ABSTRACT
Pancreatitis, acute or chronic, is a significant contributor to the ‘‘burden of gastrointestinal disease’’ in this country, according to a recent survey conducted by the American Gastroenterological Association (1). In 1998, there were about 1.2 million cases, with 327,000 inpatients and 530,000 physician office visits. The estimated total direct cost for this group of diseases was $2.1 billion in 1998. Unfortunately, progress in our understanding of the biology of these diseases has been slow, particularly with respect to the pathogenesis of the cardinal symptom of pancreatitis i.e., pain. Any physician who has dealt with these patients is aware of the fact that pain is not only the most important symptom of chronic pancreatitis but also the most difficult to treat: ‘‘Painful chronic pancreatitis is poorly understood and its management is controversial’’ (2). Our lack of knowledge about what causes pain in pancreatitis has been a serious obstacle to improvement of the care of these patients, leading to various empirical approaches that are often based on purely anatomical grounds, are generally highly invasive and at best of marginal value (3). Despite a wide variety of approaches covering innocuous (enzyme therapy), minimally invasive (endoscopic decompression and nerve blocks), and highly aggressive (surgical decompression, pancreatectomy), no consensus has emerged and no form of treatment can be considered satisfactory at the present time.
