Chronic pancreatitis is characterized by chronic, irreversible damage to the pancreas, leading to endocrine and exocrine dysfunction. This loss of pancreatic function often results in a constellation of symptoms, namely epigastric pain with radiation to the back. Pain patterns are categorized into 3 types: type A involves intermittent but severe attacks with or without pancreatitis, typically early in the course of disease; type B includes persistent chronic pain between intermittent severe attacks; and type C involves chronic, debilitating pain without severe attacks. Malabsorption due to pancreatic insufficiency, steatorrhea, and diabetes mellitus also occur, and weight loss may be common.

Risk factors for chronic pancreatitis include alcohol use, smoking, and genetic mutations. Alcohol use disorder, cystic fibrosis, autoimmune pancreatitis (see IgG4-related disease), and chronic biliary ductal obstruction are among the most common etiologies. Autoimmune pancreatitis is a rare, chronic disease with varied presentation, often mimicking pancreatic malignancy, making diagnosis challenging. Autoantibodies in the pancreas cause inflammation and enlargement. The most common genetic mutations implicated in the pathogenesis of chronic pancreatitis are cystic fibrosis transmembrane conductance regulator (CFTR), serine protease inhibitor Kazal type 1 (SPINK1), and chymotrypsin C (CTC).

Chronic pancreatitis is most common in men, and it is more common in Black individuals than White individuals.

A juvenile form, tropical chronic pancreatitis (TCP), is a nonalcoholic calcific pancreatitis of uncertain etiology seen in tropical regions of the world that affects children and young adults; TCP can lead to fibrocalculous pancreatic diabetes and pancreatic cancer.

The diagnosis of chronic pancreatitis can be challenging and relies on a combination of symptomatology, histologic, radiographic, and endoscopic findings. There is no single gold standard test to confirm the diagnosis. Some patients present with recurrent episodes of epigastric abdominal pain and pancreatic enzyme elevation, while others can present with asymptomatic diabetes mellitus and be found to have chronic pancreatitis. Regardless of the predisposing medical condition precipitating the development of chronic pancreatitis, radiographically, pancreatic atrophy and calcification with a dilated pancreatic duct are often but not always seen. Histologically, pancreatic fibrosis, duct distortion, and intra-ductal calcification are often but not always appreciated.

Related topics: acute pancreatitis, pancreatic panniculitis