Upper GI 02

Abstract

Background: Impairment in hepatocellular function may contribute to the inability to replenish cellular glutathione, the depletion of which has been demonstrated to increase susceptibility to inflammatory stress. We sought to determine if severe acute pancreatitis (AP) is associated with down-regulation of glutathione metabolism by observing the profile of ALT (transulfuration pathway) and γ-glutamyl transpeptidase in patients with AP of biliary origin. Methods: Venous blood samples taken at 24, 48, and 72 h from the onset of pain were analysed for ALT, γ-GT, alkaline phosphatase (ALP), and bilirubin, and correlated with (1) clinical severity (Atlanta criteria), and (2) the positive acute phase protein response (CRP). Results: In total, 85 patients (severe 25) were recruited. In a severe attack, ALT, γ-GT and ALP but not bilirubin, were persistently and significantly lower than a mild attack (see table). Plasma ALT strongly correlated with γ-GT (24 h: r = 0.52, P < 0.001), and inversely with CRP (24 h: r = −0.34, P = 0.004). Conclusions: Depletion of circulating ALT and γ-GT in severe disease is likely to be secondary to a down-regulation of hepatic function, and may adversely contribute to the depletion of cellular glutathione.