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Minerva Medica 2019 October;110(5):425-38

DOI: 10.23736/S0026-4806.19.06043-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Alcohol-related chronic exocrine pancreatic insufficiency: diagnosis and therapeutic management. A proposal for treatment by the Italian Association for the Study of the Pancreas (AISP) and the Italian Society of Alcohology (SIA)

Raffaele PEZZILLI 1, 2 , Fabio CAPUTO 3, 4, Gianni TESTINO 5, Valentino PATUSSI 6, Giovanni GRECO 7, Livia MACCIÒ 8, Maria Raffaella ROSSIN 9, Davide MIONI 10, Patrizia BALBINOT 5, Claudia GANDIN 11, Francesca ZANESINI 12, Luca FRULLONI 13, Sarino ARICÒ 14, Luigi C. BOTTARO 15, Rinaldo PELLICANO 16, Emanuele SCAFATO 11, the Italian Society of Alcohology (SIA) 

1 Pancreas Unit, Department of Gastroenterology, Polyclinic of Sant’Orsola, Bologna, Italy; 2 Italian Association for the Study of the Pancreas, Rome, Italy; 3 Department of Internal Medicine, SS. Annunziata Hospital, Cento, Ferrara, Italy; 4 G. Fontana Center for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; 5 Regional Alcohol Center of Liguria Region, ASL3, San Martino Hospital, Genoa, Italy; 6 Department of Alcohology, Hospital of Florence, Florence, Italy; 7 Department of Mental Health and Pathological Dependency, AUSL Romagna, SerT Ravenna, Ravenna, Italy; 8 Alcohol Unit, ASL2 Savonese, Savona, Italy; 9 ASST Fatebenefratelli, Sacco Hospital, Milan, Italy; 10 Casa di Cura Parco dei Tigli, Villa Di Teolo, Padua, Italy; 11 National Observatory on Alcohol, National Institute of Health, Rome, Italy; 12 Private Practitioner, Genoa, Italy; 13 Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy; 14 Unit of Gastroenterology, Mauriziano Hospital, Turin, Italy; 15 ASL 3 Genovese, Genoa, Italy; 16 Unit of Gastroenterology, Molinette Hospital, Turin, Italy



Current estimates of the prevalence of chronic pancreatitis, one of the most common causes of exocrine pancreatic insufficiency, are in the range of 3-10 per 100,000 people in many parts of the world. Alcohol consumption is a very important risk factor for exocrine pancreatic insufficiency and is involved in nearly half of all cases. The main hypothesis regarding the role of chronic alcohol consumption in pancreatitis is that there must be additional environmental or genetic risk factors involved for ongoing damage to occur. Treatment of patients with alcohol-related exocrine pancreatic insufficiency is complex, as the patient has two concomitant pathologies, alcohol-use disorder (AUD) and exocrine pancreatic insufficiency/chronic pancreatitis. Alcohol abstinence is the starting point for treatment, although even this along with the most advanced therapies allow only a slowdown in progression rather than restoration of function. This position paper of the Italian Association for the Study of the Pancreas and the Italian Society of Alcohology provides an overview of the pathogenesis of alcohol-related pancreatitis and discuss diagnostic issues. Treatment options for both exocrine pancreatic insufficiency/chronic pancreatitis (with a focus on pancreatic enzyme replacement therapy) and AUD (acamprosate, disulfiram, oral naltrexone, long-acting injectable naltrexone, sodium oxybate, nalmefene, baclofen, and psychosocial interventions) are also reviewed.


KEY WORDS: Alcohol-induced disorders; Chronic pancreatitis; Alcoholic pancreatitis; Exocrine pancreatic insufficiency; Alcoholism

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