THE EFFECT OF SMOKING, ALCOHOL AND NARCOTICS ON RESULTS OF CCK-STIMULATED PANCREAS FUNCTION TESTING.

Abstract

Background/Aims: Patients with suspected or established chronic pancreatitis often smoke, consume alcohol and/or receive opioids for pain control. The aim of this study was to determine if these factors affect pancreatic function. Methods: 485 subjects underwent CCK-stimulated pancreas function testing (CCK-PFT) at Mayo Clinic Rochester between January 1995 to October 2003. After exclusion of patients with concomitant gi or systemic illness there were 61 patients who had definite chronic pancreatitis (CP) based on EUS and ERCP findings and 86 who had no evidence of pancreatic or other organic gi disease (NP). Demographics, history of current smoking, alcohol and narcotic use were extracted from the chart. Results: Females were more common in both groups 64% CP and 73% NP. Abdominal pain was present in 92% of patients, diarrhea in 30% (steatorrhea in 46% with CP). There were 22% vs 35% current smokers, 21% vs 15% who used alcohol and 53% vs 34% on chronic opioids in the NP and CP groups, respectively. Overall, as would be anticipated, LO and TO were significantly lower for CP, compared to NP, p <0.001. In CP, neither opioids, alcohol, smoking or a combination of these factors produced a significant difference in LO or TO. In the NP group however, LO and TO were significantly lower in patients on opioids. This remained consistent with or without concomitant smoking and/or alcohol use. These two factors alone or combined had no effect on enzyme output. LO was below normal (< 77.8 KU/hr) in 35 (41%) of patients in the NP group compared to 54 (89%) in the CP group. However, 27 (77%) of these 35 in the NP group were on opioids. Thus, if these patients are excluded, LO was abnormal (<77.8 KU/hr) in 9% (8/86) of patients on opioids in the NP group. TO results were similar. Conclusions: Chronic opioid use appears to depress pancreas secretion independent of smoking and/or alcohol in patients without evidence of pancreatic disease but has no effect in patients with CP. In the NP group chronic opioid use at time of CCK-PFT accounted for a large percentage of those with an abnormal test, thus, chronic narcotic use should be taken into account when interpreting CCK stimulated pancreatic function testing.