Chronic pancreatitis

Abstract

Chronic pancreatitis (CP) is a chronic inflammatory condition that results in irreversible morphological changes of the pancreas, including fibrosis and loss of both exocrine and endocrine functions. The aetiology of CP is multifaceted, including genetic, environmental, and autoimmune factors. Chronic alcohol consumption, smoking, and genetic mutations are significant contributors, with mechanisms involving oxidative stress, ductal obstruction, and immune-mediated inflammation. The clinical presentation is variable, with abdominal pain, malnutrition due to exocrine insufficiency, and diabetes mellitus being common presentations. Diagnosis of CP involves clinical evaluation, laboratory tests, and imaging studies, such as CT, MRCP, and endoscopic ultrasound, to assess pancreatic damage and complications. Management is complex and includes pain control, nutritional support, pancreatic enzyme replacement and, in severe cases, surgical interventions. Endoscopic treatment, such as stenting, and surgical procedures, like pancreaticojejunostomy, are used for ductal abnormalities and intractable pain. Emerging therapies, including antifibrotic treatments and stem cell therapy, are being explored. Long-term management requires a multidisciplinary approach, addressing not only medical and surgical needs but also psychological support and patient education. Advances in imaging and molecular biology are enhancing the understanding and treatment of CP, promising improved patient outcomes and quality of life.