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Alcohol consumption in relation to acute pancreatitis

Boston University Medical Center

A study on the effect of different alcoholic beverages and drinking behaviour on the risk of acute pancreatitis was conducted, using the Swedish Mammography Cohort and Cohort of Swedish Men, to study the association between consumption of spirits, wine and beer and the risk of acute pancreatitis.

In total, 84,601 individuals, aged 46-84 years, were followed for a median of 10 years, of whom 513 developed acute pancreatitis. There was a dose-response association between the amount of spirits consumed on a single occasion and the risk of acute pancreatitis. After multivariable adjustments, there was a 52 per cent (risk ratio 1•52, 95 per cent confidence interval 1•12 to 2•06) increased risk of acute pancreatitis for every increment of five standard drinks of spirits consumed on a single occasion. There was no association between consumption of wine or beer, frequency of alcoholic beverage consumption including spirits, or average total monthly consumption of alcohol (ethanol) and the risk of acute pancreatitis.

Forum Comments

Alcohol consumption has often been found to be a risk factor for acute pancreatitis and, as the authors point out, a number of biologic mechanisms for such an association have been suggested. Overall the risk is rather low, as only 1-3% of heavy drinkers develop acute pancreatitis after 10-20 years of follow up. This study evaluated beverage-specific risk among subjects enrolled in a prospectively collected database that included information on the amount of alcohol consumed on a single occasion, frequency of drinking, total alcohol intake, and a number of potential confounders, such as education, data on body weight, smoking, diet, history of diabetes, and history of gall-bladder disease. Very complex and appropriate statistical analytic methods were used.

The study suggests that a greater number of drinks per occasion ("binge drinking") of spirits increases the risk of acute pancreatitis, but no such relation was seen for the consumption of beer or wine. Forum reviewers suggested that a faster rate of drinking, with a greater rise in Blood Alcohol Concentration (BAC), for spirits drinkers may be an important factor in the observed higher risk of pancreatitis; the increased risk may not necessarily be due to lower levels of antioxidants or to the presence of other toxic substances in spirits.

Average total alcohol consumption did not affect the risk of pancreatitis; instead, it was the number of drinks consumed per occasion (of spirits, in this study) that was associated with an increase in risk. Residual confounding by the pattern of drinking, diet, or by other lifestyle factors could still be operating, and it will require replication of these results in other studies to support the conclusions of the authors.

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Reference: Azodi OS, Orsini N, Andrén-Sandberg Å, Wolk A. Effect of type of alcoholic beverage in causing acute pancreatitis. Brit J Surgery 2011;DOI: 10.1002/bjs.7632.

Comments by the International Scientific Forum on Alcohol Research on this paper have been provided by the following members:

Fulvio Ursini, MD, Dept. of Biological Chemistry, University of Padova, Padova, Italy.

Gordon Troup, MSc, DSc, School of Physics, Monash University, Victoria, Australia.

Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway.

Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark.

Ross McCormick PhD, MSC, MBChB, Associate Dean, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA.

R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA.

For the detailed critique of this paper by the International Scientific Forum on Alcohol Research, go to www.bu.edu/alcohol-forum or click here: http://www.bu.edu/alcohol-forum/critique-051-types-of-alcohol-in-relation-to-acute-pancreatitis-11-august-2011/

The International Scientific Forum on Alcohol Research www.alcoholforum4profs.org

Professor R Curtis Ellison
Ellison@alcoholforum4profs.org

Helena Conibear
helena@alcoholforum4profs.org

UK tel: + 44 1300 320869
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