Chronic pancreatitis

Clinicians are learning more about chronic pancreatitis but are entering an era of some confusion, primarily driven by uncovering new etiologies of chronic pancreatitis. Ideally, this knowledge will lead to better diagnosis and treatment, and abandonment of ill-conceived treatments. In contrast with previous reviews, this review highlights select contributions this year that may develop into true advances in chronic pancreatitis.

Small steps have been made to understand better the molecular basis of chronic pancreatitis. Diagnosis of early chronic pancreatitis remains challenging. Rapid diagnosis by combining endoscopy and a direct stimulatory test of pancreatic function may lead to more widespread use of function testing, but this test is not ready for clinical use. Application of microarray and proteomic technologies may aid future diagnosis of chronic pancreatitis. The failure to account clearly for the phenotype of patients with chronic pancreatitis may confound delineating the etiologies of chronic pancreatitis. Clinical description and studies of autoimmune pancreatitis have led to the realization that steroids are an effective treatment for this form of chronic pancreatitis. Genetic-based studies have provided insight into the pathogenic mechanisms of chronic pancreatitis. Investigation of the role of stellate cells, an essential component fibrogenesis, has led to identification of potential novel treatments for chronic pancreatitis.

Ongoing basic and clinical research this past year has characterized further the histologic, genetic, molecular, and clinical aspects of chronic pancreatitis, efforts that may translate into novel therapies once well-designed, controlled studies have been performed.