Acute Alcohol-Related Pancreatitis

Alcohol is implicated in about 25% of acute pancreatitis (AP) cases, exerting a direct toxic effect on pancreatic cells and/or stimulating pancreatic enzyme secretion-induced duct-plugging over time and causing obstruction, and over time leading to atrophy and fibrosis from chronic pancreatitis. The diagnosis of acute pancreatitis is made on the presence of at least two of three criteria:  

• Upper abdominal pain consistent with pancreatitis; 
• Positive laboratory markers (serum amylase or lipase >3x upper limit of normal); 
• Imaging (CT, MRI, ultrasonography).  

In moderate to severe forms, alcohol-related pancreatitis can become complicated by pancreatic necrosis, pseudocyst formation and severe sepsis or bleeding that requiring surgical intervention, prolonged hospitalisation and a high risk of multi-organ failure and mortality. 

The use of prophylactic antibiotics in severe alcohol-related pancreatitis may reduce the risk of severe infection that could lead to death, however, the empirical use of antibiotics in all patients is not supported by evidence. Acutely, management relies on close observation of IV fluid balance and cautious replacement and maintaining enteral nutrition when possible. Continued interventions aimed to reduce alcohol consumption significantly decrease the recurrence of alcohol-related pancreatitis.  

Chronic pancreatitis (CP) is a relapsing and remitting condition, which can cause significant morbidity and mortality, cause prolonged hospitalisaton and disability at significant cost to the communnity. Most commonly it occurs in the setting of recurrent AP causing acute pain or constant upper abdominal pain. CP is diagnosed radiologically with calcification, ductal dilatation and atrophy on cross sectional imaging such as CT or MRI. People who drink heavily are three times more likely to get chronic pancreatitis compared to those who drink less heavily or those who abstain.