Acute pancreatitis in North America is almost always associated with either biliary tract disease or chronic alcoholism. Diverse mechanisms have been postulated to explain the role of these two factors in the chain of events that triggers an episode of acute pancreatitis. Our comments will be limited to those mechanisms that can be demonstrated experimentally and applied clinically. Regardless of which of the mechanisms plays the most important role in triggering the disease, there is little doubt that the basic pathophysiologic process is pancreatic autodigestion and that this process can produce wide-ranging abnormalities in remote organs.
Alcoholism is the most common factor in acute pancreatitis in many series from the United States.1-3 However, clinically overt pancreatitis usually develops several years after the start of heavy alcohol intake, when the pancreas has suffered chronic damage. Once the gland is sensitized, relapses can occur after ingestion of even small amounts