Rajesh Gopalakrishna, Girish Banavara Narasimnhamurthy, Vaidyanathan Kannan, Balakrishnan Vallath
Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, AIMS Ponekkara P.O. Cochin-682 041, Kerala, India.
Department of Physiology, Amrita Institute of Medical Sciences, Kochi, AIMS Ponekkara P.O. Cochin-682 041, Kerala, India.
Trop Gastroenterol. 2013 Apr-Jun;34(2):68-73. doi: 10.7869/tg.2012.100.
The aetiopathogenesis of chronic pancreatitis (CP) appears to be multifactorial with interplay of genetic and environmental factors such as alcohol, smoking and diet. Dietary factors in the form of a fat- and protein-rich diet are important cofactors in the aetiopathogenesis of alcoholic pancreatitis. Malnutrition used to be a hallmark in tropical pancreatitis. Presently, it appears that malnutrition is an effect rather than a causative factor for tropical pancreatitis; however, micronutrient deficiency could possibly be implicated in the aetiopathogenesis. The role of dietary toxins such as cassava is no longer considered an important risk factor; however, these patients are at a higher risk for defective detoxification of cyanogens. Decrease in levels of sulphur amino acids (SAAs), folate and zinc have been reported. Oxidative stress and antioxidant depletion are key pathogenetic mechanisms. The role of antioxidants in pain relief is an area of interest. Supplementation of fat-soluble vitamins and micronutrients is a cornerstone in medical management. Folate and zinc supplementation may be beneficial and is a focus of ongoing research. In the future, prophylaxis for CP by a daily micronutrient tablet among high-risk groups in endemic areas could prove to be a potentially important public health measure. However, further studies are required.
慢性胰腺炎（CP）的病因发病机制似乎是多因素的，涉及遗传和环境因素的相互作用，如酒精、吸烟和饮食。富含脂肪和蛋白质的饮食形式的饮食因素是酒精性胰腺炎病因发病机制中的重要辅助因素。营养不良曾是热带胰腺炎的一个标志。目前，营养不良似乎是热带胰腺炎的一个结果而非致病因素；然而，微量营养素缺乏可能与病因发病机制有关。木薯等饮食毒素的作用不再被视为重要的危险因素；然而，这些患者对氰化物解毒缺陷的风险更高。据报道，硫氨基酸（SAA）、叶酸和锌的水平降低。氧化应激和抗氧化剂耗竭是关键的发病机制。抗氧化剂在缓解疼痛方面的作用是一个研究热点。补充脂溶性维生素和微量营养素是医学管理的基石。补充叶酸和锌可能有益，是正在进行的研究重点。未来，在流行地区的高危人群中通过每日服用微量营养素片预防慢性胰腺炎可能被证明是一项潜在的重要公共卫生措施。然而，还需要进一步研究。
