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What is Alcohol-Induced Pancreatitis?

Alcohol-induced pancreatitis refers to a gastrointestinal inflammation of the pancreas due to alcohol consumption. 

The pancreas has two primary functions in the body:

  • Flat gland this means that it can release hormones to control blood sugar levels.
  • Digestive organ this means that it produces enzymes to aid in digestion. 

When an individual suffers from alcohol-induced pancreatitis, two forms could classify the condition: acute or chronic. 

In cases of alcohol-induced pancreatitis, symptoms appear suddenly and can range from mild to life-threatening. Individuals with severe alcohol-induced pancreatitis may experience infection, hemorrhage, organ dysfunction, and edema (fluid collection) in the abdomen.  

Alcohol-induced pancreatitis should not be confused with other pancreatitis types, which could occur due to other causes. For example, gallstones (stone-like pieces that form in the gallbladder) are the leading common cause of acute pancreatitis. 

The difference between alcohol-induced pancreatitis and other types of pancreatitis is that the former is the most dangerous because it can lead to chronic pancreatitis. 

How Does Alcohol Cause Pancreatitis?

The full pathophysiology of the disease is not known. However, some reasons may explain how alcohol causes pancreatitis. 

For example, alcohol can cause higher amounts of viscous secretions that obstruct small pancreatic ducts (like the bile duct) and premature activation of certain enzymes within acinar cells (that help produce digestive enzymes for intestinal digestion). This means that pancreatic tissue begins to auto-digest and suffer more inflammation. 

Additionally, alcohol can harm the pancreas by causing oxidative stress. This can lead to cell injury and contribute to a strong inflammatory response. 

How Much Alcohol Do You Have to Drink to Get Pancreatitis?

The British Journal of Surgery published an extensive study of 84,601 individuals (Swedish population), exploring the amount and type of alcohol consumed during one sitting and over certain timespans. 

Investigators found that most individuals drank no more than 1 to 2 alcoholic beverages per day. However, the risk of acute pancreatitis rose by 52% for every increase of 5 drinks of hard liquor (one drink is 1.35 ounces) consumed during one session. Also, the likelihood of developing acute pancreatitis did not differ between individuals who consumed beer or wine over a short or long timespan and those who did not drink.

It is important to remember that more knowledge is needed about alcohol-induced pancreatitis. If individuals can avoid alcohol consumption, they can lower their risk of this condition and other medical problems. 

Individuals who smoke heavily and drink more than 400g of alcohol per month increase their risk of acute pancreatitis by four times.  

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Symptoms of Alcoholic Pancreatitis

Individuals who experience alcoholic pancreatitis may experience different symptoms, including:

  • Nausea
  • Vomiting 
  • Constant epigastric pain (in the upper abdomen and underneath the ribs)

The abdomen may be distended. Healthcare professionals will be able to determine this upon examination. 

Individuals who experience a more severe case of alcoholic pancreatitis may have the following:

  • Periumbilical or flank ecchymosis clinicians refer to this condition as Cullen’s or Grey Turner’s signs. This is when the body has bruising around the flank, which is the body area between the last rib and top of the rib, due to a peritoneal or retroperitoneal hemorrhage (bleeding). 
  • Peritonitis — the peritoneum is a collection of tissue that lines the inner wall of the abdomen and provides support for many abdominal organs. However, alcoholic pancreatitis can cause inflammation of the area. If not treated, peritonitis can result in sepsis (a life-threatening condition).  
  • Weight loss — clinicians will reduce food intake, if not completely, in cases of alcoholic pancreatitis. Eating food can place pressure on the pancreas (because it releases digestive enzymes) and delay recovery. Depending on the severity of the pancreatitis, individuals may be on a strict diet for an extended time and lose weight as a result. 
  • Sepsis — this is a condition caused by the body’s extreme reaction to an infection in the system. If not treated properly, it can cause septic shock (blood pressure drops suddenly) and harmful damage to multiple organs. 
  • Acute respiratory distress syndrome (ARDS) — this respiratory condition refers to when an individual’s lungs are unable to deliver a sufficient amount of oxygen to the body’s vitals organs. Individuals with this condition will most likely require the support of mechanical ventilation, which increases the risk of hospital-acquired infections and death.  
  • Shock — shock or septic shock occurs when the body’s blood pressure drops suddenly and vital organs do not receive the blood necessary for proper functioning. The condition can result in respiratory, heart, or kidney failure. 

