Evolving concept of chronic pancreatitis.

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterized histologically by the presence of fibrosis and inflammation of the parenchyma with the involvement of both acini and Langherans islets. CP has been considered in the past “one” disease, caused by alcohol, at least in the Western Countries. Epidemiological data documented an association of the disease with an excessive alcohol consumption up to the end of the last century. However, the quantification of alcohol intake was heterogeneous and a concept of risk for CP in alcohol drinkers was introduced in the absence of alcohol abuse. The clinical consequence was that the treatment of CP was mainly "symptomatic", based on alcohol withdraw and pain management in an early stage of the disease and treatment of exocrine and endocrine insufficiency in a later stage. The integration between pathological/molecular biology and radiological findings identified distinct type of chronic pancreatitis, namely autoimmune pancreatitis, paraduodenal pancreatitis and pancreatitis associated with gene mutations. Other forms of CP on which there is still no international agreement are represented by organic spincter of Oddi dysfunction (SOD), CP caused by scar(s) secondary to previous episodes of necrotizing pancreatitis, pancreatitis associated with anatomical abnormalities (pancreas divisum, annular pancreas) and pancreatitis associated to slow-growing tumours of the pancreas or of the periampullar region.