The pathogenesis of gallstone pancreatitis.

The pathogenesis of gallstone pancreatitis has been re-examined. It is concluded that there is no evidence that reflux of bile occurs: even if it does, it is not, of itself, harmful in any way. Opie's ‘common channel’ theory is of historical interest only and should now be firmly discarded. Clinical studies have shown the efficacy of comprehensive biliary tract surgery in terminating the recurring pattern of attacks of pancreatitis in these patients. It is suggested that this surgery eradicates a septic focus as well as a mechanical factor and that in the majority of cases it is this infective element which is important in the pathogenesis. This working hypothesis receives strong support from established clinical facts and also from experimental studies.