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Z Gastroenterol 2013; 51(4): 358-362
DOI: 10.1055/s-0033-1335278
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© Georg Thieme Verlag KG Stuttgart · New York

50 Jahre Fortschritt in Pathophysiologie, Diagnostik und Behandlung der chronischen Pankreatitis

50 Years of Progress in Pathophysiology, Diagnosis and Treatment of Chronic Pancreatitis
M. M. Lerch
,
J. Mayerle
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Publication History

Publication Date:
12 April 2013 (online)

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Zusammenfassung

Die Zeitschrift für Gastroenterologie feiert im Jahr 2013 ihr 50-jähriges Bestehen. In diesem halben Jahrhundert haben Originalarbeiten, Übersichten und Leitlinien zur akuten Pankreatitis, zur chronischen Pankreatitis und zum Pankreaskarzinom kontinuierlich eine prominente Rolle in den Seiten der ZfG eingenommen. Schon in der Erstausgabe der Zeitschrift veröffentlichten Haemmerli und Hefti die Züricher Erfahrungen zum natürlichen Verlauf der chronischen Pankreatitis, ergänzt um eine detaillierte Darstellung des Standes der Wissenschaft im Jahr 1963. Fünfzig Jahre später ist die aktuelle Leitlinie der DGVS zur chronischen Pankreatitis in den Seiten der ZfG erschienen und erlaubt eine Zusammenfassung der Fortschritte über diesen Zeitraum. Damals wurde die chronische Pankreatitis als sehr seltene Erkrankung betrachtet (10-fach seltener als z. B. die akute Pankreatitis oder das Pankreaskarzinom), was wenig mit der tatsächlichen Prävalenz und viel mit den noch wenig empfindlichen diagnostischen Möglichkeiten, insbesondere in der Bildgebung zu tun hatte. Während die pathogenetischen Ursachen der chronischen Pankreatitis, einschließlich einer möglichen erblichen Genese, 1963 bereits weitgehend bekannt waren, hat sich das Verständnis ihrer zellulären Grundlagen rasant weiterentwickelt. Die größten Fortschritte in der Diagnostik wurden durch die Entwicklung bildgebender Verfahren wie Sonografie und Endosonografie, ERCP, CT und MRCP ermöglicht. Auch in der Therapie haben sich nicht nur die pharmakotherapeutischen Ansätze verändert (Verlassen der Sekretionshemmung als Therapieprinzip), sondern v. a. die Alternativen die endoskopisch-interventionellen und die chirurgische Therapie sind neu entstanden.

Abstract

The German Journal of Gastroenterology celebrates its fifties anniversary in 2013. Over half a century original studies, reviews and guidelines covering the topics of acute and chronic pancreatitis as well as pancreatic cancer have assumed a prominent role on its pages. Already in the first edition of the Journal Haemmerli and Hefti have summarized the Zurich experience with chronic pancreatitis and provided a detailed state-of-the-art review for the year 1963. 50 years later the current guidelines of the German Society of Digestive and Metabolic Diseases (DGVS) have been published in the same Journal and allow to summarize the scientific progress over this period. Back then chronic pancreatitis was regarded as a rare disorder (tenfold less common than e. g. acute pancreatitis or pancreatic cancer). This misconception had little to do with actual prevalence but with highly insensitive diagnostic tests, particularly in the area of diagnostic imaging. While pathogenetic factors for chronic pancreatitis, including a possible genetic disposition, were largely known in 1963, our understanding of their cellular mechanisms has very much improved. The greatest progress in diagnostic options was achieved by the introduction of novel imaging techniques such as ultrasound and endoscopic ultrasound, ERCP, CT and MRCP. In terms of therapy the notion that a blockage of pancreatitic secretion is an effective pharmacological option has been abandoned and endoscopic intervention and surgical treatment have been newly developed as alternatives.

Schlüsselwörter

Chronische Pankreatitis - Schmerztherapie der chronischen Pankreatitis - Enzymsupplementierung bei exokriner Insuffizienz - endoskopische Therapie der chronischen Pankreatitis - hereditäre Pankreatitis

Key words

chronic pancreatitis - pain management in chronic pancreatitis - enzyme replacement for exocrine failure - endoscopic therapy for chronic pancreatitis - hereditary pancreatitis
 

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