Sanjay Jagannath admits that when it comes to caring for a particular group of patients, he’s frustrated.

“Despite all the people we see with pancreatitis—acute and chronic—we still do not understand why and how best to treat,” he says. “We cannot prevent it; we don’t have the ability to reverse the damage.”

Like any top-notch gastroenterologist, Jagannath can recite the factors that likely contribute to the inflammation (alcohol, gallstones, hyperlipidemia, hypercalcemia, certain medications, inherited conditions, and others). He’s up on all the tools for making the tricky diagnosis (endoscopic ultrasound, CT, MRI, biochemical lab testing). He knows the available interventions.

What bugs him is not knowing what’s really behind this potentially deadly condition. What is its natural history? Why does the hallmark scarring of chronic pancreatitis produce debilitating pain in some and not others? “For us to make a dent,” he says, “we need to offer optimal care while learning from our patients.”

To that end, Jagannath has launched the Johns Hopkins Center for Pancreatitis, assembling a team that includes not only some of the institution’s best gastroenterologists and surgeons, but a radiologist, anesthesiologist, pathologist and even a statistician. Pulling these disciplines together, he insists, is critical.

Existing treatments range from life-style changes targeting symptoms such as diarrhea and weight loss, to endoscopy and surgery for managing chronic pain, calcification, ductal dilation, strictures and other complications. “There’s a lot of speculation about the best ways to treat pancreatitis,” says Jagannath. “With our specialists acting under clinical algorithms, we can devise the most comprehensive plans and at the same time study what we are seeing.”