Non-alcoholic Acute Pancreatitis Research Articles

Serum Lipase Amylase Ratio as an Indicator to Differentiate Alcoholic From Non-alcoholic Acute Pancreatitis: A Systematic Review and Meta-Analysis.

A lipase/amylase (L/A) ratio of more than three may be a tool for differentiating alcoholic pancreatitis from non-alcoholic pancreatitis. We conducted a systematic literature review to identify published studies. A thorough data search of various databases was conducted using keywords. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 survey. Data were extracted under the following headings: country, sample size, baseline characteristics, specificity, and sensitivity of the L/A ratio. Studies were analyzed using a bivariate random-effects model, and the sensitivity and specificity of the L/A ratio were pooled separately. Summary receiver operating characteristic (SROC) curves were plotted using the hierarchical method. A total of nine studies with 1,825 patients were identified for inclusion. SROC showed estimates of the area under the curve to be 0.75 (confidence interval (CI) = 0.71-0.79). Forest plots for sensitivity and specificity showed pooled estimates of sensitivity to be 74% (95% CI = 62-83%) while that of specificity was 63% (95% CI = 47-77%). The pooled diagnostic odds ratio was estimated to be 5 (95% CI = 3-9), the pooled positive likelihood ratio was estimated at 2.0, and the pooled negative likelihood ratio was estimated to be 0.41. We concluded that an L/A ratio of more than 3 has moderate accuracy for the diagnosis of alcoholic pancreatitis.

Parathyroid Adenoma Revealed by Acute Pancreatitis: Case Report

The association between acute pancreatitis and primary hyperparathyroidism (PHPT) has widely been reported in literature, but a causal relationship remains controversial. This case report is about a patient admitted with acute pancreatitis as a first manifestation of a parathyroid adenoma. The initial medical management followed by surgery permitted a total recuperation. The purpose of this paper is to keep in mind the metabolic etiology, by evaluating calcium and parathyroid hormone (PTH) in the differential diagnosis of non-biliary, non-alcoholic acute pancreatitis.

STUDY OF SERUM LIPASE TO AMYLASE RATIO IN DIFFERENTIATING BETWEEN ACUTE ALCOHOLIC AND NON-ALCOHOLIC PANCREATITIS

Acute pancreatitis (AP) is a common condition involving the pancreas. The estimated incidence is about 3% of cases presenting with pain in abdomen.(4) Gall stones and alcoholism together account for 80% of acute pancreatitis.(5) Although the overall mortality rate for acute pancreatitis is 2-10% and this is primarily related to the 10-30% of patients with severe disease characterized by pancreatic and peripancreatic necrosis.(6) Diagnosis remains clinical and can be supported by 1.5 - 2 fold increase above the upper limit of normal of serum amylase and lipase.(10) Amylase and lipase levels are known to be the most important factors in determining acute pancreatitis. It is well known that these levels are usually elevated in acute pancreatitis, without regard to whether it is of biliary type or alcoholic type. Furthermore whether or not these levels can be used to discern between the two types, has been also a matter of concern. It has been reported that the lipase/amylase ratio could be a new index distinguishing two types of pancreatitis, with the critical value being 2. This report had been followed by some debate between supporters and opponents. Currently CECT is the imaging modality of choice where areas of hypo perfusion correlate with necrosis. (11) It can’t differentiate between alcoholic and non-alcoholic AP. Identification of two groups could help formulating treatment protocol for either group. The aim of the present study is to establish the utility of the ratio of the serum lipase and serum amylase, a new index distinguishing acute episode of alcoholic from non alcoholic pancreatitis.

S0107 Non-Alcoholic Fatty Liver Disease and Acute Pancreatitis: Insights From the Nationwide Inpatient Sample

S0107 Non-Alcoholic Fatty Liver Disease and Acute Pancreatitis: Insights From the Nationwide Inpatient Sample

