The effect of small amounts of alcohol on the clinical course of chronic pancreatitis

Objective: To investigate the hypothesis that an increasing intake of alcoh ol accelerates the course of chronic pancreatitis. Patients and Methods: In this retrospective record analysis and subsequent prospective follow-up of 372 patients with chronic pancreatitis, we separat ely compared the clinical course of chronic pancreatitis among the followin g patients: those with early-onset idiopathic chronic pancreatitis and no a lcohol intake (group A [n=25]) and those with late-onset idiopathic chronic pancreatitis and no alcohol intake (group B [n=41]), low alcohol intake (< 50 g/d) (group C [n=57]), and high alcohol intake (<greater than or equal t o>50 g/d) (group D [n=249]). From medical records, physical examinations, q uestionnaires, death certificates, or autopsy reports, we obtained informat ion on sex, age, signs and symptoms (pain severity, calcification, endocrin e and exocrine insufficiency), complications, surgery, and survival. Results: Group D had the highest percentage of men (72%). At the onset of c hronic pancreatitis, patients in group A were significantly younger than th ose in groups B, C, and D (P<.05), and severity df pain was significantly g reater in patients in group A than in groups B, C, and D (P<.05). The perce ntage of patients who eventually developed endocrine or exocrine insufficie ncy was similar in all groups. Among patients in groups B, C, and D, an inc reasing intake of alcohol from zero to less than 50 g/d to more than 50 dd was associated with earlier inception of disease (P<.001). Pain prevalence at onset was less in group B patients than in patients in groups C and D (P <.05). Intake of a large amount of alcohol (group D): shortened time to cal cification and survival (P<.05). In addition, patients in group D had more complications (fistulas, pseudocysts, abscesses, and biliary obstruction) ( P<.05) than those in groups A and B. More patients in group A underwent pan creatic surgery compared with patients in groups B and C. Conclusions: Among patients with onset of chronic pancreatitis after age 35 years, alcohol intake, even less than 50 g/d, induced earlier disease char acterized by more frequent severe pain, calcification, and complications. I ntake of large amounts of alcohol (greater than or equal to 50 dd) reduced time to calcification and death.