Etiology and natural history of chronic pancreatitis

Chronic pancreatitis (CP) is a rare but serious disease with high morbidity and mortality. Its exact etiology remains uncertain, but several associated conditions have been identified. Geographical distribution of CP can be linked to alcoholism, especially in countries with high-protein, high-fat diets. In Afro-Asiatic countries with protein malnutrition, however, CP is frequently observed in children and young nonalcoholic adults from the poorest segments of these societies. To analyze the natural history of CP, besides etiology three additional main factors have to be considered, namely clinical pattern and therapy (surgery), pancreatic function (endocrine and exocrine), and morphology. During progress of the disease clinical picture, morphology and pancreatic function have typical correlative changes. Basically, from this viewpoint, three typical models of the disease can be distinguished: (1) early stage of uncomplicated CP; (2) late stage of uncomplicated CP, and (3) complicated CP, a disease stage which is characterised by local complications (chiefly pseudocysts and duct obstruction). The main concept of the natural history of CP bases on the thesis that CP burns itself out with spontaneous relief of pain, i.e. persistent freedom from pain occurs parallel with severe pancreatic dysfunction in the late stage of the disease. In the clinical picture and long-term course, nonalcoholic CP differs in certain essential respects from alcoholic CP; however, the two forms do not differ essentially as regards mortality and survival.