Incidence of non biliary non alcoholic acute pancreatitis in a tertiary hospital

Background: Acute pancreatitis is an important cause of hospital admission with acute abdomen. It is responsible for significant morbidity and also mortality in patients.
 Objective: To determine the incidence of non-biliary nonalcoholic acute pancreatitis (Non A non B) and also to compare the incidence with alcoholic and biliary pancreatitis in the department of surgery of Chittagong Medical College Hospital, Bangladesh as well as with the developed countries
 Methods: This prospective study was carried on 75 patients of both sex having acute abdominal pain characteristic of acute pancreatitis and serum amylase >3 times normal, admitted in General Surgery wards in CMCH and supported by biochemical test during June 2008 to May 2010.
 Results: The mean (±SD) age was 36.1±15.4 years and 32.7±14.3 years in male and female group respectively (p>0.05) and maximum number was found in the age group of 20-30 years in both groups. Choledocolithiasis were 2(33.3%) and 7(21.9%) in male and female respectively evaluated by USG. Sludge in GB 1(16. 7%) in male and 7(21.9%) in female. Biliary ascariasis 3(50.0%) and 16(50.0%) in male and female respectively. Alcoholic was found 4(16.0%), Biliary 2(8.0%) and Non Alcoholic non Biliary 19(78.0%) in male patients. Biliary 32 (64.0%) and Non Alcoholic non Biliary 18(36.0%) in female patients. The difference was statistically significant (p<0.05). It was observed that the total patients were 75 among them Alcoholic was 4(5.3%), Biliary was 34(45.3%) and Non Alcoholic non Biliary was 37(49.3%) of study patients.
 Conclusion: Non-A non-B acute pancreatitis accounts for about a half - of all cases of acute pancreatitis and is significantly less frequent among female patients. Biliary pancreatitis was higher in female subjects. Bilio pancreatic ascariasis is 50.0% in both male and female subjects.
 Journal of Surgical Sciences (2017) Vol. 21 (2): 85-88

Study of lipase/amylase index to distinguish acute episodes of alcoholic from non-alcoholic acute pancreatitis among patients of district government head-quarters hospital in Chittoor

Study of lipase/amylase index to distinguish acute episodes of alcoholic from non-alcoholic acute pancreatitis among patients of district government head-quarters hospital in Chittoor

Clinical study and outcome of alcoholic and nonalcoholic acute pancreatitis presenting to a tertiary care center

Background: Acute pancreatitis is a common condition involving the pancreas. The estimated incidence is about 3% of cases presenting with pain abdomen. The study is undertaken to study the various etiological factors and clinical factors of alcoholic and nonalcoholic acute pancreatitis and to assess the prognosis, outcome, management of an alcoholic and nonalcoholic acute pancreatitis.Methods: A total of 60 cases from BMCRI hospital attached selected during the study period from November 2015 to June 2017.Results: In the present study total 60 patients with acute pancreatitis were enrolled, 55% were alcoholic and remaining 45% were nonalcoholic. The mean age of presentation in our study was 39.2 years and in alcoholic it was 39.42 years, and nonalcoholic it was 39.07 years. There was a male predominance with males accounting for 90 percent in which 61.1% are alcoholic and 38.9 percent are nonalcoholic with 9:1 male to female ratio. In our study 100 % of patients had tenderness, 3% of alcoholic and 7.4 % of nonalcoholic presented as mass abdomen, and 21.2% alcoholic and 7.4% of nonalcoholic presented as ascites. USG abdomen was diagnostic in 93.3 % of the patients in our study. All of them managed conservatively, of the 8 patients of biliary pancreatitis 7 underwent interval cholecystectomy, and 1 underwent ERCP + ES.Conclusions: Acute pancreatitis is a common cause of acute abdomen. Alcohol being the most common cause of acute pancreatitis in the present study. Nonalcoholic pancreatitis contribute to a significant proportion of etiology of pancreatitis. Prompt identification and diagnostic work up to identify the etiology of pancreatitis followed by appropriate treatment results in cure and prevention of untoward complications.

A retrospective study of clinical efficacy of serum lipase/amylase ratio in predicting etiology of acute pancreatitis

