Impact of Alcohol Use Patterns on Clinical Outcomes in Patients with Chronic Pancreatitis

Abstract

Purpose: While it is well known that chronic pancreatitis (CP) is commonly caused by alcohol consumption, the relationship between amount and duration of alcohol consumption and development of CP is unclear. Moreover, there is no information on patterns of drinking in CP patients and how they relate to outcomes such as pain, development of exocrine failure and diabetes mellitus (DM). This study: (1) Characterized recent and lifetime alcohol use in subjects with CP; and (2) Assessed impact of alcohol use on CP outcomes (pain, exocrine failure, DM). Methods: Participants were consecutive patients with CP who provided informed consent. Quantity and frequency of recent (past 90 days) drinking was measured with the Timeline Follow-Back Interview. In addition, drinking patterns for a typical week prior to most recent abstinence and for the period of heaviest alcohol use (lifetime) were recorded. Pain was characterized as type A (flares of pain with normal intervening periods) and type B (chronic continuous pain). Exocrine insufficiency was defined by presence of steatorrhea or fecal elastase < 200 mcg/gm. CP participant subgroups were compared using Students t-tests in SPSS. To-date 36 CP subjects (56% male; mean age 44.9 yrs; 50% African-American) have been enrolled. Results: In a preliminary analysis, average drinks per day during a typical week prior to most recent abstinence and during a week of heaviest drinking were 10.2 and 10.9, respectively. Subjects with type A pain had higher drinking amounts and total drinks, but a trend toward fewer days suggesting more binge patterning (P= 0.006) during heavier as well as typical drinking weeks, respectively (8.4 vs 6.6 drinks/day) (P= 0.007). CP patients with DM (DM+) reported histories of heavier drinking than CP subjects without DM (DM-). DM+ patients also consumed more than twice as many drinks per day (18.4. vs 7.9, respectively); twice as many drinks on the days they drank (21.8 vs 11.8, respectively) and nearly 3 times as many total drinks per week (129 vs 56) (P= 0.038) as DM- patients. Similarly patterns were seen for heaviest week of drinking (P= 0.002). In contrast, comparisons of CP patients with and without exocrine failure found no group differences in patterns of alcohol consumption (recent or heaviest ever). Conclusion: CP subjects who indulge in binge drinking are at greater risk for being DM+ and for having type A pain than non-binge drinking CP subjects.