Etiopathogenesis and pathophysiology of chronic pancreatitis

Chronic pancreatitis is an irreversible fibro-inflammatory disease of the pancreas that leads to progressive loss of exocrine and endocrine functions. Other consequences of chronic pancreatitis include severe abdominal pain, narcotic dependence, and poor quality of life. The etiologies of chronic pancreatitis include toxic (alcohol or smoking), genetic/hereditary, autoimmune, metabolic abnormalities, obstructive, and idiopathic. The pathophysiology of chronic pancreatitis is also complex and differs by etiology. Various mechanisms for the development and progression of chronic pancreatitis have been postulated but the actual process is still not clearly understood. The process involves injury to the acinar cells, followed by inflammation and repair in some cases, and in other cases, the inflammation persists to create a chronic environment. This chronic inflammatory environment activates the pancreatic stellate cells that play a vital role in causing fibrosis. Several molecular events have also been shown to be involved in the pathogenesis of the disease. This chapter will discuss the various etiologies, pathophysiologies and molecular events that lead to chronic pancreatitis.