Background: The serum lipase/amylase (L/A) ratio had been proposed to distinguish the etiology of pancreatitis, the efficacy to predict the etiology of acute pancreatitis is assessed in our study as it may need different therapeutic approaches.Methods: From January 2017 to December 2017, 54 patients with acute pancreatitis were included 48 (88.9%) men and 6 (11.1%) women with a mean age of 39.2 years, ranging from 18 to 90 years. They were divided into 2 subgroups as alcohol (n=27), nonalcoholic (n=27), and their serum L/A ratio level were compared with a mean age 39.42±9.9 years in alcoholic group versus 39.04 ± 7.7 years in nonalcoholic group.Results: Male predominance in alcoholic and nonalcoholic group and all female patients (100%) etiology is nonalcoholic. The elevation of serum amylase level in nonalcoholic group on average is 600 versus in alcoholic group 512 and serum lipase level average in nonalcoholic group 766 versus in alcohol group 629. Instead, the serum L/A ratio showed no significant changes among each group. In this study, the alcoholic acute pancreatitis is more severe than nonalcoholic pancreatitis. There was also no statistically significant (p=0.90) difference in serum L/A ratio in alcoholic and nonalcoholic pancreatitis.Conclusions: The serum amylase and lipase concentrations are not able to establish etiology acute pancreatitis as assessed by imaging techniques. The L/A ratio is not a good predictive factor in distinguishing acute episode of alcoholic and non-alcoholic acute pancreatitis.

Serum Lipase Amylase Ratio in Predicting Aetiology, Severity and Outcome of Acute Pancreatitis in a Tertiary Care Hospital

Background: Acute pancreatitis is a relatively common disease with variable prevalence in different countries. Different modalities are available for predicting aetiology, severity and outcome of acute pancreatitis with different sensitivity and specificity. Moreover, some are not widely available, some are very expensive. A single, cheap, widely available marker with high sensitivity and specificity is yet to be identified. The present study intends to find out the utility of serum lipase amylase ratio in predicting the aetiology, severity and outcome of acute pancreatitis.Methods: This prospective, observational study was done at the Department of Gastrointestinal Hepatobiliary & Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, during the period of July 2014 to March 2016. A total of 71 patients with acute pancreatitis were included. Complete blood count, serum amylase, serum lipase, serum calcium, liver function test, renal function test, fasting lipid profile, ultrasonography of whole abdomen, CT scan of upper abdomen and arterial blood gas (ABG) were done in all patients. Statistical analysis was done with SPSS version 16.Results: Among 71 patients, 23(32.4%) were due to biliary cause, 15(21.1%) were due to hypertriglyceridaemia, 4(5.6%) were due to alcohol and 22(31%) were due to unknown causes. 45 (63.4%) patients had mild attack, 10(14.1%) patients had moderate attack and 16(22.5%) patients had severe attack of acute pancreatitis. Out of 71 patients, 17(23.9%) developed complication whereas 54(76.1%) developed no complication. Serum lipase amylase ratio in patients with biliary pancreatitis was 1.40±0.39 and in patients with non-biliary pancreatitis was 2.39±0.84(p <0.001). Again, serum lipase amylase ratio in patients with acute alcoholic pancreatitis was 2.89±0.79 and in patients with non-alcoholic acute pancreatitis was 1.95±0.81 (p=0.002). Serum lipase amylase ratio in patients with acute pancreatitis due to hypertriglyceridaemia was 2.75±0.68 and in patients with acute pancreatitis due to other than hypertriglyceridaemia was 1.62±.65(p< 0.001). This study showed that serum lipase amylase ratio was <2.0 in acute biliary pancreatitis and this ratio was >2.5 in acute alcoholic pancreatitis and in acute pancreatitis due to hypertriglyceridaemia. Serum lipase amylase ratio in patients with mild acute pancreatitis was 1.95±0.89; in patients with moderately severe acute pancreatitis the ratio was 2.37±0.92 and in patients with severe acute pancreatitis, the ratio was 2.22±0.70. The difference of lipase amylase ratio among these groups of patients was not statistically significant (p=0.273). Mean lipase amylase ratio among the patients without complication of acute pancreatitis was 2.03±0.92 whereas this ratio among the patients with complication was 2.17±0.68. This difference of lipase amylase ratio was not statistically significant (p=0.557).Conclusion: Role of serum lipase amylase ratio in predicting the aetiology and severity of acute pancreatitis has been addressed in several recent studies. This study was another attempt to achieve this goal. Predicting the aetiology of acute pancreatitis by such a cheap tool will guide further diagnostic work up and management strategy will avoid unnecessary investigations.Bangladesh Crit Care J September 2017; 5(2): 88-92

Acute Pancreatitis: Impact of Alcohol Consumption and Seasonal Factors.

