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. 1995 Feb;71(832):67–70. doi: 10.1136/pgmj.71.832.67

The pathogenesis of chronic pancreatitis.

S S Sidhu 1, R K Tandon 1
PMCID: PMC2397928  PMID: 7724437

Abstract

To date, there is no consensus on the evolution of chronic pancreatitis. Comfort's initial proposal of acute pancreatitis progressing to chronic pancreatitis was discarded by protagonists of the 'separate' theory. Sarles thus stresses the de novo evolution of chronic pancreatitis-acinar protein hypersecretion associated with an imbalance of pancreatic stone promoting and inhibiting factors. However, the 'necrosis-fibrosis sequence' hypothesis of Kloppel and Mallet resurrects the probability of acute pancreatitis leading to chronic pancreatitis. Dimagno offers a unifying concept that the degree of acinar injury determines the natural history of pancreatitis. Uninhibited release of toxic free radicals could be a common end point for various aetiologies resulting in acute or chronic pancreatitis. The pathogenesis of chronic calcifying pancreatitis of the tropics is possibly no different from alcoholic chronic pancreatitis. Neurocrine and paracrine mechanisms have been offered to explain pain out of proportion to radiological and histological pancreatic abnormalities in minimal change chronic pancreatitis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ammann R. W., Muellhaupt B. Progression of alcoholic acute to chronic pancreatitis. Gut. 1994 Apr;35(4):552–556. doi: 10.1136/gut.35.4.552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Fukuoka S., Freedman S. D., Yu H., Sukhatme V. P., Scheele G. A. GP-2/THP gene family encodes self-binding glycosylphosphatidylinositol-anchored proteins in apical secretory compartments of pancreas and kidney. Proc Natl Acad Sci U S A. 1992 Feb 15;89(4):1189–1193. doi: 10.1073/pnas.89.4.1189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Giorgi D., Bernard J. P., De Caro A., Multigner L., Lapointe R., Sarles H., Dagorn J. C. Pancreatic stone protein. I. Evidence that it is encoded by a pancreatic messenger ribonucleic acid. Gastroenterology. 1985 Aug;89(2):381–386. doi: 10.1016/0016-5085(85)90340-3. [DOI] [PubMed] [Google Scholar]
  4. Giorgi D., Bernard J. P., Rouquier S., Iovanna J., Sarles H., Dagorn J. C. Secretory pancreatic stone protein messenger RNA. Nucleotide sequence and expression in chronic calcifying pancreatitis. J Clin Invest. 1989 Jul;84(1):100–106. doi: 10.1172/JCI114128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Guyan P. M., Uden S., Braganza J. M. Heightened free radical activity in pancreatitis. Free Radic Biol Med. 1990;8(4):347–354. doi: 10.1016/0891-5849(90)90100-w. [DOI] [PubMed] [Google Scholar]
  6. Klöppel G., Maillet B. Chronic pancreatitis: evolution of the disease. Hepatogastroenterology. 1991 Oct;38(5):408–412. [PubMed] [Google Scholar]
  7. Klöppel G., Maillet B. Pseudocysts in chronic pancreatitis: a morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas. 1991 May;6(3):266–274. [PubMed] [Google Scholar]
  8. MONTGOMERY R. D. THE MEDICAL SIGNIFICANCE OF CYANOGEN IN PLANT FOODSTUFFS. Am J Clin Nutr. 1965 Aug;17:103–113. doi: 10.1093/ajcn/17.2.103. [DOI] [PubMed] [Google Scholar]
  9. McMillan D. E., Geevarghese P. J. Dietary cyanide and tropical malnutrition diabetes. Diabetes Care. 1979 Mar-Apr;2(2):202–208. doi: 10.2337/diacare.2.2.202. [DOI] [PubMed] [Google Scholar]
  10. Mohan V., Mohan R., Susheela L., Snehalatha C., Bharani G., Mahajan V. K., Ramachandran A., Viswanathan M., Kohner E. M. Tropical pancreatic diabetes in South India: heterogeneity in clinical and biochemical profile. Diabetologia. 1985 Apr;28(4):229–232. doi: 10.1007/BF00282238. [DOI] [PubMed] [Google Scholar]
  11. Multigner L., Figarella C., Sahel J., Sarles H. Lactoferrin and albumin in human pancreatic juice: a valuable test for diagnosis of pancreatic diseases. Dig Dis Sci. 1980 Mar;25(3):173–178. doi: 10.1007/BF01308135. [DOI] [PubMed] [Google Scholar]
