Chronic pancreatitis is a progressive inflammatory condition characterized by repeated attacks of
abdominal pain, and the destruction and
fibrosis of the pancreatic parenchyma which causes to reduced exocrine and endocrine functions. Alcohol is the most common cause of
chronic pancreatitis. Although abstinence is usually considered a prerequisite for successful treatment of alcoholic
chronic pancreatitis, we often encounter patients who have repeated attacks from the compensated stage through the transitional stage. In alcoholic
chronic pancreatitis, continued alcohol consumption causes changes in the digestive
hormones and vagal nerve function that induce the pancreatic acinar cells to oversecrete
protein, increasing the
protein concentration and viscosity of the pancreatic juice. This induces
protein sedimentation from the pancreatic juice and formation of
protein plugs within the pancreatic duct, triggering repeated attacks of
acute pancreatitis. The treatment of alcoholic
chronic pancreatitis includes alleviation of symptoms, particularly
abdominal pain, elimination of trigger factors, prevention of recurrence and
disease progression, adjuvant
therapies for pancreatic exocrine and endocrine failure. Recently, the main constituent
proteins in these
protein plugs have been identified, enabling trials of several
therapies, such as the administration of
secretin formulations and endoscopic removal.
Bromhexine hydrochloride, a bronchial
mucolytic, has an affinity for the pancreatic acinar cells, inducing them to secrete pancreatic juice of low viscosity. In this review, we summarize the most recent thoughts about alcoholic
chronic pancreatitis, and the new treatments, and in particular, we present our findings concerning the efficacy of
bromhexine hydrochloride in the treatment of this disease.