Chronic pancreatitis. The problems of diagnostic criteria.
ABSTRACT The diagnostic criteria for chronic pancreatitis proposed by the Japan Pancreas Society (JPS) classified chronic pancreatitis into (i) definite; (ii) probable, and (iii) possible chronic pancreatitis, excluding obstructive, inflammatory (autoimmune) and tumor-forming pancreatitis from the definition of chronic pancreatitis. In the JPS Criteria, imaging studies, pancreatic function tests, and histological findings are independent of each other, and thus the diagnosis of chronic pancreatitis is made if one of the criteria is satisfied, regardless of the etiology of the chronic pancreatitis. The current diagnostic criteria for chronic pancreatitis depend on abnormalities of the duct system, such as low bicarbonate output, dilation of main pancreatic duct and duct branches, and calculi in the ducts by imaging studies. We revealed that the difference between reversible and irreversible pancreatitis in experimental animals is dependent on the degree of damage of the duct epithelium where pancreas progenitor cells exist. Thus, chronic pancreatitis diagnosed by the current criteria based on abnormalities of the duct system is irreversible. In contrast, the epithelium of the ducts is usually preserved in obstructive and autoimmune pancreatitis in that both structural and functional changes recover almost completely when the obstruction is removed or the inflammatory changes disappear following steroid administration. Even in chronic pancreatitis defined as irreversible, there must be a reversible stage during its clinical course. There is a need to develop biological markers and/or imaging procedure to detect chronic pancreatitis at its reversible stage.
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ABSTRACT: A collected series of 64 cases of chronic relapsing pancreatitis is reported. Analysis of this material reveals several points of interest. There is a difference in the aetiological spectrum in Britain when compared with reports from France and the United States. In particular, nearly half the British cases were idiopathic. The clinical presentation and the age and sex ratios also varied with aetiology. Endoscopic retrograde cannulation of the pancreatic duct was of little value in confirming a diagnosis of pancreatitis in the problem case. This investigation did, however, demonstrate that a widespread dilatation of the pancreatic duct was a minority finding. In those patients with alcoholic pancreatitis follow-up studies have shown that, if the addiction can be broken, there is a 75 per cent chance that pain will diminish or disappear with the passage of time. The main indication for surgical intervention was severe pain and this study has shown that if strict criteria are observed, a worthwhile relief of symptoms can be achieved. In particular, subtotal pancreatectomy produced good results in up to 85 per cent of cases, although with an appreciable short term postoperative morbidity.British Journal of Surgery 08/1979; 66(7):471-5. · 4.84 Impact Factor
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ABSTRACT: Different materials dissolved in 0.9% NaCl were injected into the connective, interlobular tissue of the duodenal part of the rat pancreas. Activated rat pancreatic juice or trypsin were able to induce localized necrohemorrhagic pancreatitis. Only mild edema and leukocytic infiltration were observed after injecting bovine albumin, chinese ink, trypsinogen or nonactivated pancreatic juice. The progression of histological changes was followed for 2 weeks in the trypsin-induced pancreatitis. Limited foci of severe hemorrhage, liquefaction and coagulative necrosis were observed in the first 24 h. Acinar cell degeneration and regeneration were observed 48 h after the operation, fibroblasts appearing in the interlobular spaces. Four days after injection, inter- and intralobular fibrosis, acinar cell degeneration and tubular complexes were observed, presenting a picture characteristic of chronic pancreatitis. Some minimal changes were still seen in the pancreas 1 week after injection, but by the end of the 2nd week the pancreatic histology was normal. These results demonstrate the significance of active trypsin in the pancreatic interstitium with respect to the induction of pancreatitis. This model of localized necrohemorrhagic pancreatitis is highly reproducible and without significant mortality. Following the acute process, histological changes resembling chronic pancreatitis can be observed, but they are completely reversible.Digestion 02/1986; 34(2):68-77. · 1.94 Impact Factor
Article: Diagnosis of chronic pancreatitis.Gastroenterology 07/1985; 88(6):1973-95. · 12.82 Impact Factor