The papilla of Vater and chronic pancreatitis

The histological investigation of 150 surgical preparations obtained from patients with chronic pancreatitis, frequently revealed pathological changes affecting the papilla of Vater, such as inflammatory infiltration (69%), fibrosis (81%), glandular hyperplasia (94%), and adenomyosis (95%). In 59% of the cases, these changes had led to a histological suspicion of papillary stricture. No statistically significant correlations were found between the degree of pathological papillary changes and the degree of chronic pancreatitis. Nevertheless, a number of case histories indicated that the pathological changes in the papilla could be both the cause and the consequence of pancreatitis. The secondary papillary stenosis caused by chronic pancreatitis could possibly maintain or accelerate the scarring process in the pancreas. Simple papillotomy would not eradicate this "obstruction to flow" of the pancreatic juice, for the pathological changes are localized mainly at the base of the papilla and often involve the pre-papillary segment of the pancreatic duct. A more sophisticated clinical diagnostic work-up of papillary function in chronic pancreatitis might, however, lead to differential treatment.