Discovery of possible link between chronic pancreatitis and liver cirrhosis of alcoholic etiology

Chronic alcoholism is a well-known etiologic factor associated with chronic and irreversible pancreatic and liver disorders.

There is a correlation between increased ethanol consumption through many years and the risk of developing chronic pancreatitis (CP). An excessive consumption of alcohol is also associated with liver cirrhosis (LC), again with a correlation between increased ethanol consumption and the risk of LC. In clinical practice, the coincidence of both diseases, LC and CP, is rare. Furthermore, these two diseases do not share risk factors apart from alcohol consumption.

A research group leaded by Luis Aparisi, form Hospital Clínico Universitario studied the possible association between CP and LC of alcoholic etiology. They compared clinical, functional, morphological and biochemical parameters in alcoholic subjects with a definitive diagnosis of CP or LC and this will be published on October 28, 2008 in the World Journal of Gastroenterology.

In their study, one hundred and forty consecutive alcoholic patients were subdivided into three groups: CP (n = 53), LC (n = 57), and asymptomatic alcoholic (n = 30). Clinical, biochemical and morphological characteristics, Child-Pugh index, indocyanine green test, and fecal pancreatic elastase-1 test were assessed.

They found that in patients with cirrhosis, major clinical manifestations of CP such as pancreatic pain and steatorrhoea as well as imaging alterations of CP such as calcifications, duct dilation and pseudocysts were absent; insulin-dependent diabetes was present in 5.3% cases, and elastase-1 test was altered in only 7% and severely altered in none. In patients with CP, clinical characteristics of cirrhosis such as ascites, encephalopathy and gastrointestinal haemorrhage were present in one case, Child-Pugh grade > A in 5.7%, and altered indocyanine green test in 1.9% cases. In asymptomatic alcoholism, there was only a non-coincident alteration of elastase-1 test and indocyanine test in 14.8% and 10%, respectively, but other characteristics of cirrhosis or CP were absent. An inverse correlation (r = -0.746) between elastase-1 test and indocyanine test was found in alcoholic patients.

Their result indicated that there was a scarce coincidence in clinical and morphological alterations among patients with CP or LC of alcoholic etiology, but an inverse correlation between pancreatic and liver function tests. These findings support that these alcoholic diseases evolve in a different manner and have different etiopathogeny.