[Clinical aspects, spontaneous course and therapy of chronic pancreatitis. With special reference to the problem of nomenclature].

This clinical review is based on prospective long-term observation of 205 cases of alcoholic and 82 cases of non-alcoholic pancreatitis (CP). The long-term course of pancreatitis is the key to clinical classification, which thus far has been erroneously based one-sidely on morphologic criteria. CP exhibits a typical continuous alteration of the main variables (clinical picture, function, morphology) dependent on duration of the disease and etiology. Progress of the disease is determined, first, by progressive destruction of glandular tissue and, second, by possible occurrence of local complications in the pancreas. Basically there are three typical models of disease course from the clinico-biologic and morphologic viewpoint: in uncomplicated CP, (1) the early stage and (2) the late stage; in complicated CP, (3) CP with local complications (chiefly pseudocysts and duct obstruction). - In uncomplicated CP with durable pain syndrome there is a close relationship between pain attacks and pancreatic function, i.e. persistent freedom from pain occurs parallel with severe pancreas dysfunction in the late stage. Complicated CP with lasting pain syndrome, usually due to local complications, is reconverted by surgical eradication of the latter into uncomplicated CP with foreseeable course as regards postoperative pain recurrence, depending on the early or late stage of the disease. In clinical picture and long-term course, non-alcoholic CP differs in certain essential respects from alcoholic CP. The two forms do not differ essentially as regards mortality and survival.