Does an association exist between chronic pancreatitis and liver cirrhosis in alcoholic subjects?

Abstract

Aim: To study the possible association between chronic pancreatitis (CP) and liver cirrhosis (LC) of alcoholic etiology, after excluding any other causes.

Methods: 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.

Results: In patients with cirrhosis, major clinical manifestations of CP such as pancreatic pain and steatorrhea, as well as imaging alterations of CP such as calcifications, duct dilation and pseudocysts were absent; insulin-dependent diabetes was present in 5.3% of 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 hemorrhage 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.

Conclusion: There is 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 etiopathogenesis.

Figures

Figure 1

Fecal E1 test (μg/g feces) in patients with ACP, ALC or ASA. Reference lines for altered E1: vs ALC, P < 0.001; ACP vs ASA, P < 0.001; ALC vs ASA, P = 0.747.

Figure 2

PDR, %/min of ICG in patients with ACP, ALC or ASA. Reference lines for altered PDR: vs ALC, P < 0.001; ACP vs ASA, P = 0.048; ALC vs ASA, P < 0.001.

Figure 3

An inverse correlation (r = -0.746, P < 0.001) between indocyanine clearance (PDR, %/min) and fecal E1 test (μg/g feces) in patients with ACP, ALC or ASA. Reference lines: PDR (%/min) = 15; E1 test = 100. Vertical line for PDR (%/min) = 10, and horizontal line for E1 test = 100 are marked in the figure.