Integrityofthepancreaticduct-acinarsystemin thepathogenesisofacutepancreatitis

摘要

BACKGROUND: Acute pancreatitis is an acute inlfammatory process of the pancreas that frequently involves peripancreatic tissues and at times remote organ systems. For a long time, the etiology and pathogenesis of acute pancreatitis has been intensively investigated worldwide, but the pathogenetic theories are controversial. The integrity of the pancreatic duct-acinar system might play an important role in the pathogenesis of this disease. DATA SOURCES: Web of Science and PubMed databases were searched for published studies (between January 1966 and June 2009) to identify relevant articles using the keywords"acinar hyperstimulation","pathogenesis","acute pancreatitis","pancreatic duct-acinar system", and "pancreatic duct pressure". Most of the relevant articles were reviewed. RESULTS:From critical reading of the relevant articles, we found that the underlying mechanisms involved in the pathogenesis of acute pancreatitis are still under debate and ill-understood. On the basis of the relevant studies, we propose a hypothesis for the pathogenesis of acute pancreatitis, in which the integrity of the pancreatic duct-acinar system plays an essential role in the onset and progression of various forms of the disease. CONCLUSIONS: In our hypothesis, pancreatic duct obstruc-tion and hyperstimulation of the exocrine pancreas are preconditions for the onset of acute pancreatitis;under the common conditions of pancreatic duct obstruction and acinar hyperstimulation, acute pancreatitis arises and develops. This may be an important common pathophysiological mechanism causing various forms of acute pancreatitis.