ALCOHOL-RELATED PANCREATITIS

Alcohol misuse may result in the development of chronic pancreatitis.

Some individuals may develop this condition with alcohol intake as low as 1 to 20 grammes per day (1 units).

Others may need to drink in excess of 200 grammes per day (25 units) before evidence of the disease develops.

Some people never develop this condition no matter how much they drink or for how long.

In susceptible individuals the longer the duration of the drinking the greater the risk.

Alcoholic pancreatitis is a disorder mainly of men in their third to fifth decades.

It may present as an acute episode of abdominal pain, nausea and vomiting and in severe cases can be accompanied by profound metabolic abnormalities and circulatory collapse.

These episodes may recur, often precipitated by an increase in alcohol consumption.

Complications such as pressure on the common bile duct, localised leakage of pancreatic fluid and pancreatic exocrine (external secretions) and endocrine insufficiency may develop resulting in jaundice, pseudocyst formation, malabsorption and diabetes.

In some individuals, however, the clinical course is insidious with progression to pancreatic insufficiency without acute inflammatory episodes.

Withdrawal of alcohol at an early stage may arrest the process and, even when the condition is established, may reduce the number of inflammatory episodes and allow for better control of both the exocrine and endocrine insufficiency.

The diagnosis is made using pancreatic function tests and imaging.  A straight x-ray of the abdomen may reveal pancreatic calcification (cloudy or chalky deposits maybe containing calcium), and endoscopic retrograde cholangiopancreatography (ERCP) will show the typical picture of an attenuated (weakened) ductal system.

Management is directed at relief of the pain and correction of both the exocrine and endocrine insufficiency.