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Metabolic Aspects of Chronic Pancreatitis

  • J. Mössner
Conference paper

Abstract

There are various causes of metabolic disorders in chronic pancreatitis (Table 1). In the industrialized countries more than 70% of all cases of chronic pancreatitis are caused by alcohol abuse. Thus, one has to differentiate between metabolic disorders as a consequence of chronic ethanol intoxication of various organs such as liver and metabolic disorders related to chronic pancreatitis itself, such as maldigestion. Chronic pancreatitis per se or via
Table 1

Causes of metabolic disorders in chronic pancreatitis

Cause

Consequence of:

Maldigestion

Loss of acinar cell mass and function

 

Obstruction of pancreatic ducts

 

Obstruction of bile duct

Malabsorption

Chronic pancreatitis (?)

 

Toxic effects of ethanol on gut mucosa

Endocrine insufficiency

Insulin deficiency due to islet damage

 

Deficiency of other islet hormones

Ethanol abuse

Direct toxic effects of ethanol on various organ systems such as liver

Malnutrition

Alcohol abuse

 

Chronic pain

Arteriosclerosis

Smoking

Malignancies

Smoking (lung cancer), immune deficiency due to alcohol abuse

Infections

Immunedeficiency due to alcohol abuse

 

Chronic bronchitis due to smoking

Pulmonary dysfunction

Chronic bronchitis due to smoking

Acute replases of chronic pancreatitis

 
maldigestion may impair absorption. Malassimilation in this disease may, therefore, have several causes. Furthermore, alcohol abuse is often associated with malnutrition which in addition will be responsible for metabolic disorders. Many people who abuse alcohol are smokers. The fate of patients with chronic pancreatitis, therefore, is often complicated by the consequences of smoking such as pulmonary and right heart insufficiency due to chronic bronchitis. Metabolism may be disturbed due to lung cancer and very often due to general arteriosclerosis. Infectious complications have to be kept in mind which often occur in patients with impaired lung function and immune deficiency due to alcohol abuse. Chronic pancreatitis may lead to insulin deficiency. However, I do not want to discuss the whole array of metabolic disorders seen in diabetes.

