review of literature on clinical pancreatology - The Pancreapedia

Association with liver diseaseAlthough chronic pancreatitis and liver cirrhosis are common sequelae <strong>of</strong> excess alcoholconsumption, the two conditions are rarely associated. It was studied the prevalence <strong>of</strong>simultaneous liver cirrhosis and chronic pancreatitis by post-mortem autopsy data from 620individuals with a history <strong>of</strong> excess alcohol consumption and 100 non-alcoholics (controls).The individuals were classified into groups based on macroscopic observations <strong>of</strong> pancreas(no injury, acute pancreatitis, fibrosis and chronic pancreatitis) and liver (no injury, moderatesteatosis, severe steatosis, and cirrhosis). The same classification system was used forhistological data, which was used to confirm and correlate macroscopic results. Out <strong>of</strong> the183 patients with liver cirrhosis, 33 (18 %) had chronic pancreatitis and 93 (51 %) pancreaticfibrosis. Out <strong>of</strong> the 230 patients with severe steatosis, 37 (16 %) had chronic pancreatitis and97 (42 %) were found to have a pancreatic fibrosis. Thirty-three (39 %) with chronicpancreatitis also showed liver cirrhosis and 37 (44 %) severe steatosis. Thirty-eight percent<strong>of</strong> the patients with a pancreatic fibrosis were found to have also liver cirrhosis and in another40 percent severe steatosis. Thirty-five patients showed neither hepatic nor pancreatic injury.It was found no chronic pancreatitis or liver cirrhosis in the control group (n=100). It wasconcluded that contrary to common believe there is a close association between pancreaticand hepatic injury in patients with increased alcohol consumption, and the degree <strong>of</strong> organdamage between the two organs correlate [261].Alcohol-induced chronic pancreatitisChronic pancreatitis is a progressive inflammatory condition characterized by repeatedattacks <strong>of</strong> abdominal pain, and the destruction and fibrosis <strong>of</strong> the pancreatic parenchymawhich causes to reduced exocrine and endocrine functions. Alcohol is the most commoncause <strong>of</strong> chronic pancreatitis. Although abstinence is usually considered a prerequisite forsuccessful treatment <strong>of</strong> alcoholic chronic pancreatitis, one <strong>of</strong>ten encounter patients who haverepeated attacks from the compensated stage through the transitional stage. In alcoholicchronic pancreatitis, continued alcohol consumption causes changes in the digestivehormones and vagal nerve function that induce the pancreatic acinar cells to oversecreteprotein, increasing the protein concentration and viscosity <strong>of</strong> the pancreatic juice. Thisinduces protein sedimentation from the pancreatic juice and formation <strong>of</strong> protein plugs withinthe pancreatic duct, triggering repeated attacks <strong>of</strong> acute pancreatitis. The treatment <strong>of</strong>alcoholic chronic pancreatitis includes alleviation <strong>of</strong> symptoms, particularly abdominal pain,elimination <strong>of</strong> trigger factors, prevention <strong>of</strong> recurrence and disease progression, adjuvanttherapies for pancreatic exocrine and endocrine failure. Recently, the main constituentproteins in these protein plugs have been identified, enabling trials <strong>of</strong> several therapies, suchas the administration <strong>of</strong> secretin formulations and endoscopic removal. Bromhexinehydrochloride, a bronchial mucolytic, has an affinity for the pancreatic acinar cells, inducingthem to secrete pancreatic juice <strong>of</strong> low viscosity. In one <strong>review</strong>, it was summarized the mostrecent thoughts about alcoholic chronic pancreatitis, and the new treatments, and inparticular, it was presented our findings concerning the efficacy <strong>of</strong> bromhexine hydrochloridein the treatment <strong>of</strong> this disease [262].Seventy percent <strong>of</strong> pancreatitis cases are considered to be induced by alcohol in Finland.Half <strong>of</strong> those fallen ill with alcohol-induced acute pancreatitis will have relapses. Aprospective follow-up study showed that the level <strong>of</strong> dependence on alcohol constitutes themost important risk factor. Continued drinking was shown to be a dose-responsive risk factorfor relapse; abstinence provided for a complete protection against renewed pancreatitis. In arandomized study, a semi-annual meeting with a healthcare pr<strong>of</strong>essional specialized insubstance abuse problems significantly reduced new episodes <strong>of</strong> acute pancreatitis. It is thus