Pain may not be as sudden and easily localized in alcoholic pancreatitis, contrasting with cases of gallstone-induced acute pancreatitis. 

How is Alcoholic Pancreatitis Diagnosed?

Individuals with suspicion of alcoholic pancreatitis are recommended to visit a hospital facility. For the medical condition to be diagnosed, individuals must meet at least two of the following three criteria:

  • Clinical features characteristic of the condition — these can include abdominal pain, which may or may not extend to the back, and tenderness of the abdomen upon physical examination. 
  • Laboratory evidence — this comprises serum lipase (fat digestive enzyme) levels that are at least three times higher than the normal value. Clinicians may also consider a hepatic panel and calcium and triglyceride levels to rule out acute pancreatitis due to other causes.
  • Imaging indicative of the condition — individuals may have a CT scan with a solution administered through the veins to see if there is pancreatic enlargement, a loss of pancreatic borders, surrounding fluid, and fat stranding (density of the affected fat changes). 

Additionally, individuals who misuse alcohol may show symptoms of an alcohol use disorder (AUD), including but not limited to:

  • Jaundice due to liver insufficiency 
  • Alcohol cirrhosis (deep scarring of liver tissue)
  • Strong cravings for alcohol consumption
  • Inability to hold work, family, or social obligations
  • Withdrawal symptoms, such as nausea or sweating, when the individual stops drinking for a short period

Types of Alcohol-Induced Pancreatitis

Acute Pancreatitis

Individuals with cases of acute pancreatitis will develop symptoms suddenly. In these cases, individuals are recommended not to drink or eat until clinicians authorize it. Eating or drinking can further inflammation and create severe pain in some cases. 

Acute pancreatitis will usually last from a few days to weeks. Clinicians will provide mainly supportive care. In alcohol-induced pancreatitis, pain does not often appear until 1 to 3 days after a binge drinking session. 

“In the U.S., chronic alcohol consumption is the single most common cause of chronic pancreatitis, resulting in ~40 to 70% of all cases, and increases an individual's risk of developing pancreatic cancer by 20 times.”

- NCBI

Chronic Pancreatitis

Chronic pancreatitis often occurs when multiple acute pancreatitis episodes have resulted in scarring and permanent damage to drink pancreatic tissue. This condition is long-term, lasting for months or years. 

Alcohol is the most attributed cause of chronic pancreatitis. Individuals who experience one episode of acute pancreatitis due to alcohol should avoid alcohol consumption to minimize their risk of developing chronic pancreatitis.

Can Alcoholic Pancreatitis Be Cured?

Individuals who have alcoholic pancreatitis will receive the same care as that provided for pancreatitis due to other causes. The exception here is that clinicians will include alcohol cessation during or after hospitalization to reduce further inflammation. 

Specifically, individuals with alcoholic pancreatitis will undergo the following:

  • Accurate diagnosis clinicians will consider specific criteria to determine if individuals with a suspected case of alcohol-induced pancreatitis meet at least two of the requirements. 
  • Supportive care because patients with pancreatitis will not be able to eat or drink until their condition improves, clinicians will provide goal-directed fluid therapy, administer painkillers and antiemetics (to combat nausea and vomiting), and replete electrolytes. 
  • Gradual introduction of a special diet clinicians may initiate feeding trials once 24 hours have passed since the onset of alcohol-induced pancreatitis. Usually, this will consist of a small low-fat diet, with soft or solid meals.  

