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However, there is now emerging evidence in favour of the necrosis\u2010fibrosis hypothesis that alcoholic pancreatitis begins as an acute process and that repeated acute attacks lead to chronic pancreatitis, resulting in exocrine and endocrine failure. Over the past 10\u201015 years, the focus of research into the pathogenesis of alcoholic pancreatitis has shifted from possible sphincteric and ductular abnormalities to the acinar cell itself which has increasingly been implicated as the initial site of injury. Recent studies have shown that the acinar cell can metabolize alcohol at rates comparable to those observed in hepatocytes. In addition, it has been demonstrated that alcohol and its metabolites exert direct effects on the pancreatic acinar cell which may promote premature digestive enzyme activation and oxidant stress. The challenge remains to identify predisposing and triggering factors in this disease.<\/jats:p>","DOI":"10.1080\/13556219872209","type":"journal-article","created":{"date-parts":[[2002,7,26]],"date-time":"2002-07-26T15:50:12Z","timestamp":1027698612000},"page":"137-150","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Alcohol and the pancreas"],"prefix":"10.1111","volume":"3","author":[{"given":"MINOTI V.","family":"APTE","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PAUL S.","family":"HABER","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"IAN D.","family":"NORTON","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JEREMY S.","family":"WILSON","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,6,9]]},"reference":[{"key":"e_1_2_1_2_2","volume-title":"Pancreatitis symposium of Marseille 1963","author":"Sarles H","year":"1965"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.25.7.756"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(85)90468-8"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-196007000-00019"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-74-2-264"},{"key":"e_1_2_1_7_2","first-page":"382","article-title":"Pancreatic fibrosis in acute alcoholics and nonalcoholics without clinical pancreatitis","volume":"79","author":"Pitchumoni CS","year":"1984","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.35.4.552"},{"key":"e_1_2_1_9_2","first-page":"274","article-title":"[Development of chronic pancreatitis from acute pancreatitis: a pathogenetic concept]","volume":"120","author":"Kloppel G","year":"1995","journal-title":"Zentralb Chir"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01308298"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006676-199205000-00017"},{"key":"e_1_2_1_12_2","first-page":"820","article-title":"Course and outcome of chronic pancreatitis. 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