Abstinence after First Acute Alcohol-Associated Pancreatitis Protects Against Recurrent Pancreatitis and Minimizes the Risk of Pancreatic Dysfunction

Nikkola, Jussi; Räty, Sari; Laukkarinen, Johanna; Seppänen, Hanna; Lappalainen-Lehto, Riitta; Järvinen, Satu; Nordback, Isto; Sand, Juhani

doi:10.1093/alcalc/agt019

Cited by 62 publications

(41 citation statements)

References 21 publications

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“…Other issues related to outcome including access to and use of outpatient or inpatient resources before diagnosis and until enrollment were not captured. Health-care access is important as it is clearly recognized that early alcohol and perhaps smoking cessation counseling can prevent recurrent pancreatitis and potential progression to CP (26,27). Potential disparities in health-care access based on race will need to be further explored given the significantly higher rates of alcohol and tobacco use as well as disability in black compared with white CP patients.…”

Section: Discussionmentioning

confidence: 99%

Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis

Wilcox

Sandhu

Singh

et al. 2016

American Journal of Gastroenterology

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OBJECTIVES: Racial differences in susceptibility and progression of pancreatitis have been reported in epidemiologic studies using administrative or retrospective data. There has been little study, however, on the clinical profile, causes, and outcome of chronic pancreatitis (CP) in black patients. METHODS: We analyzed data on black patients with CP prospectively enrolled in the multicenter North American Pancreatitis Studies from 26 US centers during the years 2000–2014. CP was defined by definitive evidence on imaging studies or histology. Information on demographics, etiology, risk factors, disease phenotype, treatment, and perceived effectiveness was obtained from responses to detailed questionnaires completed by both patients and physicians. RESULTS: Of the 1,159 patients enrolled, 248 (21%) were black. When compared with whites, blacks were significantly more likely to be male (60.9 vs. 53%), ever (88.2 vs. 71.8%), or current smokers (64.2 vs. 45.9%), or have a physician-defined alcohol etiology (77 vs. 41.9%). There was no overall difference in the duration of CP although for alcoholic CP, blacks had a longer duration of disease (8.6 vs. 6.97 years; P=0.02). Blacks were also significantly more likely to have advanced changes on pancreatic morphology (calcifications (63.3 vs. 55.2%), atrophy (43.2 vs. 34.6%), pancreatic ductal stricture or dilatation (72.6 vs. 65.5%) or common bile duct stricture (18.6 vs. 8.2%)) and function (endocrine insufficiency 39.9 vs. 30.2%). Moreover, the prevalence of any (94.7 vs. 83%), constant (62.6 vs. 51%), and severe (78.4 vs. 65.8%) pain and disability (35.1 vs. 21.4%) were significantly higher in blacks. Observed differences were in part related to variances in etiology and duration of disease. No differences in medical or endoscopic treatments were seen between races although prior cholecystectomy (31.1 vs. 19%) was more common in white patients. CONCLUSIONS: Differences were observed between blacks and whites in the underlying cause, morphologic expression, and pain characteristics of CP, which in part are explained by the underlying risk factor(s) with alcohol and tobacco being much more frequent in black patients as well as disease duration.

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Section: Discussionmentioning

confidence: 99%

Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis

Wilcox

Sandhu

Singh

et al. 2016

American Journal of Gastroenterology

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“…Pancreatic dysfunction was previously shown as rare among patients who stop drinking after the first episode of alcohol-associated pancreatitis. Fecal elastase levels returned to normal after two years of abstinence except for one patient (6%) that maintained low elastase-1 activity (17) . In contrast, in our study four (12.1%) ex-alcoholics had fecal elastase 1 levels lower than 100 µg, indicating that they might have exocrine pancreatic insufficiency although asymptomatic and with normal pancreas by imaging procedures.…”

Section: Discussionmentioning

confidence: 90%

Comparison of Fecal Elastase 1 for Exocrine Pancreatic Insufficiency Evaluation Between Ex-Alcoholics and Chronic Pancreatitis Patients

Mattar

Lima

Costa

et al. 2014

Arq. Gastroenterol.

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-Context -Fecal elastase is a noninvasive test for pancreatic insufficiency diagnosis. Objective -Evaluate the usefulness of fecal elastase 1 for the indication of exocrine pancreatic insufficiency among former alcohol addicts and patients with chronic pancreatitis. Methods -Forty-three patients with chronic pancreatitis and thirty-three asymptomatic former alcohol addicts entered the study. The levels of fecal elastase 1 were measured using a commercial kit. Pancreatic imaging findings were used to categorize the groups. Results -The levels of fecal elastase 1 were significantly lower in the patients than in the former alcohol addicts and in the group with tissue calcifications, duct alterations, or atrophy. With a cutoff level of 100 µg/g, the sensitivity of fecal elastase 1 in chronic pancreatitis was 46.51% and its specificity was 87.88% with a positive predictive value of 83.33% and a negative predictive value of 55.77%. When patients were stratified according to the severity of their pancreatitis, the sensitivity was 6.25% for mild pancreatitis and 70.37% for marked pancreatitis. Conclusion -Low level of fecal elastase 1 was associated with marked rather than mild chronic pancreatitis; however, it may be useful to indicate pancreatic exocrine insufficiency in asymptomatic former alcohol addicts. HEADINGS -Pancreatic elastase. Chronic pancreatitis. Alcoholics. Exocrine pancreatic insufficiency.

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“…The definitions of various etiological causes were as follows: (i) biliary: jaundice, elevated serum bilirubin levels, imaging features of dilated intrahepatic and/or extrahepatic duct (≥1 cm in diameter) or calculus found in the biliary system; (ii) hyperlipidemia: serum triglyceride (TG) ≥11.30 mmol/L, or of 5.65–11.30 mmol/L with chylemia; (iii) alcohol: considered as a cause of pancreatitis due to heavy alcoholic consumption (>80 g/day for more than 5 years), with elevated serum γ‐glutamyl transferase (γ‐GT) and mean corpuscular volume (MCV) of red blood cell (RBC) . (iv) pancreaticobiliary malformation: confirmed by magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP); (v) idiopathic: a diagnosis of pancreatitis could not be made after a thorough medical history screening, physical examination, laboratory studies, and non‐invasive imaging modalities such as abdominal ultrasonography and/or computed tomography (CT) …”

Section: Methodsmentioning

confidence: 99%

Etiology, clinical features and management of acute recurrent pancreatitis

Deng

Wang

et al. 2014

J of Digest Diseases

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Abstinence after First Acute Alcohol-Associated Pancreatitis Protects Against Recurrent Pancreatitis and Minimizes the Risk of Pancreatic Dysfunction

Abstract: Regardless of the mediator mechanisms of acute alcoholic pancreatitis, abstinence after the first episode protects against recurrent attacks. Pancreatic dysfunction is also rare among abstinent patients.

Cited by 62 publications

References 21 publications

Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis

Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis

Comparison of Fecal Elastase 1 for Exocrine Pancreatic Insufficiency Evaluation Between Ex-Alcoholics and Chronic Pancreatitis Patients

Etiology, clinical features and management of acute recurrent pancreatitis

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