Keywords

Chronic Pancreatitis Pancreatic Insufficiency Serum Zinc Level Acute Relapse Metabolic Aspect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Abrams JJ, Ginsberg H, Grundy SM (1982) Metabolism of cholesterol and plasma triglycerides in nonketonic diabetes mellitus. Diabetes 31:903–910PubMedCrossRefGoogle Scholar
  2. Acheson DW, Hunt LP, Rose P, Houston JB, Braganza JM (1989) Factors contributing to the accelerated clearance of theophylline and antipyrine in adults with exocrine pancreatic disease. Clin Sci 76:377–385PubMedGoogle Scholar
  3. Aenishänslin HW, Stalder GA (1974) Malabsorption von Vitamin B12 bei exokriner Pankreasinsuffizienz. Schweiz Med Wochenschr 104:1377–1379PubMedGoogle Scholar
  4. Allen RH, Seetharam B, Podell E, Alpers DH (1978) Effect of proteolytic enzymes on the binding of cobalamin to R protein and intrinsic factor. J Clin Invest 61:47–54PubMedCrossRefGoogle Scholar
  5. Angelin B, Einarsson K, Ewerth S, Leijd B (1980) Biliary lipid composition in patients with portal cirrhosis of the liver. Scand J Gastroenterol 15:849–852PubMedCrossRefGoogle Scholar
  6. Bai JC, Andruesh A, Matelo G, Martinez C, Vazquez H, Boerr L, Sambuelli A (1989) Fecal fat concentration in the differential diagnosis of steatorrhea. Am J Gastroenterol 84:27–30PubMedGoogle Scholar
  7. Berg NO, Dahlqvist A, Lindberg T, Lindstrand K, Norden A (1972) Morphology, dipeptidases and disaccharidases of small intestinal mucosa in vitamin B12 and folic acid deficiency. Scand J Haematol 9:167–173PubMedCrossRefGoogle Scholar
  8. Caspary WF, Winckler K, Lankisch PG, Creutzfeldt W (1975) Influence of exocrine and endocrine pancreatic function on intestinal brushborder enzymatic activities. Gut 16:89–92PubMedCrossRefGoogle Scholar
  9. DiMagno EP, Clain JE (1986) Chronic pancreatitis. In: Go VLW, Gardner JD, Brooks FP, Lebenthal E, DiMagno EP, Scheele GA (eds) The exocrine pancreas. Raven, New York, pp 541–575Google Scholar
  10. DiMagno EP, Go VLW, Summerskill WHJ (1973) Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 288:813–815PubMedCrossRefGoogle Scholar
  11. Dutta SK, Butin MP, Russell RM, Costa BD (1982a) Deficiency of fat soluble vitamins in treated patients with pancreatic insufficiency. Ann Intern Med 97:549–552PubMedGoogle Scholar
  12. Dutta SK, Iber FL, Aamodt RL (1982b) Evidence for impaired intestinal absorption of zinc in pancreatic disease. Clin Res 30:244AGoogle Scholar
  13. Einarsson K, Angelin B, Johansson C (1987) Biliary lipid metabolism in chronic pancreatitis: influence of steatorrhoea. Gut 28:1495–1499PubMedCrossRefGoogle Scholar
  14. Fabris C, Farini R, Del Favero G, Gurrieri G, Piccoli A, Sturniolo GC, Panucci A, Naccarato R (1985) Copper, zinc and copper/zinc ratio in chronic pancreatitis and pancreatic cancer. Clin Biochem 18:373–375PubMedCrossRefGoogle Scholar
  15. Funakoshi A, Kimura T, Shinozaki H, Ibayashi H (1986) Comparisons between absorption of vitamin E in patients with chronic pancreatitis and healthy controls: the bioavailability of vitamin E. Tohoku J Exp Med 148:393–401PubMedCrossRefGoogle Scholar
  16. Guarnieri G, Toigo G, Situlin R, Crapesi L, Del Bianco MA, Zanettovich A, Mandero E, Resetta G (1986) Muscle biopsy studies on protein-energy malnutrition in patients with chronic relapsing pancreatitis. Infusionsther Klin Ernahr 13:168–171Google Scholar
  17. Gueant JL, Djalali M, Aouadj R, Gaucher P, Monin B, Nicolas JP (1986) In vitro and in vivo evidence that the malabsorption of cobalamin is related to its binding on haptocorrin (R binder) in chronic pancreatitis. Am J Clin Nutr 44:265–277PubMedGoogle Scholar
  18. Helman CA, Barbezat GO, Bank S (1978) Jejunal monosaccharide, water, and electrolyte transport in patients with chronic pancreatitis. Gut 19:46–49PubMedCrossRefGoogle Scholar
