title: Pathogenesis of chronic pancreatitis: an evidence-based review of past theories and recent developments.
abstract: In the past several decades, four prominent theories of chronic pancreatitis pathogenesis have emerged: the toxic-metabolic theory, the oxidative stress hypothesis, the stone and duct obstruction theory, and the necrosis-fibrosis hypothesis. Although these traditional theories are formulated based on compelling scientific observations, substantial contradictory data also exist for each. Furthermore, the basic premises of some of these theories are directly contradictory. Because of the recent scientific progress in the underlying genetic, cellular, and molecular pathophysiology, there have been substantial advances in the understanding of chronic pancreatitis pathogenesis. This paper will provide an evidence-based review and critique of the traditional pathogenic theories, followed by a discussion of the new advances in pancreatic fibrogenesis. Moreover, we will discuss plausible pathogenic sequences applied to each of the known etiologies.
authors.affiliation: The Pancreas Clinic, Section of Endoscopy and Pancreaticobiliary Disease, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio 44118, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.forename: Gregory
authors.initials: G
authors.lastname: Zuccaro
mesh_terms: D000818:Animals; D002137:Calculi / Q000150:complications; D002908:Chronic Disease; D003251:Constriction, Pathologic; D000431:Ethanol / Q000633:toxicity; D019317:Evidence-Based Medicine; D006801:Humans; D018384:Oxidative Stress; D010183:Pancreatic Ducts / Q000473:pathology; D010195:Pancreatitis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology
chemical_list: D000431:Ethanol