Pancréatite chronique I: Introduction

Chronic pancreatitis is a degenerative inflammatory disorder characterized by persistent inflammation and irreversible fibrosis of the pancreas. Unlike acute pancreatitis, which arises suddenly and lasts briefly, chronic pancreatitis is a long-term condition that progressively worsens pancreatic damage over time. Both involve pancreatic inflammation, but chronic pancreatitis causes permanent structural changes.

Chronic pancreatitis develops from multiple etiological factors including chronic alcohol abuse, autoimmune disease, genetic predisposition, pancreatic duct obstruction, hypertriglyceridemia, hypercalcemia, and pancreatic cancer. Chronic alcohol consumption activates pancreatic stellate cells, while autoimmune disorders cause the immune system to attack the pancreas. Genetic factors increase susceptibility, and duct obstruction from gallstones or tumors causes enzyme backup and inflammation.

Persistent inflammation evolves into fibrosis, involving collagen deposition and extracellular matrix components like fibronectin, laminin, and proteoglycans. This fibrosis disrupts pancreatic architecture, causing narrowing and obstruction of pancreatic ducts. These structural changes impair both exocrine and endocrine functions, leading to malabsorption and metabolic dysfunction.

Chronic pancreatitis typically presents with recurring cramp-like upper abdominal pain radiating to the back, exacerbated by fatty food consumption. Patients experience nausea, vomiting, diarrhea, and steatorrhea leading to weight loss from nutrient malabsorption. Pain may be intermittent or near-constant, described as heavy, gnawing, or burning, and is unaffected by food or antacids.

When etiological factors trigger inflammation, immune cells become activated and release inflammatory mediators such as cytokines and chemokines. These mediators damage pancreatic tissue, initiating the inflammatory cascade. Over time, this sustained immune activation perpetuates tissue damage and promotes the transition from inflammation to fibrosis.

Chronic pancreatitis can result in serious complications including pseudocyst formation, bile duct or duodenal obstruction, pancreatic ascites or pleural effusion, splenic vein thrombosis, pseudoaneurysms, and pancreatic cancer. These complications arise from progressive ductal obstruction, tissue damage, and vascular involvement, significantly impacting patient outcomes and requiring close monitoring.

Pancreatic duct obstruction, caused by gallstones or tumors, prevents digestive enzymes from flowing normally through the duct. This backup of enzymes within the pancreas triggers inflammation and tissue damage. The obstruction disrupts normal pancreatic function and perpetuates the inflammatory cycle that leads to fibrosis and irreversible organ damage.