Intrapancreatic Fat Deposition: Cause or Consequence of First Acute Pancreatitis Attack?

Considering the scientific evidence nowadays available, we suggest that IPFD should be carefully differentiated between pancreatic fat accumulation (an overflow of fat in the pancreas in patients with adipose excess) and fatty replacement (characterized by a change in the cellular identity with an acinar-to-adipocyte transdifferentiation in patients with pancreatic damage, such as AP). Different from the conclusions of the authors of this study, we believe that fatty replacement is not the “first hit” predisposing to pancreatic disease, but the “second hit” driving to pancreatic meta-inflammation and chronic damage (Figure 1).