Dietary Chaos Syndrome

Abstract

Dietary chaos syndrome. A 50-year-old African American male presented to the emergency department with severe epigastric pain, nausea and vomiting. On exam, he was emaciated with a body mass index of 16Kg/m2. Physical exam was positive for epigastric tenderness and sluggish bowel sounds. At the time of admission, Lipase was 669 U/L, total bilirubin was <0.2 mg/dl, AST 257U/L, ALT 212U/L, albumin 2.8 g/dl and serum triglycerides and calcium were normal. There was no prior history of cholelithiasis or alcohol abuse. Computerized tomography(CT) scan of the abdomen revealed pancreatitis and no gallstones were identified. His prior medical history included malnutrition secondary to major depressive disorder. Prior to the episode of abdominal pain, the patient was reported to be anorexic after he stopped taking his psychotropic medications. He had lost about 9 lbs. He had resumed feeding again when this episode occurred. His condition improved with conservative management and lipase decreased to 56U/L in two days. Patient recovered spontaneously, raising the specter of “dietary chaos” syndrome. Discussion: Malnutrition has been described to be associated with acinar cell atrophy and injury, epithelial metaplasia, and increased zymogen granule release in the pancreas. This may cause high trypsinogen levels. Weight loss may also cause compression of internal organs. This situation may lead to conversion of trypsinogen to trypsin within the pancreas and subsequent activation of other proteases, trigerring inflammatory processes leading to pancreatitis. This has been termed the “dietary chaos” syndrome. Though this condition is described in anorexia nervosa and bulimia, it would be reasonable to consider it in our cachectic patient with a similar syndrome. Recurrent episodes of acute pancreatitis could lead to chronic pancreatitis. This condition resolves with normalization of dietary patterns or resolution of the “dietary chaos.” The “Dietary chaos” syndrome should thus be considered in all malnourished or anorexic patients with idiopathic pancreatitis, particularly during refeeding after prolonged starvation.