Fibrosis, Atrophy, and Ductal Pathology in Chronic Pancreatitis Are Associated With Pancreatic Function but Independent of Symptoms

OBJECTIVES: More knowledge into the pathophysiology underlying pain and other complications in chronic pancreatitis (CP) is needed. The aim was to associate advanced imaging information of the pancreas with etiology and clinical and laboratory parameters of CP. METHODS: Magnetic resonance cholangiopancreatography including diffusion-weighted imaging was obtained in 23 patients with painful CP and 17 controls. Apparent diffusion coefficients, ductal pathology, and pancreas atrophy were assessed. Etiology of CP and clinical and laboratory parameters including pain scores were correlated with the imaging findings. RESULTS: The patients had restricted apparent diffusion coefficients, that is, fibrotic changes, compared with the controls (P = 0.0003). The diffusion coefficients were not associated with atrophy- or ductal-related parameters (all P > 0.7). The fibrotic changes as well as atrophy- and ductal-related parameters were not associated with pain or any other symptom parameters (all P > 0.05). Alcoholic etiology was associated with ductal pathology (both P = 0.02). Furthermore, atrophy- and ductal-related parameters were associated with vitamin D, phosphate, hemoglobin, and glycated hemoglobin levels (all P < 0.03). CONCLUSIONS: Patients with CP have fibrosis, atrophy, and ductal pathology. Although changes in atrophy- and ductal-related parameters were, to some degree, associated with exocrine and endocrine insufficiency, pain and other symptoms seem to have a more complex pathogenesis independent of imaging pathology.