Low serum amylase levels in drinking alcoholics.

BACKGROUND: We have reported that the serum level of amylase, different from other pancreatic enzymes, increases temporarily after abstinence in alcoholics. To elucidate the mechanism of this phenomenon, pancreatic isoamylase, salivary isoamylase, and amylase in urine were measured together with total serum amylase. METHODS: Total serum amylase, pancreatic isoamylase, and salivary isoamylase values were measured in 38 male patients admitted to the National Alcoholism Center, Kurihama Hospital, for alcoholism after abstinence. In an investigation of amylase secretion, amylase in urine was measured in some patients after abstinence. RESULTS: In the group with abnormally high total serum amylase on admission, levels were found to decrease after abstinence. In patients with pancreatic disorders in this group, abstinence leads to a decrease in total serum amylase, but in patients with no such disorders, total serum amylase increases temporarily due to increases in salivary isoamylase. In the group with normal total serum amylase on admission, levels increased sharply after abstinence, and both pancreatic isoamylase and salivary isoamylase contributed to the gains. In the group with low total serum amylase, a sharp increase of 2-fold or more was noted after abstinence, and a major contributor was pancreatic isoamylase. The ratio of urine amylase to total serum amylase gradually declined, indicating clearly that abstinence led to a decrease in the excretion of amylase in urine. CONCLUSIONS: In cases of heavy alcohol consumption, a decrease in the production or secretion of pancreatic isoamylase and salivary isoamylase while drinking could happen. It was thus suggested that the increase in serum amylase might be due to the fact that this situation is improved by abstinence, plus the fact that excretion of amylase in urine increases during alcohol consumption, and abstinence brings about a decline in such excretion. Measurement of total serum amylase is not appropriate for diagnosing pancreatitis in alcoholic patients or those who consume large quantities of alcohol.

Long term results of lateral pancreaticojejunostomy for chronic alcoholic pancreatitis.

OBJECTIVE: To assess our long term results of lateral pancreaticojejunostomy in patients with alcoholic pancreatitis. DESIGN: Retrospective study. SETTING: University hospital, France. SUBJECTS: 57 patients (48 men, 9 women, mean (SD) age 46 (7) years who required surgical treatment of chronic alcoholic pancreatitis between January 1977 and October 1995. INTERVENTIONS: Lateral pancreaticojejunostomy with or without another procedure. Outcome classified as excellent, good, fair, or poor. MAIN OUTCOME MEASURES: Postoperative morbidity and mortality; relief of pain; reduction in use of analgesics and exocrine supplements; effect on exocrine and endocrine insufficiency; and return to paid work. RESULTS: There were no postoperative deaths and no pancreatic fistulae, but there were 17 other postoperative complications (30%). Median follow up was 65 months (range 8-206), during which 12 patients died (21%). Result was judged excellent in 16 (28%), good in 27 (47%), fair in 5 (9%), and poor in 9 (16%). Pain control was significantly improved, analgesic usage decreased, less pancreatic enzyme supplementation was required, and 25 patients returned to paid work (p = 0.0001 in each case). Exocrine and endocrine function remained stable. The results were better if the patient gave up misusing alcohol (p = 0.03) and if the operation was done within 4 years of the development of pancreatitis (p = 0.03). CONCLUSIONS: Lateral pancreaticojejunostomy is a safe procedure that can improve functional outcome in patients with chronic alcoholic pancreatitis, and does not worsen pancreatic function.

[The clinico-pathogenetic validation of rehabilitative-stage treatment in chronic pancreatitis]. / Kliniko-patohenetychne obhruntuvannia reabilitatsiino-etapnoho likuvannia khronichnoho pankreatytu.

A total of 252 patients were examined. It has been shown that forms of chronic pancreatitis (ChP) have some distinguishing features of the clinical course of the disease and depend on morphofunctional state of pancreas, its ecbolic activity, degree of microcirculatory disorders, state of lipid peroxidation (LPO), that of the antioxidant system of defence as well as psychophysiologic status of the personality, circadian and seasonal variability of functional activity of pancreas in patients with chronic pancreatitis. Substantiated in the paper is rehabilitative staged treatment of ChP patients, depending on ChP forms with due regard to the above-mentioned mechanisms of its relapse, most important of which is LPO status, that of antioxidant system of defence and microcirculation.