Zator Zachary, Whitcomb David C
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Department of Cell Biology and Molecular Physiology, Department of Human Genetics, University of Pittsburgh, Gastroenterology, Room 401.4, 3708 Fifth Ave, Pittsburgh, PA 15213, USA.
Therap Adv Gastroenterol. 2017 Mar;10(3):323-336. doi: 10.1177/1756283X16684687. Epub 2017 Jan 5.
Diseases of the exocrine pancreas such as recurrent acute pancreatitis (RAP), chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC) represent syndromes defined according to traditional clinicopathologic criteria. The failure of traditional approaches to identify primary mechanisms underlying these progressive disorders illustrates a greater problem of failure of the germ theory of disease for complex disorders. Multiple genetic discoveries and new complex disease models force consideration of a new paradigm of 'precision medicine', requiring a new mechanistic definition of CP. Recognizing the advances in understanding complex gene and environment interactions, as well as the development of new strategies that limit or prevent the development of devastating end-stage diseases of the pancreas may lead to substantial improvements in patient care.
外分泌性胰腺疾病，如复发性急性胰腺炎（RAP）、慢性胰腺炎（CP）和胰腺导管腺癌（PDAC），是根据传统临床病理标准定义的综合征。传统方法未能识别这些进行性疾病的主要机制，这说明了疾病的病菌理论在复杂疾病方面存在更大的失效问题。多项基因发现和新的复杂疾病模型促使人们考虑一种新的“精准医学”范式，这需要对CP进行新的机制定义。认识到在理解复杂基因与环境相互作用方面取得的进展，以及开发限制或预防胰腺毁灭性终末期疾病发展的新策略，可能会大幅改善患者护理。
