Withdrawal May Trigger Alcoholic Pancreatitis
It is generally assumed that ethanol toxicity is entirely responsible for alcoholic pancreatitis. However, withdrawal may also play a role given that few patients hospitalized for pancreatitis are intoxicated and that pancreatitis-associated protein appears in the serum after drinking stops. To investigate this possibility, Finnish researchers studied 100 patients with a first episode of acute alcoholic pancreatitis.
- Most patients had already stopped drinking before they began to feel nausea or to vomit (69 of 76 patients [91%] with nausea and vomiting) or to feel abdominal pain (54 of 79 [68%] with abdominal pain).
- Of 83 patients able to be assessed, only 24 (29%) had developed some pancreatitis symptoms before they consumed their last drink; 36 (43%) had developed symptoms on the first day they stopped drinking and the remainder developed symptoms later (usually the second or third day).
This study cannot answer whether direct toxicity or withdrawal from alcohol causes pancreatitis because serum alcohol levels were likely greater than zero in most patients when symptoms developed. And perhaps patients chose to drink less as they became ill but before they recognized specific pancreatitis symptoms. Nonetheless, it is interesting that most patients with acute pancreatitis stopped drinking before, and not after, developing symptoms. This observation suggests that there may be a window of time during which an episode of alcoholic pancreatitis can be predicted and perhaps prevented.Richard Saitz, MD, MPH
Nordback I, Pelli H, Lappalainen-Lehto R, et al. Is it long-term continuous drinking or the post-drinking withdrawal period that triggers the first acute alcoholic pancreatitis? Scand J Gastroenterol. 2005;40(10):1235–1239.