Current Gastroenterology Reports

, Volume 7, Issue 2, pp 96–100

Alcoholic pancreatitis: New insights into an old disease

  • Lucio Gullo
  • Marina Migliori
  • Maria Angela Brunetti


Alcoholic pancreatitis is an old disease that continues to present controversial issues. One of the most hotly debated issues is whether alcoholic pancreatitis is a chronic disease from the beginning or if instead it becomes chronic after repeated episodes of acute pancreatitis. Histologic studies, including very large series of patients with alcoholic pancreatitis, have clearly shown that this disease is chronic from the beginning and that, if acute necrotic pancreatitis occurs, it is associated with chronic lesions. The possibility that acute alcoholic pancreatitis can occur in the absence of chronic lesions cannot be excluded, but, if this occurs, it is rare. In addition to alcohol, genetic factors certainly play a determining role. Until now many genetic studies have been made on chronic pancreatitis; the first dealt with hereditary pancreatitis. In this disease it has been shown that mutations of the cationic trypsinogen gene and of SPINK1 are implicated in its pathogenesis. Concerning alcoholic pancreatitis, several studies have been made, but the results so far are disappointing.


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References and Recommended Reading

  1. 1.
    Marks IN, Bank S: The aetiology, clinical features and diagnosis of pancreatitis in the south Western Cape: a review of 243 cases. SA Med J 1963, 37:1039–1053. The first etiologic and clinical study of chronic pancreatitis in a large series of patients.Google Scholar
  2. 2.
    Sarles H, Sarles JC, Camatte R, et al.: Observations on 205 confirmed cases of acute pancreatitis, recurring pancreatitis, and chronic pancreatitis. Gut 1965, 6:545–558. This paper proposed a new concept of alcoholic pancreatitis on the basis of histologic and clinical data.PubMedGoogle Scholar
  3. 3.
    Gastard J, Joubaud F, Farbos T, et al.: Etiology and course of primary chronic pancreatitis in Western France. Digestion 1973, 9:416–428.PubMedGoogle Scholar
  4. 4.
    Bernades P, Belghiti J, Athouel M, et al.: Histoire naturelle de la pancr’eatite chronique: ’etude de 120 cas. Gastroenterol Clin Biol 1983, 7:8–13.PubMedGoogle Scholar
  5. 5.
    Levy P, Milan C, Pignon JP, et al.: Mortality factors associated with chronic pancreatitis: unidimensional and multidimensional analysis of a medical-surgical series of 240 patients. Gastroenterology 1989, 96:1165–1172.PubMedGoogle Scholar
  6. 6.
    Gullo L, Costa PL, Labò G: Chronic pancreatitis in Italy: etiological, clinical and histological observations based on 253 cases. Rendic Gastroenterol 1977, 9:97–104.Google Scholar
  7. 7.
    Ammann RW, Akovbiantz A, Largiader F, Schueler G: Course and outcome of chronic pancreatitis: longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 1984, 86:820–828. A good clinical study of chronic pancreatitis.PubMedGoogle Scholar
  8. 8.
    Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W: Natural course in chronic pancreatitis: pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 1993, 54:148–155.PubMedGoogle Scholar
  9. 9.
    Layer P, Yamamoto H, Kalthoff L, et al.: The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology 1994, 107:1481–1487.PubMedGoogle Scholar
