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Thomas Foitzik, MD; Kent B. Lewandrowski, MD; Carlos Fernández-del Castillo, MD; David W. Rattner, MD; Ernst Klar, MD; Andrew L. Warshaw, MD

Arch Surg. 1994;129(10):1081-1085.

Abstract
Objective
To evaluate the factors thought to be involved in the pathogenesis of acute pancreatitis associated with alcohol.

Background
The mechanism of alcohol-induced pancreatitis is believed to involve synergistic effects of various pathogenetic factors. The present study was designed to evaluate the possible contribution of pancreatic duct obstruction, physiologic exocrine stimulation, or secretory hyperstimulation to alcohol-induced pancreatic injury.

Methods
Wistar rats were allocated randomly to a control group (group 1), or to a group with pancreatic duct obstruction (group 2), physiologic exocrine stimulation (group 3), ductal obstruction and exocrine stimulation (group 4), or exocrine hyperstimulation with the cholecystokinin analogue cerulein (group 5). Three hours after this pretreatment, animals in each experimental group were randomly divided into two subgroups for intragastric administration of either water (groups 1A through 5A) or beer (groups 1B through 5B). Test solutions were instilled over 9 hours (total amount of alcohol administered, 4.8 g/kg). Twenty-four hours after beginning the test infusion, animals were killed for histologic evaluation of pancreatic edema and determination of an acinar cell necrosis score. Serum amylase levels were determined at 3, 9, and 24 hours.

Results
No increase in amylase levels or significant morphologic changes were found in control animals (group 1A) or in animals subjected to physiologic exocrine stimulation (group 2A). Pancreatic duct obstruction, with or without physiologic exocrine hyperstimulation (groups 3A and 4A), and exocrine hyperstimulation (group 5A) induced pancreatitis of similar severity with minor acinar cell damage. Alcohol superimposed on exocrine hyperstimulation (group 5B) increased acinar cell injury (group 5A, 0.4±0.1 points vs 5B, 1.0±0.2 points; P<.05) and serum amylase levels at 24 hours (group 5a, 41±6 U/L vs group 5B, 72±11 U/L; P<.05), whereas no differences between subgroups A and B (water vs beer) were found in groups 1 through 4.

Conclusion
Our findings suggest that the pathogenesis of acute alcoholic pancreatitis may require a state of exocrine hyperstimulation, perhaps via cholecystokinin, but do not support a role for constriction or obstruction of Oddi's sphincter.

(Arch Surg. 1994;129:1081-1085)

Author Affiliations
From the Departments of Surgery (Drs Foitzik, Fernández-del Castillo, Rattner, and Warshaw) and Pathology (Dr Lewandrowski), Massachusetts General Hospital and Harvard Medical School, Boston; and the Department of Surgery, University of Heidelberg, Germany (Dr Klar).

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