  19. Jain NK, Patel VP, Agarwal N, Khawaja FI, GeeVarghese PJ, Pitchumoni CS (1985) A comparative study of bentiromide test vs rice flour breath hydrogen test in the detection of exocrine pancreatic insufficiency. Gastroenterology 88:1429Google Scholar
  20. Jenett M, Fischbach W, Mössner J, Gerhards W, Koch W (1986) Polyarthritis, Fettgewebsnekrosen und Osteolysen als seltene Komplikation nach acuter Pankreatitis. Gastroenterol Hepatol A108:52Google Scholar
  21. Joffe BI, Novis B, Seftel HC et al. (1971) Ischemic heart disease and pancreatic diabetes. Lancet 2:269PubMedCrossRefGoogle Scholar
  22. Keller U, Szoelloesy E, Varga L, Gyr K (1984) Pancreatic glucagon secretion and exocrine function (BT-PABA test) in chronic pancreatitis. Dig Dis Sci 29:853–857PubMedCrossRefGoogle Scholar
  23. Kondo T, Hayakawa T, Shibata T, Kitagawa M, Sakai Y, Ono H (1989) Urinary and serum zinc levels in chronic pancreatitis. Pancreas 4:79–82PubMedCrossRefGoogle Scholar
  24. Krasner N, Cochran KM, Russell RI, Carmichael HA, Thompson GG (1976) Alcohol and absorption from the small intestine. 1. Impairment of absorption from the small intestine. Gut 17:245–248PubMedCrossRefGoogle Scholar
  25. Lembcke B, Kraus B, Lankisch PG (1985) Small intestinal function in chronic relapsing pancreatitis. Hepatogastroenterology 32:149–151PubMedGoogle Scholar
  26. Mayet W-J, Hermann E, Poralla T, Zschiedrich H, Meyer zum Büschenfeld K-H (1989) Subkutane Fettnekrosen, Arthritiden und Vaskulitis kleiner Hautgefäße bei chronischer Pankreatitis. Z Gastroenterol 27:1–5PubMedGoogle Scholar
  27. Mekhjian HS, May ES (1977) Acute and chronic effects of ethanol on fluid transport in the human small intestine. Gastroenterology 72:1280–1286PubMedGoogle Scholar
  28. Mezey E (1975) Intestinal function in chronic alcoholism. Ann NY Acad Sci 252:215–227PubMedCrossRefGoogle Scholar
  29. Möller T, Appelt G, Müller G, Rongos R, Schütte W, Wegner D. (1988) Die pankreatobiliäre Sekretion bei enteraler Hyperoxalurie. Dtsch Z Verdau Stoff-wechselkr 48:315–320Google Scholar
  30. Mössner J, Koch W, Kestel W, Schneider J (1986) Intestinal absorption of folic acid, glucose, sodium and water in chronic pancreatitis. Z Gastroenterol 24:212–217PubMedGoogle Scholar
  31. Nealon WH, Townsend CM Jr, Thompson JC (1988) The time course of beta cell dysfunction in chronic ethanol-induced pancreatitis: a prospective analysis. Surgery 104:1074–1079PubMedGoogle Scholar
  32. Pitchumoni CS, Scheele G, Lee PC, Lebenthal E (1986) Effects of nutrition on the exocrine pancreas. In: Go VLW, Gardner JD, Brooks FP, Lebenthal E, DiMagno EP, Scheele GA (eds) The exocrine pancreas. Raven, New York, pp 387–406Google Scholar
  33. Regan PT, Malagelada JR, DiMagno EP, Go VLW (1979) Reduced intraluminal bile acid concentrations and fat maldigestion in pancreatic insufficiency: correction by treatment. Gastroenterology 77:285–289PubMedGoogle Scholar
  34. Schumacher B, Lübke HJ, Hagen-Aukamp C, Jungblut RM, Hengels KJ (1989) Nekrotisierende Pannikulitis bei Pankreatitis Z Gastroenterol 27:6–9PubMedGoogle Scholar
  35. Sevel D, Bristow JH, Bank S et al. (1971) Diabetic retinopathy in chronic pancreatitis. Arch Ophthalmol 86:245–250PubMedGoogle Scholar
  36. Toskes PP (1980) Current concepts of cobalaming (vitamin B12) absorption and malabsorption. J Clin Gastroenterol 2:287–297PubMedCrossRefGoogle Scholar
  37. Toskes PP, Hansell J, Cerda J, Deren JJ (1971) Vitamin B12 malabsorption in chronic pancreatic insufficiency. Studies suggesting the presence of a pancreatic “intrinsic factor”. N Engl J Med 284:627–632PubMedCrossRefGoogle Scholar
  38. Wallner B, Friedrich JM, Pietrzyk Ch (1988) Knöcherne Läsionen bei chronischer Pankreatitis. ROFO 149:289–293PubMedCrossRefGoogle Scholar
  39. Wilson FA, Hoyumpa AM (1979) Ethanol and small intestinal transport. Gastroenterology 76:388–403PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • J. Mössner
    • 1
  1. 1.Outpatient ClinicUniversity of WürzburgWürzburgGermany

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