The pathophysiology of alcoholic pancreatitis

The causal relationship between alcohol abuse and pancreatitis is undisputed. However, why some alcoholics manifest pancreatitis whereas others do not remains unexplained. Epidemiological data increasingly point toward an adjuvant role for genetic, dietary, and environmental factors. Significant advances have taken place in the last several years in the characterization of the pathophysiology of both experimental and human alcoholic pancreatitis. However, the pathogenesis of alcoholic pancreatitis remains unsettled. Toxic effects of alcohol on pancreatic acinar cells, "plugging" of pancreatic ductules by proteinaceous material, and reflux of bilio-duodenal juice into the pancreatic ducts have been suggested as putative pathogenetic mechanisms. Whereas at the present time only hypotheses can be formulated, it seems likely that the genesis of alcohol-related pancreatitis follows one or several of these proposed mechanisms. Pain in alcoholic pancreatitis is common and yet unexplained. Understanding the mechanism of pain in such patients is the key to our ability to manage it successfully. In this review, I have attempted to summarize and critically analyze our current understanding of these challenging problems.