Review in Depth
927 Foreword Helmut Friess and Markus W. Büchler
929 Pathogenesis and the natural course of chronic pancreatitis Tim Strate, Emre Yekebas, Wolfram T. Knoefel, Christian Bloechle and Jako R. Izbicki
935 Modern diagnostics of chronic pancreatitis Bernhard Glasbrenner, Stefan Kahl and Peter Malfertheiner
943 Conservative treatment of chronic pancreatitis Asif Khalid and David C. Whitcomb
951 Interventional treatment of chronic pancreatitis René Laugier and Philippe Grandval
957 Pain management in chronic pancreatitis Åke Andrén-Sandberg, Dag Hoem and Hjörtur Gislason
971 Surgical treatment and long-term follow-up in chronic pancreatitis Helmut Friess, Pascal O. Berberat, Martin Wirtz and Markus W. Büchler
Chronic pancreatitis is an inflammatory disease of the exocrine pancreas which leads to irreversible and progressive destruction of the whole organ, resulting in severe exocrine and endocrine insufficiency. In Western industrialized countries heavy alcohol consumption is the main aetiological factor of chronic pancreatitis (70–80% of the patients). Several less common causes such as nutritional factors, gene mutations (hereditary chronic pancreatitis), metabolic disturbances, congenital anomalies of the ductal system (e.g. pancreas divisum), and acquired pancreatic duct obstructions have been reported and are meanwhile better characterized. However, the origin of the disease is still unknown in up to 10% of the cases (idiopathic chronic pancreatitis).
The clinical symptoms of chronic pancreatitis are related to the damage of the exocrine parenchyma and impairment of exocrine pancreatic function. Upper abdominal pain, maldigestion, steatorrhoea, weight loss and a pathological glucose metabolism are the symptoms which have to be treated in these patients. The initial therapy for chronic pancreatitis is still conservative and symptomatic. However, if patients do not sufficiently respond to these measures, surgery or interventional therapy should be considered. Complications such as duodenal obstruction, stenosis of the common bile duct or pancreatic duct, or compression of retropancreatic vessels are clear indications for surgery. In addition, chronic severe abdominal pain that is resistant to conservative therapy has also become an indication for surgery, because in more than 80% of the patients a significant reduction in pain can be achieved. The value of surgery in chronic pancreatitis is also underlined by prospective clinical trials suggesting that an early operation can interrupt the disease process leading to significantly better long-term results than conservative therapy. Surgical approaches for chronic pancreatitis have changed during the last two decades. Nowadays, duct drainage operations are only indicated in special cases because of unsatisfactory long-term results. They are reserved to cases with obstruction and dilatation of the main pancreatic duct without pancreatic head enlargement and without involvement of surrounding organs. On the other hand, radical oncological operations such as the classical or pylorus preserving Whipple operation have lost their role in surgery for chronic pancreatitis, since organ preserving operations lead to better long-term results. Thus, various types of duodenum preserving pancreatic head resections have been established. They include a subtotal resection of the pancreatic head, thereby specifically targeting chronic pancreatitis induced complications at the surrounding organs, while preserving the stomach, the bile duct and the duodenum.
This Review in depth on chronic pancreatitis, summarizes the latest developments in the field of chronic pancreatitis, including novel aspects of this disease and an up-date summary of the literature in this field. The world's leading experts in the field of pancreatology present state-of-the-art reviews covering the aetiology, pathophysiology and diagnostics, as well as conservative, interventional and surgical treatment of chronic pancreatitis.
We would like to thank all the contributors for their efforts in sharing their knowledge, and we hope that this special issue will stimulate further clinical progress in this disease.