THE PATHOGENESIS OF CHRONIC-PANCREATITIS

To date, there is no consensus on the evolution of chronic pancreatiti s. Comfort's initial proposal of acute pancreatitis progressing to chr onic pancreatitis was discarded by protagonists of the 'separate' theo ry. Sarles thus stresses the de novo evolution of chronic pancreatitis - acinar protein hypersecretion associated with an imbalance of pancr eatic stone promoting and inhibiting factors, However, the (necrosis-f ibrosis sequence' hypothesis of Kloppel and Mallet resurrects the prob ability of acute pancreatitis leading to chronic pancreatitis, Dimagno offers a unifying concept that the degree of acinar injury determines history of pancreatitis. Uninhibited release of toxic free radicals c ould be a common end point for various aetiologies resulting in acute or chronic pancreatitis. The pathogenesis of chronic calcifying pancre atitis of the tropics is possibly no different from alcoholic chronic pancreatitis. Neurocrine and paracrine mechanisms have been offered to explain pain out of proportion to radiological and histological pancr eatic abnormalities in minimal change chronic pancreatitis.