  10. 10.
    Dani R, Mott CB, Guarita DR, Nogueira CED: Epidemiology and etiology of chronic pancreatitis in Brazil: a tale of two cities. Pancreas 1990, 5:474–478.PubMedCrossRefGoogle Scholar
  11. 11.
    Stevens T, Conwell DL, Zuccaro G: Pathogenesis of chronic pancreatitis: an evidence-based review of past theories and recent developments. Am J Gastroenterol 2004, 99:2256–2270.PubMedCrossRefGoogle Scholar
  12. 12.
    Estival A, Clemente F, Ribet A: Ethanol metabolism by the rat pancreas. Toxicol Appl Pharmacol 1981, 61:155–165.PubMedCrossRefGoogle Scholar
  13. 13.
    Haber PS, Apte MV, Applegate TL, et al.: Metabolism of ethanol by rat pancreatic acinar cells. J Lab Clin Med 1998, 132:294–302.PubMedCrossRefGoogle Scholar
  14. 14.
    Lange LG: Non-oxidative ethanol metabolism: formation of fatty acid ethyl esters by cholesterol esterase. Proc Natl Acad Sci U S A 1982, 79:3954–3957.PubMedCrossRefGoogle Scholar
  15. 15.
    Sarles H, Bernard JP, Gullo L: Pathogenesis of chronic pancreatitis. Gut 1990, 31:629–632.PubMedGoogle Scholar
  16. 16.
    Apte MV, Phillips PA, Fahmy RG, et al.: Does alcoholic directly stimulate pancreatic fibrogenesis? Studies with rat pancreatic stellate cells. Gastroenterolology 2000, 118:780–794.CrossRefGoogle Scholar
  17. 17.
    Suda K, Shiotsu H, Nakamura T, et al.: Pancreatic fibrosis in patients with chronic alcohol abuse: correlation with alcoholic pancreatitis. Am J Gastroenterol 1994, 89:2060–2062.PubMedGoogle Scholar
  18. 18.
    Kloppel G, Maillet B: Pseudocysts in chronic pancreatitis: a morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas 1991, 6:266–274.PubMedCrossRefGoogle Scholar
  19. 19.
    Kloppel G, Maillet B: Pathology of acute and chronic pancreatitis. Pancreas 1993, 8:659–670.PubMedCrossRefGoogle Scholar
  20. 20.
    Ammann RW, Heitz PU, Kloppel G: Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 1996, 111:224–231.PubMedCrossRefGoogle Scholar
  21. 21.
    Gorry MC, Gabbaizedeh D, Furey W, et al.: Mutations in the cationic trypsinogen gene are associated with recurrent acute and chronic pancreatitis. Gastroenterology 1997, 113:1063–1068.PubMedCrossRefGoogle Scholar
  22. 22.
    Kloppel G: Progression from acute to chronic pancreatitis: a pathologist’s view. Surg Clin North Am 1999, 79:801–814.PubMedCrossRefGoogle Scholar
  23. 23.
    Lankisch PG: Progression from acute to chronic pancreatitis: a physician’s view. Surg Clin North Am 1999, 79:815–827.PubMedCrossRefGoogle Scholar
  24. 24.
    Comfort MW, Gambill DEE, Baggenstoss AH: Chronic relapsing pancreatitis. Gastroenterology 1946, 6:239–285. The first description of alcoholic pancreatitis in a well-selected series of patients.Google Scholar
  25. 25.
    Renner IG, Savage WT, Pantoja JL, Renner VJ: Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases. Dig Dis Sci 1985, 30:1005–1018.PubMedCrossRefGoogle Scholar
  26. 26.
    Clark E: Pancreatitis in acute and chronic alcoholism. Am J Dig Dis 1942, 9:428–431.Google Scholar
  27. 27.
    Seligson U, Cho JW, Ihre T, Lundh G: Clinical course and autopsy findings in acute and chronic pancreatitis. Acta Chir Scand 1982, 148:269–274.PubMedGoogle Scholar
  28. 28.
