Defining chronic pancreatitis with a focus on pathological stress responses

Abstract

‘Chronic pancreatitis is a disease of the pancreas in which recurrent inflammatory episodes result in replacement of pancreatic parenchyma by fibrous connective tissue. This fibrotic reorganisation of the pancreas leads to a progressive exocrine and endocrine pancreatic insufficiency. In addition, characteristic complications arise, such as pseudocysts, pancreatic duct obstructions, duodenal obstruction, vascular complications, obstruction of the bile ducts, malnutrition and pain syndrome. Pain presents as the main symptom of patients with chronic pancreatitis. Chronic pancreatitis is a risk factor for pancreatic carcinoma. Chronic pancreatitis significantly reduces the quality of life and the life expectancy of affected patients.’ This is the definition adopted for chronic pancreatitis by 74 experts from 11 gastroenterological, surgical, pediatric and radiological societies in Germany, Austria and Switzerland. It was integrated into the only evidence-based guideline so far on chronic pancreatitis [1,2], that complies with the S3 Oxford classification standard for level-of-evidence grades. The authors felt that this definition represents, in a nutshell, how chronic pancreatitis presents clinically, what the underlying mechanism is recurrent inflammation leading to fibrosis [3], the key clinical complications that can be expected and should be looked for, as well as the long