Pancreas: Alcoholic pancreatitis—it's the alcohol, stupid

@article{Apte2009PancreasAP,
  title={Pancreas: Alcoholic pancreatitis—it's the alcohol, stupid},
  author={Minoti V. Apte and Romano C. Pirola and Jeremy S. Wilson},
  journal={Nature Reviews Gastroenterology \&Hepatology},
  year={2009},
  volume={6},
  pages={321-322}
}
The management of alcoholic pancreatitis is mostly reactive; little is done to prevent disease progression. It is time for physicians to pay attention to the root cause of the condition—that is, alcohol—rather than just responding to its effects. This article discusses an important paper that describes the first prospective, randomized, controlled, clinical trial to investigate the effect of brief interventions for alcohol abuse on the progression of alcoholic pancreatitis. 

Alcohol and the pancreas.

The various hypotheses for pancreatic damage are discussed, together with the management of alcoholic pancreatitis and the role of operative intervention.

Chronic pancreatitis: an update for home care and hospice clinicians.

It is important for home care clinicians to recognize the signs of pancreatitis and understand the current evidence-based treatment strategies to control the symptoms.

Management of acute pancreatitis: a practical guide.

This article is an up-to-date practical guide for the management of acute pancreatitis, consistent with the latest evidence-based guidelines, which builds upon the key findings and recommendations of the NCEPOD report.

Management of alcohol use disorders in patients with chronic pancreatitis.

It is demonstrated that multidisciplinary management seems to give a positive and sustainable effect on alcohol abuse and may be a useful concept for optimal classification, selection and treatment of patients with chronic pancreatitis.

The Impact of Social Work Intervention in Alcohol-Induced Pancreatitis in Ireland: a Single-Center Experience.

It appears that the hospital's current social work intervention for alcohol-induced pancreatitis is ineffective in preventing relapse, and long-term prospective studies are required to formulate and better implement more efficacious interventions for such patients.

Antibiotic susceptibility of Staphylococcus aureus in suppurative lesions in Lacor Hospital, Uganda.

Histology of the mass showed a well differentiated adenocarcinona of the body and tail of the pancreas, which highlights the differentiation of pancreatic cancer from autoimmune pancreatitis and, to a lesser extent, other forms of Pancreatitis and benign pancreatic lesions.

Pancreatic cancer in an 18-year-old boy.

Histology of the mass showed a well differentiated adenocarcinona of the body and tail of the pancreas, which highlights the differentiation of pancreatic cancer from autoimmune pancreatitis and, to a lesser extent, other forms of pancitis and benign pancreatic lesions.

Environmental Risk Factors for Chronic Pancreatitis and Pancreatic Cancer

The observation that only ∼10% of heavy drinkers develop chronic pancreatitis not only suggests that other environmental factors, such as tobacco smoke, are potent additional risk factors, but also that the genetic component of pancreatitis is more common than previously presumed.

Serum proinflammatory cytokine levels and white blood cell differential count in patients with different degrees of severity of acute alcoholic pancreatitis.

The results suggest that proliferation and overstimulation of this subset of leukocytes might contribute to the development of the systemic inflammatory response in patients with SAAP.

Depressive Symptoms, Pain, and Quality of Life among Patients with Nonalcohol-Related Chronic Pancreatitis

Findings suggest that among patients with nonalcoholic pancreatitis, the presence of depressive symptoms is common and may be a risk factor associated with increased pain and decreased quality of life.

References

SHOWING 1-10 OF 12 REFERENCES

Abstinence in alcoholic chronic pancreatitis. Effect on pain and outcome.

  • W. Strum
  • Medicine
    Journal of clinical gastroenterology
  • 1995
This article examines the literature dealing with the effect of abstinence on chronic pain and the long-term outcome of chronic pancreatitis and concludes that if abdominal pain continues after abstinence and the pancreatic duct remains dilated, a lateral pancreatojejunostomy helps most patients.

The recurrence of acute alcohol-associated pancreatitis can be reduced: a randomized controlled trial.

The repeated visits at 6-month intervals at the gastrointestinal outpatient clinic, consisting of an intervention against alcohol consumption, appear to be better than the single standardized intervention alone during hospitalization in reducing the development of recurrent AP during a 2-year period.

Where there’s smoke there’s not necessarily fire

In vivo and in vitro studies have demonstrated that smoking significantly inhibits pancreatic secretion, and the concept that smoking enhances the toxic effects of alcohol on the pancreas was examined in a recent experimental study.

Cigarette smoking accelerates progression of alcoholic chronic pancreatitis

In this study, tobacco smoking was associated with earlier diagnosis of chronic alcoholic pancreatitis and with the appearance of calcifications and diabetes, independent of alcohol consumption.

Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy.

The pancreatic stellate cells are now established as key cells in fibrogenesis, particularly when activated either directly by toxic factors associated with pancreatitis or by cytokines released during pancreatic necroinflammation.

Mechanisms of Pancreatic Fibrosis

Evidence indicates a key role for activated PSCs in the fibrotic process, and studies are underway to characterise the signaling pathways/molecules responsible for mediating PSC activation, in order to identify potential therapeutic targets for the inhibition of PSCactivation, thereby preventing or reversing the development of pancreatic fibrosis.

Bacterial endotoxin: a trigger factor for alcoholic pancreatitis? Evidence from a novel, physiologically relevant animal model.

Strong in vivo and in vitro evidence is provided that suggests that LPS is a trigger factor in the initiation and progression of alcoholic pancreatitis.

A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis.

Antioxidant supplementation was effective in relieving pain and reducing levels of oxidative stress in patients with CP.

Randomized controlled trial.