"Non-alcoholic duct destructive chronic pancreatitis" or "primary chronic pancreatitis"?

Editor,—We read with great interest the article by Ectors et al ( Gut 1997; 41 :263–8) in which the authors describe a particular form of chronic pancreatitis in patients without chronic alcohol intake. The authors suggest the term “non-alcoholic duct destructive chronic pancreatitis” for this type of pancreatic disease in order to stress: (1) the absence of any history of alcohol abuse; (2) the target of the chronic immunological reaction; and (3) the destructive nature of the process. Characteristically some of these cases were associated with an autoimmune disease, such as primary sclerosing cholangitis, ulcerative colitis, Crohn’s disease, or Sjogren’s syndrome. The authors conclude that the inflammatory changes in the pancreatic ducts observed in this particular form of chronic pancreatitis are suggestive of an autoimmune process. A few years ago our group postulated a new hypothesis for the pathogenesis of a particular form of chronic pancreatitis, which we defined as “primary chronic pancreatitis”.1 We suggested that the key step in the pathogenesis of this type of chronic pancreatitis may be …