We aimed to evaluate the potential relation between the incidence of (alcoholic and non-alcoholic) acute pancreatitis (AP) and alcohol consumption in the general population, and whether the occurrence of AP shows any seasonal variation, particularly in relation to periods with expected increased alcohol consumption. All patients with first-time AP between 2003 and 2012 in a well-defined area in Sweden were retrospectively identified. Data on AP aetiology (alcoholic and non-alcoholic) and severity were registered. Data on annual alcohol sales as well as on self-reported alcohol consumption were obtained. In total, 1457 AP patients were included (83% non-alcoholic AP, 17% alcoholic AP). The overall AP incidence showed increasing time trends for women and men (P < 0.05), but there were no significant changes in the incidence of alcoholic AP, in either sex (P > 0.05). Alcohol sales during the study period decreased (P = 0.002), mainly due to decreased sales of spirits (P = 0.001) and beer (P = 0.002), while self-reported alcohol consumption remained stable for women (P > 0.05) and decreased for men (P = 0.022). Neither alcohol sales nor consumption was related to the time trends of AP (P > 0.05 for all). No significant differences were found in the occurrence of AP among different seasons of the year or between holidays associated with higher alcohol consumption compared to periods before and after these holidays (P > 0.05 for all). Changes in alcohol consumption in the general population do not appear to be related to changes in the incidence of AP and there are no significant seasonal differences in the occurrence of AP in Sweden. The incidence of acute pancreatitis (AP) is increasing, and alcohol is still recognized as one of the most common causes. In this study, however, we could not ascertain any clear relations between the sales and consumption of alcohol in the general population and the incidence of alcoholic or non-alcoholic AP.

Role of Serum Enzymes and CT Scan in Severity and Differentiation of Alcoholic vs Non-Alcoholic Acute Pancreatitis in a Tertiary Care Hospital of Bihar

Role of Serum Enzymes and CT Scan in Severity and Differentiation of Alcoholic vs Non-Alcoholic Acute Pancreatitis in a Tertiary Care Hospital of Bihar

Are we ready for early discharge of patients with mild non-alcoholic acute interstitial pancreatitis?

Are we ready for early discharge of patients with mild non-alcoholic acute interstitial pancreatitis?

NAFLD Diagnosed with Abdominal Ultrasound is a Marker of Severity in Acute Pancreatitis

Objective: Obesity, particularly metabolic obesity, is associated with an increased incidence and enhanced severity of acute pancreatitis (AP). Non Alcoholic Fatty Liver Disease (NAFLD) is a marker of metabolic obesity, which can be easily diagnosed, with the help of initial abdominal ultrasound (AUS) routinely performed in all patients with AP upon admission to assess a biliary etiology. The aim of this study is to identify the clinical utility of detecting NAFLD by AUS in determining the severity of patients with AP Methods: Five hundred and seventy four patients with non-alcoholic AP were divided into two groups on the basis of presence or absence of NAFLD detected by AUS at the time of admission. The diagnosis of NAFLD was based solely on imaging findings. Well-established single markers of prognosis as well as scoring systems were studied in both groups. The data was analyzed using the student's t-test, chi-square test and multivariate regression analysis. Results: Patients with NAFLD had a more severe disease as compared to patients without NAFLD as measured by single markers of prognosis like serum albumin, mean length of stay, ICU admission and mortality as well as scoring systems like BISAP score and Modified Atlanta Classification system ( P value < 0.05) BMI, by itself, was not associated with any difference in outcomes in patients with and without NAFLD as assessed by multivariate regression analysis. Age, sex and individual components of metabolic syndrome also had no influence on the prognostic markers Conclusion: Presence of NAFLD as diagnosed by early AUS can be used as an additional single marker of prognosis in AP. The diagnosis of NAFLD is objective and almost always available at the time of initial presentation of AP.