Additionally, if alcohol is the cause of pancreatitis, clinicians may recommend different therapy options to help individuals recover and prevent further pancreatitis episodes. For example, individuals may undergo treatments such as:

  • Inpatient treatment facilities 
  • Outpatient treatment facilities 
  • Supervised detoxification and withdrawal process (to minimize the risk of overdose and long-term abstinence)
  • Counseling, including cognitive-behavioral therapy (CBT)
  • Additional modification of lifestyle habits, including smoking cessation and diets
  • Medication-assisted treatment (MAT)

Individuals who have experienced an initial episode of acute alcoholic pancreatitis face a 24% likelihood of developing acute pancreatitis once again and a 16% likelihood of developing chronic pancreatitis. 

Common Questions and Answers

Why is alcohol so bad for pancreatitis?

Alcohol can interfere with the normal functioning of the pancreas and cause further inflammation. If an individual has pancreatitis, that means the pancreas is already under stress and causing pain and discomfort. Alcohol use would only worsen the symptoms and clinical course of the disease. 

What percentage of alcoholics get pancreatitis?

Although alcohol may make the pancreas more sensitive to external damage and environmental factors like a high-fat diet or cigarette use, not many individuals with alcohol use disorder (AUD) will develop pancreatitis. The percentage of people who will develop the condition is less than 5%.

What color is stool with pancreatitis?

The stool is pale yellow and will float. This happens because improper functioning of the pancreas results in the malabsorption of fat. 

Can you fully recover from acute pancreatitis?

Yes. Individuals who experience mild-to-severe acute pancreatitis can fully recover. However, because an individual suffers an initial episode, there is a likelihood of recurrence. Clinicians may recommend modifications to diets or lifestyle habits, such as smoking or alcohol cessation, to prevent future episodes of the disease. Smoking is a risk factor for pancreatitis.

How much alcohol can you have with pancreatitis?

If you have pancreatitis, the recommendation is not to continue drinking alcohol. Alcohol is a substance that can cause further inflammation and delay recovery. In general, food and drinks can trigger the secretion of enzymes from the pancreas, causing pain to worsen. 

Can I ever drink alcohol again after pancreatitis?

Individuals who have already had an initial episode of pancreatitis due to alcohol should no longer drink the beverage. Continued alcohol consumption can increase the risk of a recurrent episode of the disease, and in more severe cases, lead to chronic alcoholic pancreatitis.

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Resources

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“Acute Pancreatitis.” Harvard Health, Harvard Health Publishing, July 2019, www.health.harvard.edu/a_to_z/acute-pancreatitis-a-to-z.

“Acute Pancreatitis and Alcohol.” Gastrointestinal Society, 16 July 2020, badgut.org/information-centre/a-z-digestive-topics/acute-pancreatitis-and-alcohol/.

Klochkov, Anton, et al. “Alcoholic Pancreatitis.” StatPearls [Internet]., U.S. National Library of Medicine, 23 Apr. 2020, www.ncbi.nlm.nih.gov/books/NBK537191/.

Yen, S, et al. “Consumption of Alcohol and Tobacco and Other Risk Factors for Pancreatitis.” American Journal of Epidemiology, U.S. National Library of Medicine, Sept. 1982, www.ncbi.nlm.nih.gov/pubmed/7124709.

Yadav, D., Whitcomb, D. The role of alcohol and smoking in pancreatitis. Nat Rev Gastroenterol Hepatol 7, 131–145 (2010). https://doi.org/10.1038/nrgastro.2010.6 https://www.nature.com/articles/nrgastro.2010.6

Setiawan, Veronica Wendy et al. “Prospective Study of Alcohol Drinking, Smoking, and Pancreatitis: The Multiethnic Cohort.” Pancreas vol. 45,6 (2016): 819-25. doi:10.1097/MPA.0000000000000657 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905778/

Dufour, Mary C. MD, MPH; Adamson, Megan D. MD The Epidemiology of Alcohol-Induced Pancreatitis, Pancreas: November 2003 - Volume 27 - Issue 4 - p 286-290 https://journals.lww.com/pancreasjournal/Abstract/2003/11000/The_Epidemiology_of_Alcohol_Induced_Pancreatitis.2.aspx

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