  12. Noronha M., Bordalo O., Dreiling D. A. Alcohol and the pancreas. II. Pancreatic morphology of advanced alcoholic pancreatitis. Am J Gastroenterol. 1981 Aug;76(2):120–124. [PubMed] [Google Scholar]
  13. Pitkäranta P., Kivisaari L., Nordling S., Nuutinen P., Schroder T. Vascular changes of pancreatic ducts and vessels in acute necrotizing, and in chronic pancreatitis in humans. Int J Pancreatol. 1991 Jan;8(1):13–22. doi: 10.1007/BF02930219. [DOI] [PubMed] [Google Scholar]
  14. Provansal-Cheylan M., Mariani A., Bernard J. P., Sarles H., Dupuy P. Pancreatic stone protein: quantification in pancreatic juice by enzyme-linked immunosorbent assay and comparison with other methods. Pancreas. 1989;4(6):680–689. [PubMed] [Google Scholar]
  15. Regan P. T., Malagelada J. R., DiMagno E. P. Duodenal calcium outputs in health and pancreatic disease. Gut. 1980 Jul;21(7):614–618. doi: 10.1136/gut.21.7.614. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Renner I. G., Savage W. T., 3rd, Pantoja J. L., Renner V. J. Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases. Dig Dis Sci. 1985 Oct;30(10):1005–1018. doi: 10.1007/BF01308298. [DOI] [PubMed] [Google Scholar]
  17. Sandilands D., Jeffrey I. J., Haboubi N. Y., MacLennan I. A., Braganza J. M. Abnormal drug metabolism in chronic pancreatitis. Treatment with antioxidants. Gastroenterology. 1990 Mar;98(3):766–772. doi: 10.1016/0016-5085(90)90300-p. [DOI] [PubMed] [Google Scholar]
  18. Sarles H., Adler G., Dani R., Frey C., Gullo L., Harada H., Martin E., Norohna M., Scuro L. A. The pancreatitis classification of Marseilles-Rome 1988. Scand J Gastroenterol. 1989 Aug;24(6):641–642. doi: 10.3109/00365528909093102. [DOI] [PubMed] [Google Scholar]
  19. Sarles H., Bernard J. P., Gullo L. Pathogenesis of chronic pancreatitis. Gut. 1990 Jun;31(6):629–632. doi: 10.1136/gut.31.6.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Sarles H., Bernard J. P., Johnson C. Pathogenesis and epidemiology of chronic pancreatitis. Annu Rev Med. 1989;40:453–468. doi: 10.1146/annurev.me.40.020189.002321. [DOI] [PubMed] [Google Scholar]
  21. Sarles H. Definitions and classifications of pancreatitis. Pancreas. 1991 Jul;6(4):470–474. doi: 10.1097/00006676-199107000-00015. [DOI] [PubMed] [Google Scholar]
  22. Sarles H., LaHaie R., Dollet J. M., Beck B., Michel R., Debry G. Effect of parental malnutrition on enzyme content of rat pancreas. Dig Dis Sci. 1987 May;32(5):520–528. doi: 10.1007/BF01296036. [DOI] [PubMed] [Google Scholar]
  23. Sauniere J. F., Sarles H. Exocrine pancreatic function and protein-calorie malnutrition in Dakar and Abidjan (West Africa): silent pancreatic insufficiency. Am J Clin Nutr. 1988 Nov;48(5):1233–1238. doi: 10.1093/ajcn/48.5.1233. [DOI] [PubMed] [Google Scholar]
  24. Shenoy K. T., Shanmugam J., Balakrishnan V. Viral & Mycoplasma pneumoniae antibodies in chronic pancreatitis of tropics. Indian J Med Res. 1986 Jul;84:22–26. [PubMed] [Google Scholar]
  25. Tasso F. Etude ultrastructurale du pancréas dans 8 cas de pancréatites chroniques. Ann Anat Pathol (Paris) 1967 Oct-Dec;12(4):343–372. [PubMed] [Google Scholar]
  26. Tasso F., Stemmelin N., Sarles H., Clop J. Comparative morphometric study of the human pancreas in its normal state and in primary chronic calcifying pancreatitis. Biomedicine. 1973 Mar;18(2):134–144. [PubMed] [Google Scholar]
  27. Teuscher T., Baillod P., Rosman J. B., Teuscher A. Absence of diabetes in a rural West African population with a high carbohydrate/cassava diet. Lancet. 1987 Apr 4;1(8536):765–768. doi: 10.1016/s0140-6736(87)92797-8. [DOI] [PubMed] [Google Scholar]
  28. Uscanga L., Kennedy R. H., Choux R., Druguet M., Grimaud J. A., Sarles H. Sequential connective matrix changes in experimental acute pancreatitis. An immunohistochemical and biochemical assessment in the rat. Int J Pancreatol. 1987 Feb;2(1):33–45. doi: 10.1007/BF02788347. [DOI] [PubMed] [Google Scholar]
  29. Walsh T. N., Rode J., Theis B. A., Russell R. C. Minimal change chronic pancreatitis. Gut. 1992 Nov;33(11):1566–1571. doi: 10.1136/gut.33.11.1566. [DOI] [PMC free article] [PubMed] [Google Scholar]

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