PANCREATITIS: A NARRATIVE AND COMPARATIVE REVIEW ON ETIOLOGY, PATHOPHYSIOLOGY, DIAGNOSIS AND THERAPEUTIC APPROACHES IN RECENT LITERATURE (2020-2025)

Abstract

Pancreatitis represents a spectrum of inflammatory pathologies of the pancreas of significant morbidity and mortality. Acute pancreatitis (AP) is characterized by a sudden inflammatory process, usually self-limited, but with the potential to evolve into multiple organ failure and death. Chronic pancreatitis (CP), in turn, is a progressive and irreversible fibroinflammatory condition. This narrative and comparative review aims to synthesize the latest advances and trends, based on publications indexed in PubMed between 2020 and 2025. The article explores the etiology, with emphasis on dominant causes (cholelithiasis and alcoholism) and emerging causes (genetic factors and intestinal microbiota). Pathophysiology is analyzed from the perspective of pancreatic autodigestion and systemic inflammatory response, with an in-depth discussion on the causal relationship between intestinal dysbiosis, endoplasmic reticulum stress and disease progression. The diagnostic approach is detailed, with a comparative analysis of the main severity scores (BISAP, APACHE II, Ranson's and CTSI), revealing the complementarity of these tools in risk stratification and prognosis prediction. Finally, the treatment is discussed, highlighting support management as the current therapeutic basis and pointing to the urgent need for target therapies that can modulate the inflammatory process and the new pathogenic pathways identified. Current evidence suggests a paradigm shift, with genetic etiology and intestinal dysbiosis emerging as targets for therapeutic and personalized approaches in the future, while surgery for chronic pain in pancreatitis is compared between Frey and Beger's techniques.