    Kloppel G, Gerkan R, Dreyer T: Pathomorphology of acute pancreatitis: analysis of 367 autopsy cases and 3 surgical specimens. In Pancreatitis: Concepts and Classification. Proceedings of the 2nd International Symposium on the Classification of Pancreatitis, Marseille France, 1984. Edited by Gyr KE, Singer MV, Sarles H. Amsterdam: Excerpta Medica; 1984:29–35.Google Scholar
  29. 29.
    Machado MCC, Monteiro JE, Bacchella T, et al.: Acute pancreatic necrosis in chronic alcoholic pancreatitis. Dig Dis Sci 1984, 29:709–713.PubMedCrossRefGoogle Scholar
  30. 30.
    Migliori M, Manca M, Santini D, et al.: Does acute alcoholic pancreatitis precede the chronic form or is the opposite true? A histological study. J Clin Gastroenterol 2004, 38:272–275.PubMedCrossRefGoogle Scholar
  31. 31.
    Skinazi F, Levy P, Bernades P: Les pancr’eatites aigues alcooliques r’evèlent-elles toujours une pancr’eatite chronique? Gastroenterol Clin Biol 1995, 19:266–269.PubMedGoogle Scholar
  32. 32.
    Gullo L: Chronic pancreatitis in Italy. In Pancreatitis: New Data and Geographical Distribution. Edited by Sarles H, Tohnson CD, Saumiere JF. Paris: Arnette Blackwell; 1991:157–165.Google Scholar
  33. 33.
    Hanck C, Singer MV: Does acute alcoholic pancreatitis exist without preexisting chronic pancreatitis? Scand J Gastroenterol 1997, 32:625–626.PubMedCrossRefGoogle Scholar
  34. 34.
    Verlaan M, Te Morsche RH, Roelofs HM, et al.: Genetic polymorphisms in alcohol-metabolizing enzymes and chronic pancreatitis. Alcohol Alcohol 2004, 39:20–24.PubMedGoogle Scholar
  35. 35.
    Maruyama K, Takahashi H, Matsushita S, et al.: Genotypes of alcohol-metabolizing enzymes in relation to alcoholic chronic pancreatitis in Japan. Alcohol Clin Exp Res 1999, 23(Suppl 4):85S-91S.PubMedCrossRefGoogle Scholar
  36. 36.
    Durbec JP, Sarles H: Multicenter survey of the etiology of pancreatic diseases: relationship between the relative risk of developing chronic pancreatitis and alcohol, protein and lipid consumption. Digestion 1978, 18:337–350.PubMedGoogle Scholar
  37. 37.
    Yen S, Hsieh CC, MacMahon B: Consumption of alcohol and tobacco and other risk factors for pancreatitis. Am J Epidemiol 1982, 116:407–414.PubMedGoogle Scholar
  38. 38.
    Payan H, Sarles H, Demirdjian M, et al.: Study of the histological features of chronic pancreatitis by correspondence analysis: identification of chronic calcifying pancreatitis as an entity. Rev Eur Etudes Clin Biol 1972, 17:663–670.Google Scholar
  39. 39.
    Nakamura K, Sarles H, Payan H: Three-dimensional reconstruction of the pancreatic ducts in chronic pancreatitis. Gastroenterology 1972, 62:942–949. This study clearly demonstrates that the lesions of alcoholic pancreatitis start in the small pancreatic ducts.PubMedGoogle Scholar
  40. 40.
    Uys CJ, Bank S, Marks IN: The pathology of chronic pancreatitis in Cape Town. Digestion 1973, 9:454–468.PubMedCrossRefGoogle Scholar
  41. 41.
    Sahel J, Cros C, Durbec P, et al.: Multicenter pathological study of chronic pancreatitis: morphological regional variations and differences between chronic calcifying pancreatitis and obstructive pancreatitis. Pancreas 1986, 1:471–477. The largest histologic study of alcoholic pancreatitis.PubMedCrossRefGoogle Scholar
  42. 42.
    Online Mendelian Inheritance in Man (OSSIP 167800) Scholar
  43. 43.
    Comfort MW, Steinberg AG: Pedigree of a family with hereditary chronic relapsing pancreatitis. Gastroenterology 1952, 21:54–63.PubMedGoogle Scholar
  44. 44.
