ORIGINAL ARTICLE
Exocrine Pancreatic Insufficiency and Chronic Pancreatitis in Chronic Alcoholic Liver Disease Coincidence or Shared Toxicity? Sami Aoufi Rabih, MD, PhD,* Rebeca Garcı´a Agudo, MD, PhD,Þ Marı´a Luisa Legaz Huidobro, MD,þ Marina Ynfante Ferru´s, MD,þ Pedro Gonza´lez Carro, MD,þ Francisco Pe´rez Rolda´n, MD, PhD,þ Francisco Ruiz Carrillo, MD,þ and Jose´ Marı´a Tenı´as Burillo, MD, PhD§
Objectives: The aims of this study were to determine the prevalence of exocrine pancreatic insufficiency (EPI) and chronic pancreatitis (CP) in patients with chronic alcoholic liver disease and to analyze the possible associated factors. Methods: This is an analytical observational study of cases and controls for a sample of patients with chronic alcoholic and nonalcoholic liver disease. Exocrine pancreatic insufficiency was diagnosed using the 13C mixed-triglyceride breath test. Patients with abdominal pain underwent endoscopic ultrasonography for CP evaluation using the Wiersema criteria. Results: A total of 154 patients were included, 129 with alcoholic liver disease (83 with cirrhosis) and 25 with nonalcoholic liver disease. Exocrine pancreatic insufficiency was found in 55.2% versus 16.7% (P G 0.001), 70% of patients without cirrhosis compared with 46.2% of patients with cirrhosis had pancreatic insufficiency (P = 0.017), and 82.7% of patients with alcoholic liver disease and abdominal pain had CP (P G 0.001). Exocrine pancreatic insufficiency was associated with the male sex, alcohol intake, abdominal pain, degree of liver failure, and the absence of portal hypertension. Chronic pancreatitis was correlated with age younger than 55 years and abdominal pain. Conclusions: Patients with alcoholic liver disease had a high prevalence of EPI and CP; this prevalence was even higher in patients who have not yet developed cirrhosis with liver failure or portal hypertension. Key Words: chronic alcoholic liver disease, exocrine pancreatic insufficiency, chronic pancreatitis, liver cirrhosis, endoscopic ultrasonography (Pancreas 2014;43: 730Y734)
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hronic alcohol consumption is associated with varying degrees of liver disease, ranging from simple fatty liver (steatosis) to confirmed cirrhosis. Alcohol is metabolized in the liver via the cytosolic dehydrogenases, cytochrome P450, and peroxisomes.1 Liver damage occurs as a result of alcohol oxidation in this organ and an imbalance in the redox mechanisms, as well as a consequence of increased oxidative stress caused by the same oxidation process or due to an absence or deficiency
From the *Hepatorenal Unit, Gastroenterology and Hepatology Department, †Hepatorenal Unit, Nephrology Department, ‡Gastroenterology and Hepatology Department, and §Investigation Unit, La Mancha-Centro Hospital Complex, Alca´zar de San Juan, Ciudad Real, Spain. Received for publication May 21, 2013; accepted January 9, 2014. Reprints: Sami Aoufi Rabih, MD, PhD, Hepatorenal Unit, Gastroenterology and Hepatology Department, La Mancha-Centro Hospital Complex, Avenida de la Constitucio´n s/n, 13600 Alca´zar de San Juan, Ciudad Real, Spain (e
Exocrine Pancreatic Insufficiency and Chronic Pancreatitis in Chronic Alcoholic Liver Disease Coincidence or Shared Toxicity? Sami Aoufi Rabih, MD, PhD,* Rebeca Garcı´a Agudo, MD, PhD,Þ Marı´a Luisa Legaz Huidobro, MD,þ Marina Ynfante Ferru´s, MD,þ Pedro Gonza´lez Carro, MD,þ Francisco Pe´rez Rolda´n, MD, PhD,þ Francisco Ruiz Carrillo, MD,þ and Jose´ Marı´a Tenı´as Burillo, MD, PhD§
Objectives: The aims of this study were to determine the prevalence of exocrine pancreatic insufficiency (EPI) and chronic pancreatitis (CP) in patients with chronic alcoholic liver disease and to analyze the possible associated factors. Methods: This is an analytical observational study of cases and controls for a sample of patients with chronic alcoholic and nonalcoholic liver disease. Exocrine pancreatic insufficiency was diagnosed using the 13C mixed-triglyceride breath test. Patients with abdominal pain underwent endoscopic ultrasonography for CP evaluation using the Wiersema criteria. Results: A total of 154 patients were included, 129 with alcoholic liver disease (83 with cirrhosis) and 25 with nonalcoholic liver disease. Exocrine pancreatic insufficiency was found in 55.2% versus 16.7% (P G 0.001), 70% of patients without cirrhosis compared with 46.2% of patients with cirrhosis had pancreatic insufficiency (P = 0.017), and 82.7% of patients with alcoholic liver disease and abdominal pain had CP (P G 0.001). Exocrine pancreatic insufficiency was associated with the male sex, alcohol intake, abdominal pain, degree of liver failure, and the absence of portal hypertension. Chronic pancreatitis was correlated with age younger than 55 years and abdominal pain. Conclusions: Patients with alcoholic liver disease had a high prevalence of EPI and CP; this prevalence was even higher in patients who have not yet developed cirrhosis with liver failure or portal hypertension. Key Words: chronic alcoholic liver disease, exocrine pancreatic insufficiency, chronic pancreatitis, liver cirrhosis, endoscopic ultrasonography (Pancreas 2014;43: 730Y734)
C
hronic alcohol consumption is associated with varying degrees of liver disease, ranging from simple fatty liver (steatosis) to confirmed cirrhosis. Alcohol is metabolized in the liver via the cytosolic dehydrogenases, cytochrome P450, and peroxisomes.1 Liver damage occurs as a result of alcohol oxidation in this organ and an imbalance in the redox mechanisms, as well as a consequence of increased oxidative stress caused by the same oxidation process or due to an absence or deficiency
From the *Hepatorenal Unit, Gastroenterology and Hepatology Department, †Hepatorenal Unit, Nephrology Department, ‡Gastroenterology and Hepatology Department, and §Investigation Unit, La Mancha-Centro Hospital Complex, Alca´zar de San Juan, Ciudad Real, Spain. Received for publication May 21, 2013; accepted January 9, 2014. Reprints: Sami Aoufi Rabih, MD, PhD, Hepatorenal Unit, Gastroenterology and Hepatology Department, La Mancha-Centro Hospital Complex, Avenida de la Constitucio´n s/n, 13600 Alca´zar de San Juan, Ciudad Real, Spain (e
