Pancreatitis - Chronic

Chronic pancreatitis is a progressive inflammatory disease of the pancreas characterized by irreversible structural damage, fibrosis, and loss of exocrine and endocrine function, leading to persistent abdominal pain and complications such as malabsorption and diabetes.

Definition

Epidemiology

Incidence: ~5–12 per 100,000 population per year
Male predominance (2:1), often related to alcohol consumption
Peak onset: 30–50 years
Global prevalence is increasing due to better imaging and recognition
Majority of cases in adults are alcohol-related; genetic and autoimmune causes also recognized

Etiology

Chronic alcohol consumption (most common in adults)
Genetic mutations: PRSS1, SPINK1, CFTR, CTRC (hereditary pancreatitis)
Autoimmune pancreatitis (IgG4-related disease)
Obstructive causes: pancreatic duct strictures, stones, tumors
Hypertriglyceridemia, hypercalcemia
Idiopathic (unknown cause in ~20–30% of cases)

Pathophysiology

Recurrent episodes of acute inflammation lead to progressive fibrosis
Loss of acinar cells reduces exocrine enzyme secretion → malabsorption
Islet cell destruction leads to endocrine dysfunction → diabetes mellitus
Ductal obstruction (stones, strictures) contributes to stasis and inflammation
Chronic inflammation leads to calcifications and atrophy of pancreatic tissue
Pain may result from ductal hypertension, inflammation, and neuropathic mechanisms