Chronic Pancreatitis: New Insights in Etiology

Chronic pancreatitis is a persistent inflammatory condition of the pancreas characterized by recurrent episodes of abdominal pain with variable patterns of intensity and duration.1 Although there are numerous etiologies for pancreatitis (Figure 1), there is uniformity in the progressive fibrotic damage to the pancreatic parenchyma seen among all patients that eventually results in irreversible morphologic and functional impairment. It has been estimated that the prevalence of chronic pancreatitis in the United States is roughly 50/100,000 persons and the annual incidence ranges from 5 to 12/100,000 persons.2 Chronic pancreatitis has profound effects on patient’s quality of life frequently necessitating hospitalization for pain control or complications from the disease process. In one recent study on the burden of the disease in the United States, authors found that there had been 19,724 admissions nationwide in 2009 with a principal diagnosis of chronic pancreatitis resulting in a mean length of stay of 5.1 days and mean hospital charges of $28,634.3 This same study noted that there had been 78 deaths among these admissions pointing toward the gravity of this disease. In a similar study, researchers found that pancreatitis ranked 8th among all digestive diseases in years of potential life lost before age 75 with an average of 12.3 years lost per death among the average patient with chronic pancreatitis who dies from his or her disease.4 Clearly, if we are to make progress toward symptom control and treatment we need to improve our understanding of the pathogenesis of the disease and our ability to diagnose the correct etiology at the soonest time point.