Advances in Biomarkers, Diagnostic Approaches, Endoscopic Techniques, and Surgical Management of Chronic and Autoimmune Pancreatitis

Chronic pancreatitis (CP) is a progressive fibroinflammatory disease of the exocrine pancreas, in which recurrent or persistent acinar cell injury lead to irreversible pancreatic tissue damage.





The global incidence of chronic pancreatitis (CP) is estimated at approximately 9–10 cases per 100,000 person-years, with marked geographical heterogeneity and comparatively elevated rates reported in Eastern Europe and selected Asian populations. The worldwide prevalence is estimated to range between 45 and 153 cases per 100,000 individuals, likewise demonstrating substantial regional variability. Such epidemiological disparities are attributable to differing distributions of established risk factors, including alcohol consumption, tobacco use, and genetic predisposition.





The etiology of CP is multifactorial, involving genetic, environmental and behavioral factors. The most common causes are excess alcohol consumption and cigarette smoking, which together contributed for the majority of cases in Western populations. Alcohol exerts its effect on pancreatic acinar cells via its oxidative and non-oxidative metabolites, while smoking is an independent and synergistic risk factor, present in over 60% of cases. Genetic mutations are implicated in a subset of patients, particularly those with early-onset or idiopathic disease. The most frequently gene mutations involved in the pathways are protease dependent mechanism (SPINK1, PRSS1, CTRC), endoplasmic reticulum stress-related mechanisms (CPA1 and CEL) or ductal dysfunction-related mechanism (CFTR). Other recognized etiologies include obstructive causes (such as pancreatic duct strictures, stones, or congenital anomalies like pancreas divisum), metabolic disorders (notably hypercalcemia and hypertriglyceridemia) and autoimmunity. Autoimmune pancreatitis (AIP) is a distinct form of chronic pancreatitis. AIP type 1 is part of the broader IgG4-related disease spectrum, with overlapping clinical and radiological features that often mimic pancreatic cancer, while AIP type 2 primarily affects the pancreas and is characterized by neutrophilic inflammation of the pancreatic ducts and it is often associated to inflammatory bowel disease (IBD), particularly ulcerative colitis. AIP type 3 occours as an immune-related adverse event (irAE) to immune checkpoint inhibitor (ICI) therapy.





The management of CP and AIP necessitates a comprehensive multidisciplinary approach, drawing on the expertise of clinicians, basic scientists, laboratory medicine specialists, geneticists, nutritionists, radiologists, endoscopists and surgeons to achieve accurate diagnosis and optimize therapeutic strategies. Furthermore, given the elevated risk of pancreatic cancer, rigorous long-term follow-up is mandatory.





In patients with CP requiring therapeutic intervention -such as duodenal or bile duct obstruction, symptomatic pseudocysts or chronic pain refractory to medical therapy- endoscopic approaches are generally preferred as the initial strategy. Nevertheless, although the optimal timing of surgery remains a matter of debate, evidence suggests that early surgical intervention (either pancreatic resection or drainage) provides superior long-term pain relief, particularly when performed before the development of extrapancreatic pain. Moreover, pancreatic resection retains a distinct role in the presence of an inflammatory mass or when malignancy is suspected, which occurs in approximately 5% of cases.





Overall, CP remains a substantial and likely underrecognized global health challenge. Although progress has been made in elucidating its pathophysiology, accurate and timely diagnosis continues to pose difficulties, frequently resulting in delayed treatment and increased morbidity. Early identification of CP is therefore crucial to enable pancreatic interventions before irreversible progression leads to significant exocrine and endocrine insufficiency, complications, and impaired quality of life. Conversely, precise diagnosis of AIP is essential to ensure the prompt initiation of corticosteroid therapy, to prevent misclassification as pancreatic cancer and the risk of unnecessary surgery, and to preserve both exocrine and endocrine pancreatic function.





This Research Topic aims to highlight the recent progresses in the identification of novel diagnostic tools and innovations in management of CP and AIP. Emerging serological, molecular, and imaging biomarkers are showing promise in differentiating AIP from pancreatic cancer and predicting disease relapse. Advances in functional imaging (DWI, T1 mapping, etc), contrast-enhanced MRI, and endoscopic ultrasound (EUS), including elastography and fine-needle biopsy (FNB) are improving diagnostic precision. Moreover, the role of EUS-guided interventions and minimally invasive surgical approaches continues to expand, offering tailored treatment strategies and improved patient outcomes.



We invite original research, clinical case studies and reviews that explore cutting-edge developments in this field, from laboratory and genetic tests to the latest diagnostic technologies and therapeutic innovations. By integrating multidisciplinary perspectives from gastroenterologists, geneticists, laboratory physicians, nutritionists, pathologists, radiologists and surgeons, this Topic seeks to advance our collective understanding and management of CP and AIP, ultimately improving diagnostic accuracy and patient care.