Pathophysiology

Patients with common chronic pancreatitis suffer from repeated vomiting, severe epigastric pain and weight loss. GP presents various clinical symptoms due to stricture of the common bile duct and the duodenum. Inflammatory infiltration and fibrosis induce scarring in the groove, and result in obstructive jaundice by narrowing the common bile duct. Stricture of the duodenum by marked thickening of the duodenal wall causes abdominal fullness, nausea and vomiting.

The function of Brunner's glands is not well known. The cytoplasma of the Brunner's gland epithelial cells contains neutral mucin that is PAS-positive and

Fig. 4. Stricture of the common bile duct (ERCP).

diastase resistant. The mucin might play a role in neutralizing the duodenum content of elevated gastric acid. Hyperplasia of Brunner's glands is probably an adaptive reaction to the exocrine insufficiency of the pancreas or the changes in gastric function (hyperacidity, accelerated emptying of the stomach) caused by chronic pancreatitis.

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