Acute Pancreatitis and Hypertriglyceridemia

Abstract

An association between acute pancreatitis and hypertriglyceridemia has long been recognized. The frequency of this association may be as high as 25 per cent. Whether the lipid abnormalities are secondary to acute pancreatitis and therefore temporary or whether they are primary and possibly etiologically involved is unsettled. Most experimental and clinical evidences suggest that hypertriglyceridemia precedes and apparently cause the development of pancreatitis. The mechanism of injury may be mediated through free fatty acids released from the triglycerides. It has recently been identified a group of normotriglyceridemic patients with a previous attack of acute pancreatitis, at least 6 months earlier, who had an impaired clearance of serum triglycerides after an oral fat tolerance test. The clearance of ingested triglycerides was significantly impaired as compared with a control group, irrespective of the presence of diabetes, alcohol consumption or biliary lithiasis. The authors suggested that a triglyceride tolerance test is the only way to detect those patients in whom future attacks of pancreatitis may be precipitated by a diet rich in fat or an alcoholic debauch. In a further study the authors suggested that the abnormal oral fat tolerance test in these patients with previous acute pancreatitis and normotriglyceridemia is secondary to an impaired chylomicron remnants clearance. These findings strongly suggest a relatively common and preexistent defect in lipid metabolism which may be important in the pathogenesis of the disease.