    Le Bodic L, Bignon JD, Raguenes O, et al.: The hereditary pancreatitis gene maps to long arm of chromosome 7. Hum Mol Genet 1996, 5:549–554.CrossRefGoogle Scholar
  45. 45.
    Whitcomb DC, Preston RA, Aston CE, et al.: A gene for hereditary pancreatitis maps to chromosome 7q35. Gastroenterology 1996, 110:1975–1980.PubMedCrossRefGoogle Scholar
  46. 46.
    Whitcomb DC, Gorry MC, Preston RA, et al.: Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 1996, 14:141–145. The first description of a mutation in the cationic trypsinogen gene in hereditary pancreatitis.PubMedCrossRefGoogle Scholar
  47. 47.
    Whitcomb DC: Hereditary pancreatitis: new insights into acute and chronic pancreatitis. Gut 1999, 45:317–322.PubMedCrossRefGoogle Scholar
  48. 48.
    Bordalo O, Goncalves D, Noronha M, et al.: Newer concept for the pathogenesis of chronic alcoholic pancreatitis. Am J Gastroenterol 1977, 68:278–285.PubMedGoogle Scholar
  49. 49.
    Braganza JM: Pancreatic disease: a casualty of hepatic ’detoxification’? Lancet 1983, 2:1000–1003.PubMedCrossRefGoogle Scholar
  50. 50.
    Witt H, Luck W, Hennies HC, et al.: Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nat Genet 2000, 25:213–216.PubMedCrossRefGoogle Scholar
  51. 51.
    Paris J, Farriaux JP, G’erard A, Merveille P: Etude des pancr’eatopathies observ’ees dans les trois g’en’erations d’une même famille. Lille Med 1969, 14:588–594. A pioneering study of the gene involvement in chronic pancreatitis.PubMedGoogle Scholar
  52. 52.
    Sharer N, Schwarz M, Malone G, et al.: Mutations of the cystic fibrosis gene in patients with chronic pancreatitis. N Engl J Med 1998, 339:645–652.PubMedCrossRefGoogle Scholar
  53. 53.
    Cohn JA, Friedman KJ, Noone PG, et al.: Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med 1998, 339:653–658.PubMedCrossRefGoogle Scholar
  54. 54.
    Truninger K, Ammann RW, Blum HE, Witt H: Genetic aspects of chronic pancreatitis: insights into aetiopathogenesis and clinical implications. Swiss Med Wkly 2001, 131:565–574.PubMedGoogle Scholar
  55. 55.
    Hanck C, Schneider A, Whitcomb DC: Genetic polymorphisms in alcoholic pancreatitis. Best Pract Res Clin Gastroenterol 2003, 17:613–623.PubMedCrossRefGoogle Scholar
  56. 56.
    Gaia E, Salacone P, Gallo M, et al.: Germline mutations in CFTR and PSTI genes in chronic pancreatitis patients. Dig Dis Sci 2002, 47:2416–2421.PubMedCrossRefGoogle Scholar
  57. 57.
    Schneider A, Pfutzer RH, Barmada MM, et al.: Limited contribution of the SPINK1 N34S mutation to the risk and severity of alcoholic chronic pancreatitis: a report from the United States. Dig Dis Sci 2003, 48:1110–1115.PubMedCrossRefGoogle Scholar
  58. 58.
    Pezzilli R, Morselli-Labate AM, Mantovani V, et al.: Mutations of the CFTR gene in pancreatic disease. Pancreas 2003, 27:332–346.PubMedCrossRefGoogle Scholar
  59. 59.
    Schneider A, Barmada MM, Slivka A, et al.: Analysis of tumor necrosis factor-alpha, transforming growth factor-beta 1, interleukin-10, and interferon-gamma polymorphisms in patients with alcoholic chronic pancreatitis. Alcohol 2004, 32:19–24.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Lucio Gullo
    • 1
  • Marina Migliori
    • 1
  • Maria Angela Brunetti
    • 1
  1. 1.Institute of Internal MedicineUniversity of Bologna, St. Orsola HospitalBolognaItaly

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