Duct destructive chronic pancreatitis. A new insight into the pathology of idiopathic non-alcoholic chronic pancreatitis

See article on page263 In a leading article published in Gut in 1990, Sarles et al made the opening comment that “there have been few efforts to classify diseases of the pancreas by their specific pathological features and causes... “.1 Indeed, the classification of pancreatitis is fraught with a major difficulty, that of developing a comprehensive system which embodies aetiology, pathogenesis, clinical features, and pathological findings. The 1984 Marseille-Rome classification included three types: acute pancreatitis, chronic pancreatitis and obstructive pancreatitis.2 The 1992 Atlanta classification dealt almost exclusively with acute pancreatitis.3 In the West, chronic alcoholism and biliary tract disease are probably the two most common causes of chronic pancreatitis and account for approximately 80% of cases. Other rarer causes include heredity, hyperparathyroidism, haemochromatosis, hyperlipoproteinaemia and pancreatic carcinoma. In addition to the above, malnutrition and environmental factors may account for chronic pancreatitis in tropical areas of Asia and Africa. Ten to forty per cent of patients (the numbers differ in published series) have so called …