Alcoholism and pancreatitis; does nutrition play a role?
Alcoholism and Pancreatitis
Does Nutrition Play a Role?
The pancreas is a gastrointestinal organ that performs two key functions: it assists in the digestion of food, and regulates blood sugar levels. Disorders of the pancreas influence nutritional status significantly. Conversely, nutrition may play a role in the susceptibility of the pancreas to injury. Injury to the pancreas often results in inflammation of the organ, a condition that is broadly defined as pancreatitis. The frequent occurrence of pancreatitis in alcoholics has evoked interest in the causative role that alcohol may play in its development. Poor diet and malnutrition associated with alcohol abuse may be important factors associated with pancreatic injury in alcoholics.
THE FUNCTION OF THE PANCREAS
The pancreas is an accessory organ in digestion because it assists in the breakdown of ingested food. It accomplishes this function by producing and secreting three enzymes necessary for digestion: amylase, trypsin, and lipase, which catalyze the breakdown of carbohydrate, protein, and fat, respectively. In their chemically simpler forms, these nutrients can be absorbed easily by the small intestine.
The pancreas also functions to maintain blood sugar levels. Insulin and glucagon, two hormones that are synthesized and released by the pancreas, act together in this regulatory process. Elevated blood sugar levels induce the release of insulin, which facilitates glucose utilization. Glucagon release is induced with diminished blood glucose levels. This hormone stimulates processes that increase blood sugar concentrations. Acting together, the two hormones maintain the blood sugar level within a rather narrow range, despite wide fluctuations in sugar intake.
ACUTE AND CHRONIC PANCREATITIS
The term "pancreatitis" implies inflammation of the pancreas to the pathologist. To the clinician, however, the diagnosis of pancreatitis is made without the benefit of a microscope; the condition is suggested by the occurrence of severe abdominal pain that extends from below the rib cage to the umbilical area, often continuing around to the back. This pain may be ameliorated by bending forward. Nausea and vomiting often accompany the pain, and there may be pancreatic swelling or edema (Figure 1); atrophy (shrinkage); calcification (presence of calcium deposits) (Figure 2); or elevated levels of pancreatic enzymes in the blood as well.
The clinician often will distinguish between two types of pancreatitis: acute and chronic. Acute pancreatitis often has an abrupt onset, is potentially reversible, and usually is associated with gallstones. Although little is known about the pathogenesis of this condition, it has been suggested that the pancreas is damaged by the misdirected action of the pancreatic enzymes. The how and why of this scenario is a matter of continuing controversy, but the end result is an enzymatic attack on the pancreas itself (autodigestion) that rapidly destroys its structural and functional integrity. Severe cases of acute pancreatitis may be fatal, especially when complicated by shock (low blood pressure) or fever.
In contrast, chronic pancreatitis is a longstanding, relapsing, and irreversible pancreatic disorder. The majority of such cases have been linked to alcoholism or malnutrition (at least in developing countries). The prolonged and indolent...