A randomized controlled trial of home monitoring versus hospitalization for mild non-alcoholic acute interstitial pancreatitis: A pilot study

Background/ObjectivesAcute pancreatitis (AP) is a disease typically requiring in-hospital treatment. We conducted a trial to assess the feasibility of early discharge from the hospital for patients with mild non-alcoholic acute pancreatitis (NAAP). MethodsEighty-four patients with mild NAAP were randomized to home or hospital groups after a short hospital stay (≤24 h). AP was defined by the revised Atlanta criteria. Mild AP was defined as an Imrie score≤5 and a harmless acute pancreatitis score (HAPS)≤2 in the first 24-h of presentation. A nurse visited all patients in the home group on the 2nd, 3rd and 5th days. All patients presented for follow-up in clinic on the 7th, 14th, and 30th days. The primary outcome was the time to resolution of pain. Secondary outcomes evaluated included time to resumption of an oral diet, 30 day hospital readmission rate as well as the total costs associated with either approach to care. ResultsThere was no difference between the groups with regards to demographics, prognostic severity scores, symptoms, and biliary findings. No patients developed organ failure, pancreatic necrosis, or died in either group. Time to the resolution of pain and resumption of solid food intake were similar. Three (3.6%) patients required readmission within 30 days, 1 from home and 2 from the hospital groups. The total cost was significantly less in home group ($139 ± 73 vs. $951 ± 715,p < 0.001). ConclusionsMild NAAP can be safely treated at home with regular visits by a nurse under the supervision of a physician. Widespread adoption of this practice may result in large cost savings.

809 A Prospective Randomized Controlled Trial of Home Monitoring Versus Hospitalization for Mild Non-Alcoholic Acute Interstitial Pancreatitis

809 A Prospective Randomized Controlled Trial of Home Monitoring Versus Hospitalization for Mild Non-Alcoholic Acute Interstitial Pancreatitis

Progression From Acute to Chronic Pancreatitis

Knowledge of the natural course of acute pancreatitis (AP) and risk of progression to chronic pancreatitis (CP) is limited. The aims were to describe: (1) the incidence of progression from AP to CP, (2) prognostic factors for progression, and (3) the natural course and mortality of progressive AP. During 1977 to 1982, patients admitted to hospitals in Copenhagen with a diagnosis of AP or CP were included in a prospective cohort and followed up by the Danish registries in 2008. The subcohort analyses comprised 352 AP patients. Progressive AP was found in 85 patients (24.1%) during follow-up; 48.2% developed from alcoholic AP, 47.0% from idiopathic AP, and 4.8% from other causes. The mortality rate for patients with progressive AP was 2.7 times higher than in patients with nonprogressive acute pancreatitis, and 5.3 to 6.5 times higher than in the background population. In Cox regression analyses corrected for age, only smoking was of significance for the progression from AP to CP. Acute pancreatitis can progress to CP, not only from alcoholic but also from nonalcoholic AP. Smoking was the strongest risk factor associated with progression. The mortality rate for these patients was 5 to 6 times the mortality rate in the population.

Acute pancreatitis associated with primary hyperparathyroidism

Coexistence of primary hyperparathyroidism and acute pancreatitis has widely been reported in literature, but a causal relationship remains controversial. A case of acute pancreatitis as a first symptom of primary hyperparathyroidism with severe hypercalcemia is reported. In this patient a reduction of serum calcium level was obtained with medical therapy and resulted in the resolution of acute pancreatitis symptoms within 10 days. At the same time a parathyroid adenoma was clinically identified and elective parathyroidectomy was performed with complete normalization of intact parathyroid hormone and serum calcium level. At three-year follow-up, no recurrence or complications of pancreatitis were documented. The presented case suggests a cause and effect relationship between acute pancreatitis and severe hypercalcemia which should be kept in mind in the differential diagnosis of non-biliary, non-alcoholic acute pancreatitis. Reduction of hypercalcemia with medical treatment can represent a good chance for elective surgical neck exploration.

Pancreatic response to endotoxin after chronic alcohol exposure: switch from apoptosis to necrosis?

