Pathogenesis of Chronic Pancreatitis
Studies from the Marseille group allowed differentiation of acute pancreatitis (a group of lesions secondary to either extrapancreatic causes such as gallstones or to pancreatic diseases such as cancer and chronic pancreatitis), from chronic pancreatitis. Two forms of chronic pancreatitis arc easily...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
1989-01-01
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| Series: | Canadian Journal of Gastroenterology |
| Online Access: | http://dx.doi.org/10.1155/1989/493683 |
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| Summary: | Studies from the Marseille group allowed differentiation of acute
pancreatitis (a group of lesions secondary to either extrapancreatic causes such as
gallstones or to pancreatic diseases such as cancer and chronic pancreatitis), from
chronic pancreatitis. Two forms of chronic pancreatitis arc easily distinguished: obstructive
pancreatitis secondary to pre-existing obstruction on pancreatic ducts (tumours,
scars, etc); and the most frequent disease, chronic calcifying pancreatitis, which is a
pancreatic lithiasis due to a double phenomenon. This double phenomenon is the
precipitation of insoluble calcium salts and the precipitation of degraded fragments
of a newly discovered secretory protein known as pancreatic stone protein (PSP).
This family of glycoproteins, the amino acid sequence of which has been established,
is synthesized by the pancreatic acinar cell and its biosynthesis is decreased in
patients presenting with chronic calcifying pancreatitis. The secretory form of PSP
prevents the formation of calcium salt crystals in the pancreatic juice which is normally
supersaturated in calcium. Though the lesions and the secretory modifications
of PSP are common to all forms of chronic calcifying pancreatitis, there are different
etiological forms of the disease; alcoholic, tropical, hypercalcemic, hereditary and
idiopathic. Alcohol consumption acts on pancreatic secretion by different mechanisms
and is responsible for an increased secretion of secretory protein (enzymes)
due to cholinergic, vagal reflexes sensitive to ethanol. Alcohol consumption is generally
associated with protein rich and either fat rich or fat poor diets, both of which are
risk factors. Hypercalcemia also increases the secretion of protein and the viscosity of
pancreatic juice. The tropical form is not due, as previously suggested, to cassava
(manioc) consumption or kwashiorkor, but it is endemic in populations submitted to
fat poor, protein poor diets. These etiological factors are only acting on predisposed
patients. This suggests chat a low or abnormal biosynthesis of PSP is responsible for
the predisposition. |
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| ISSN: | 0835-7900 |