Review of idiopathic pancreatitis

Abstract

Recent advances in understanding of pancreatitis and advances in technology have uncovered the veils of idiopathic pancreatitis to a point where a thorough history and judicious use of diagnostic techniques elucidate the cause in over 80% of cases. This review examines the multitude of etiologies of what were once labeled idiopathic pancreatitis and provides the current evidence on each. This review begins with a background review of the current epidemiology of idiopathic pancreatitis prior to discussion of various etiologies. Etiologies of medications, infections, toxins, autoimmune disorders, vascular causes, and anatomic and functional causes are explored in detail. We conclude with management of true idiopathic pancreatitis and a summary of the various etiologic agents. Throughout this review, areas of controversies are highlighted.

Figure 1

¹To arrive at the label of recurrent undiagnosed pancreatitis, a history, physical exam, routine laboratory investigations, chest radiograph, abdominal ultrasound, and or computed tomography must fail to find the etiology of pancreatitis. Although sludge may be picked up on transabdominal ultrasound, the low sensitivity precludes exclusion of diagnosis of microlithiasis. ES: Endoscopic sphincterotomy; TIP: True idiopathic pancreatitis; EUS: Endoscopic ultrasound; CT: Computed tomography; URSO: Ursodeoxycholic acid.