Not All Cases of Chronic Pancreatitis Are Alcohol-Induced
Alcohol has been implicated in the development of chronic pancreatitis (CP) in 60%–90% of patients, but a new study in Clinical Gastroenterology and Hepatology reports the relative rate of alcohol-related chronic pancreatitis (CP) is lower when compared to other causes.
Patients with no identifiable cause for their disease as well as those with non-alcohol-related causes represent an unexpectedly large subgroup, particularly among women.
Gregory A. Coté, MD, MS, of Indiana University School of Medicine and lead author of this study, said "One of the more remarkable observations is that in more than 50 percent of patients, alcohol was not considered as the causative factor of chronic pancreatitis. Future analyses will likely identify previously unrecognized genetic factors and/or interaction between genes and environmental factors as potential explanations of disease development. In the meantime, the era of dismissing all cases of chronic pancreatitis as alcohol-induced has undoubtedly come to a close."
Coté and colleagues investigated the epidemiology of alcohol-related CP at 20 tertiary US referral centers using data from patients with CP (n = 539) and controls (n = 695) enrolled in the North American Pancreatitis Study-2 (NAPS-2) from 2000 to 2006.
The NAPS-2 was designed to further the understanding of the role of gene-environment interactions in patients with recurrent acute pancreatitis and CP.
CP was defined by definitive evidence from imaging or histologic analyses. Subjects and physicians each completed a study questionnaire. Using physician-assigned diagnoses, patients were assigned to an etiology group: alcohol (with/without other diagnoses), nonalcohol (any etiology of CP from other than alcohol), or idiopathic (no etiology identified).
The researchers found the distribution of patients among etiology groups was: 44.5% had CP due to alcohol consumption, 26.9% had non-alcohol related CP, and 28.6% had CP of unknown cause.
The physicians identified alcohol as the etiology more frequently in men (59.4% men vs 28.1% women). For women, the etiology was more often nonalcohol (18% men vs 36.7% women) or idiopathic (22.6% men vs 35.2% women). Nonalcohol etiologies were equally divided among obstructive, genetic, and other causes.
Compared with controls, patients with idiopathic CP were more likely to have ever smoked (58.6% vs 49.7%, P
Among the risk factors assessed, smoking (ever, current, and amount) was independently associated with idiopathic CP.
Pancreatitis usually begins as a sudden attack. When the pancreas becomes inflamed, its digestive enzymes attack the tissue that produces them. One of these enzymes, called trypsin, can cause tissue damage and bleeding, which may cause the pancreas tissue cells and blood vessels to swell. In some cases, the attacks may recur frequently over time, which is known as CP. The onset of CP remains hard to define. This condition can be caused by alcohol, smoking and a multitude of other factors.
For more information on pancreatitis, read the AGA brochure "Understanding Pancreatitis"
Gregory A. Coté, Dhiraj Yadav, Adam Slivka, Robert H. Hawes, Michelle A. Anderson, Frank R. Burton, Randall E. Brand, Peter A. Banks, Michele D. Lewis, James A. Disario. Alcohol and Smoking as Risk Factors in an Epidemiology Study of Patients With Chronic Pancreatitis. Clinical Gastroenterology and Hepatology, 2011; 9 (3): 266 DOI: 10.1016/j.cgh.2010.10.015
American Gastroenterological Association Press Release, March 11, 2011