From the Guidelines
Pancreatitis due to alcohol abuse typically presents with severe, constant upper abdominal pain that often radiates to the back, accompanied by nausea, vomiting, fever, and jaundice, as reported in the most recent guidelines 1. The symptoms of pancreatitis due to alcohol abuse can vary in severity, but common signs and symptoms include:
- Severe, constant upper abdominal pain that radiates to the back
- Nausea and vomiting
- Fever
- Rapid pulse
- Tenderness when touching the abdomen
- Jaundice (yellowing of the skin and eyes)
- Bloating
- Indigestion
- Clay-colored stools In severe cases, complications can include difficulty breathing, low blood pressure, and dehydration. Chronic alcohol-induced pancreatitis may additionally cause weight loss, diarrhea with oily stools (steatorrhea), and diabetes due to pancreatic damage affecting insulin production. These symptoms occur because alcohol causes direct toxic damage to pancreatic cells and increases protein secretion that can block pancreatic ducts, leading to inflammation and autodigestion of the pancreas by its own digestive enzymes, as supported by the 2019 WSES guidelines for the management of severe acute pancreatitis 1. The severity of symptoms often correlates with the extent of pancreatic inflammation and damage, highlighting the importance of early diagnosis and treatment to prevent long-term complications, as emphasized in the 2019 guidelines 1. It is essential to note that the management of severe acute pancreatitis involves a multidisciplinary approach, including fluid resuscitation, pain management, and nutritional support, as outlined in the ESPEN guidelines on parenteral nutrition: pancreas 1. However, the most recent and highest quality study, the 2019 WSES guidelines, should be prioritized when making clinical decisions regarding the management of pancreatitis due to alcohol abuse 1.
From the Research
Signs and Symptoms of Pancreatitis due to Alcohol Abuse
The diagnosis of pancreatitis due to alcohol abuse depends primarily on clinical acumen in interpreting symptoms and signs of abdominal distress, buttressed by elevated pancreatic enzymes (amylase and lipase) 2. The key signs and symptoms include:
- Abdominal pain
- Elevated serum levels of pancreatic enzymes such as amylase and lipase
- Alterations in pancreas imaging
- Abdominal distress
Diagnosis and Laboratory Findings
The diagnosis of acute pancreatitis is based on the presence of abdominal pain, serum increase of pancreatic enzymes or their presence in urine and/or the presence of alterations of the pancreas imaging 3. Laboratory findings may include:
- Elevated levels of serum amylase and lipase
- Elevated levels of pancreatic isoamylase
- Abnormal levels of serum enzymes in chronic alcoholics without abdominal pain
Pathogenesis and Mechanisms
The pathogenesis of alcoholic pancreatitis is not fully defined, but it is believed that ethanol sensitizes the pancreas to injury and additional factors trigger the development of overt pancreatitis 4. The mechanisms by which ethanol alters pancreatic functions and may predispose the pancreas to disease include:
- Effects on acinar cells, such as calcium signaling, secretion of zymogens, autophagy, cellular regeneration, the unfolded protein response, and mitochondrial membrane integrity
- Effects on pancreatic stellate cells, which have a critical role in normal tissue repair and the pathologic fibrotic response
- Cumulative effect of ethanol on the pancreas, which predisposes the organ to pancreatitis 4