Pancreatic-duct reflux in patients with gallstone pancreatitis?

The pathogenesis of gallstone pancreatitis remains controversial and current thinking supports duodenopancreatic-duct reflux after the passage of a gallstone into the duodenum. A consecutive series of 292 operative cholangiograms was studied: the presence of pancreatic-duct reflux, common-bileduct diameter, presence of gallstones, and duodenal filling were recorded. Of 21 patients who had previously had an attack of acute pancreatitis 11 had pancreatic-duct reflux on their operative cholangiograms (52.4%), whereas of 271 patients who had no history of pancreatic disease, pancreatic-duct reflux occurred in 45 (16.6%). 6 of 11 men with pancreatic-duct reflux had previously had acute pancreatitis, compared with 5 of 45 women. There was no significant correlation between the presence of pancreatic-duct reflux and common-bileduct stones, bileduct diameter, absence of duodenal filling, or history of jaundice. The increased tendency for pancreatic-duct reflux to occur in patients with gallstone pancreatitis is independent of duodenopancreatic-duct reflux and may not be related to the presence or recent passage of common-bileduct stones.