Chronic alcohol consumption is known to increase the susceptibility to acute and chronic pancreatitis, and it is likely that a cofactor is required to initiate the progression to alcoholic pancreatitis. The severity and complications of alcoholic and nonalcoholic acute pancreatitis may be influenced by a number of cofactors, including endotoxemia. To explore the effect of a possible cofactor, we used endotoxin [lipopolysaccharide (LPS)] as a tool to induce cellular injury in the alcoholic pancreas. Single, increasing doses of endotoxin were injected in rats fed an alcohol or control diet and killed 24 h after the injection. We examined the mechanism by which LPS exacerbates pancreatic injury in alcohol-fed rats and whether the injury is associated with apoptosis or necrosis. We showed that chronic alcohol exposure alone inhibits apoptosis through the intrinsic pathway and the downstream apoptosis executor caspase-3 compared with the controls. Pancreatic necrosis and inflammation increased after LPS injection in control and alcohol-fed rats in a dose-dependent fashion but with a significantly greater response in the alcohol-fed animals. Caspase activities and TdT-mediated dUTP nick-end labeling positivity were lower in the alcoholic pancreas injected with LPS, whereas the histopathology and inflammation were more severe compared with the control-fed animals. Assessment of a putative indicator of necrosis, the ratio of ADP to ATP, indicated that alcohol exposure accelerates pancreatic necrosis in response to endotoxin. These findings suggest that the pancreas exposed to alcohol is more sensitive to LPS-induced damage because of increased sensitivity to necrotic cell death rather than apoptotic cell death. Similar to the liver, the pancreas is capable of responding to LPS with a more severe response in alcohol-fed animals, favoring pancreatic necrosis rather than apoptosis. We speculate that this mechanism may occur in acute alcoholic pancreatitis patients.

Limited contribution of the SPINK1 N34S mutation to the risk and severity of alcoholic chronic pancreatitis: a report from the United States.

Mutations in the SPINK1 gene (e.g. N34S) have been reported in patients with idiopathic, familial, tropical, and alcoholic pancreatitis. The prevalence of SPINK1 N34S differs between different patient populations, and its contribution to the risk and the severity of alcoholic chronic pancreatitis has not been defined in the United States. Mutational analysis of the exon 3 was performed in 32 patients with alcoholic chronic pancreatitis, 39 patients with nonalcoholic chronic pancreatitis or recurrent acute pancreatitis, and 190 previously studied healthy controls. The course of alcoholic chronic pancreatitis with and without N34S was compared in age of onset- and sex-matched patients. All SPINK1 gene sequence variations were heterozygous. SPINK1 N34S was present in 3/190 (1.6%) and P55S was found in 2/190 (1.1%) of controls. In alcoholics, the N34S mutation was identified in 2/32 patients (6.3%, P > 0.05). In nonalcoholics, N34S and P55S were identified in 6/39 patients (15.4%, P < 0.005, N34S N = 4, P55S N = 1, N34S/P55S N = 1). The clinical course of alcoholic chronic pancreatitis was similar between patients with and without the N34S mutation. The N34S mutation is uncommon in patients with alcoholic chronic pancreatitis in the United States; its prevalence is similar to other countries and appears not to alter the onset or the severity of alcoholic chronic pancreatitis.

Usefulness of carbohydrate-deficient transferrin and trypsin activity in the diagnosis of acute alcoholic pancreatitis

The aim of this study was to assess if carbohydrate-deficient transferrin (CDT) and trypsin activity differentiate acute alcoholic pancreatitis from nonalcohol-related pancreatitis, and as a secondary goal to evaluate its use in comparison to healthy controls. Serum levels of CDT and trypsin activity were measured in frozen sera from 70 nonconsecutive patients with acute pancreatitis and in 16 healthy controls. Causes of pancreatitis were gallstones in 51%, chronic alcoholism in 23%, and other or unknown causes in 26% of the patients. Serum CDT was significantly higher in alcoholic pancreatitis than in the nonalcoholic disease (p < 0.0001) with a median (interquartile range) of 30.8 U/L (23.6-41.7 U/L) in chronic alcoholism, 16.7 U/L (13.05-21.1 U/L) in gallstones, 17.5 U/L (15.9-21.6 U/L) in unknown cause, 19.3 U/L (15.1-27.7 U/L) in other etiologies, and 16.1 U/L (12.1-18.8 U/L) in controls. At a cutoff over 22.5 U/L, CDT showed a sensitivity of 87.5% and a specificity of 85.2%. Serum levels of trypsin activity were significantly higher (p = 0.0007) in alcoholic pancreatitis, median 165 U/L (76-405 U/L) than in nonalcoholic pancreatitis, median 73 U/L (46.5-100.5 U/L). At a cutoff value over 152 U/L, the sensitivity of trypsin activity was 60% with a specificity of 100%. In the multivariate analysis, patient's age (< or = 44 yr), CDT (>22.5 U/L), and trypsin activity (>152 U/L) enabled correct prediction of acute alcoholic pancreatitis in 98% of the cases. Serum CDT and trypsin activity are of clinical utility in differentiating alcoholic from nonalcoholic acute pancreatitis.