Chronic pancreatitis: classification, relationship to acute pancreatitis, and early diagnosis

Abstract

and eventual development of intraductal calculi in a high proportion of cases. Histologically, it is associated with perilobular fibrosis and acinar destruction with acute and chronic inflammatory cells.4 The most frequent cause of CCP is alcohol and tobacco use. Other forms include hereditary, tropical, and idiopathic chronic calcifying pancreatitis. The senile onset form of idiopathic CCP is often painless. 2. Obstructive chronic pancreatitis:5 This develops upstream from an area of ductal obstruction and is often due to tumor or postinflammatory (acute pancreatitis) pancreatic duct stricture. Persistent obstruction leads to pancreatic atrophy upstream from the area of ductal narrowing. Often painless, though it may occasionally present with clinically acute pancreatitis. Intraductal calculi are generally not seen. 3. Autoimmune chronic pancreatitis:6 A systemic fibroinflammatory disorder affecting the pancreas and other organs. It is also called lymphoplasmacytic sclerosing pancreatitis, based on its histologic features. The inflammatory component consists of a lymphoplasmacytic infiltrate rich in IgG4-positive cells, which responds to steroid therapy. Intense fibrosis may lead to permanent structural damage and functional insufficiency. It is a relative painless disorder, and clinical acute pancreatitis is not a common presentation. Intraductal calculi are not common, but may develop in the late “burnt out” stage.