland tissue, eventually leading to endocrine and exocrine insufficiency. Between 5 and 10 out of 100,000 people are affected each year, with sex differences varying depending on the specific form of the disease. It generally affects those over 40-50 years old, but there are also forms that begin at a younger age, such as those associated with genetic mutations.

For a long time, chronic pancreatitis was believed to be caused by alcohol abuse, as symptoms include pain in the early stages and endocrine and exocrine insufficiency in more advanced stages. Today, gastroenterology experts explain how, thanks to new imaging techniques, it has been possible to identify the different forms of this disease over the past twenty years and to choose the most appropriate therapy for each.

What Causes Chronic Pancreatitis?

For years, doctors and researchers believed chronic pancreatitis was caused by alcohol abuse in Western countries, and therapy focused on reducing painful symptoms and addressing pancreatic dysfunction. However, modern diagnostic techniques combined with molecular biology have identified new forms of chronic pancreatitis:

• Paraduodenal pancreatitis;
• Pancreatitis associated with genetic mutations;
• Autoimmune pancreatitis;

These three types differ not only morphologically but also, and especially, clinically. This discovery has led to the understanding that this disease doesn't have a purely chronic origin but rather an acute one (in most cases), progressing to a chronic state following ductal and parenchymal alterations.

The main factor promoting the onset and progression of chronic pancreatitis is impaired pancreatic flow into the duodenum, initiating an obstructive mechanism that includes:

• Sphincter of Oddi dysfunction;
• Neoplastic alterations of the ductal system and pancreatic papilla;
• Consequences of pancreatic necrosis scarring;
• Genetic mutations;
• Chronic immunological process;

As can be seen, alcohol and cigarettes play no role in the etiology of this disease. Rather, they are pathogenic factors that promote the appearance of cystic fibrosis and the formation of pancreatic calcifications, exacerbating the typical painful symptoms of chronic pancreatitis and accelerating disease progression to exocrine insufficiency.

GET A QUOTE

Need more information?

Recognizing Chronic Pancreatitis

Symptoms of Chronic Pancreatitis

Chronic pancreatitis is characterized by epigastric pain that can be sporadic or continuous in the early stages. However, with aging, diabetes and steatorrhea (the presence of undigested fatty substances in the stool), symptoms of endocrine and exocrine insufficiency respectively, will begin to appear.

How is Chronic Pancreatitis Diagnosed?

In 5 to 10% of patients, the diagnosis of chronic pancreatitis is not made in the early stages but only when signs of diabetes and steatorrhea begin to appear or following completely nonspecific symptoms. Fortunately, thanks to scientific and medical advancements, this percentage is decreasing over time as it becomes increasingly possible to document the causes of idiopathic forms, particularly those due to biliary or ductal causes.

Why is Early Diagnosis of Chronic Pancreatitis Important?

Acute pancreatitis represents a medical challenge not only for its diagnosis but also for choosing the best therapeutic approach. Since pancreatitis is characterized by a progressive process, initially acute, then recurrent, and finally chronic, if diagnosed in the chronic and therefore late phase, it is difficult to establish the initial type and therefore guide the patient toward the most appropriate treatment.

Treatment and Prognosis of Chronic Pancreatitis

Treatment aims to prevent the progression of pancreatic damage, relieve painful symptoms, and avoid the loss of endocrine and exocrine pancreatic functions.

The first objective can be achieved by correcting risk factors.

Managing chronic abdominal pain is often frustrating and a significant therapeutic challenge.

Here are some general indications regarding chronic pancreatitis:

• Analgesics: The initial approach should involve non-addictive medications before resorting to narcotics, which may be necessary for severe pain;
• Pancreatic "rest": High-dose pancreatic enzyme use can reduce abdominal pain. This has been adequately documented in patients with idiopathic pancreatitis, but not for the alcohol-related form. Alcohol abstinence can prevent exacerbations of pain symptoms and acute pancreatitis episodes;
• Surgical treatment: Pain resistant to treatment may require surgical drainage in cases of suspected obstruction or associated pseudocysts, although long-term outcomes are variable. Partial resection of the glandular parenchyma should be based on the location of ductal changes;
• For reasons that aren't fully understood, some patients experience a decrease in pain symptoms over the years;

If so, treatment focuses on endocrine and exocrine insufficiency.

What are the Risk Factors for Chronic Pancreatitis?

Risk factors for chronic pancreatitis include:

• Gallstones;
• Trauma and abdominal surgery;
• Hypercalcemia;
• Hyperlipidemia;
• Medications (valproic acid, sulfonamides, tetracyclines, hydrochlorothiazide, furosemide);
• Viral infection (Mumps, Hepatitis);
• Pancreas divisum;
• Gastrointestinal disease;
• Familial hereditary pancreatitis;
• Endoscopic retrograde cholangiopancreatography (ERCP);
• Hypoperfusion (vasculitis);

[dt_sc_button title="Free Quote" size="medium" style="bordered" icon_type="" link="url:https%3A%2F%2F127.0.0.1/tds%2Fdevis%2F" textcolor="#ffffff" bgcolor="#0c73ba"]