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The Pathogenesis of Chronic Pancreatitis

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Chronic Pancreatitis

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Abstract

Chronic abdominal pain remains a major clinical challenge in chronic pancreatitis (CP) and is present in up to 90% of the patients. It is associated with a poor life quality, an increased health resource utilization and is the primary cause of hospitalization Lieb et al. (Aliment Pharmacol Ther 29:706–19, 2009). The etiologies of pain in CP are increasingly better understood and likely involve multiple mechanisms. The focus of this chapter is to provide an overview of the mechanisms involved in chronic pancreatic pain. First, the traditional view of pain in CP is discussed where pain is thought to arise due to mechanical problems such as obstruction of the pancreatic gland. Although this theory is widely accepted and forms the theoretical background for invasive treatments of pain it is largely undocumented and has been challenged by recent research where no uniform associations between morphological changes and pain exist. The next section provides an overview of a novel neurobiological understanding of pain in CP, which is shifting the focus of pain from mechanical problems towards changes in peripheral and central pain processing. This has substantial consequences for treatment and may result in a paradigm shift of pain management of CP in a foreseeable future. Finally, we briefly discuss extra-pancreatic causes of pain in associated with CP, which are important to diagnose, as they are often easy to treat.

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Authors and Affiliations

  1. Mech-Sense, Department of Gastroenterology and Hepatology, Clinical Institute, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark

    Jakob Lykke Poulsen, Søren Schou Olesen & Asbjørn Mohr Drewes

  2. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China

    Bo Ye M.D. & Wei-Qin Li M.D.

  3. Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany

    Ali A. Aghdassi, Matthias Sendler, Julia Mayerle & Markus M. Lerch M.D., F.R.C.P.

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  1. Jakob Lykke Poulsen
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Correspondence to Asbjørn Mohr Drewes , Wei-Qin Li M.D. , Markus M. Lerch M.D., F.R.C.P. , Asbjørn Mohr Drewes , Wei-Qin Li M.D. or Markus M. Lerch M.D., F.R.C.P. .

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  1. Department of Gastroenterology, Changhai Hospital, Shanghai, China

    Zhao-Shen Li

  2. Changhai Hospital, Department of Gastroenterology, Shanghai, China

    Zhuan Liao

  3. INSERM, Brest, France

    Jian-Min Chen

  4. INSERM UMR 1078, Brest, France

    Claude Férec

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Poulsen, J.L. et al. (2017). The Pathogenesis of Chronic Pancreatitis. In: Li, ZS., Liao, Z., Chen, JM., Férec, C. (eds) Chronic Pancreatitis. Springer, Singapore. https://doi.org/10.1007/978-981-10-4515-8_5

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