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Types of alcohol in relation to acute pancreatitis
Azodi OS, Orsini N, Andrén-Sandberg Å, Wolk A.  Effect of type of alcoholic beverage in causing acute pancreatitis.  Brit J Surgery 2011;DOI: 10.1002/bjs.7632.
Authors’ Abstract
Background:  The effect of different alcoholic beverages and drinking behaviour on the risk of acute pancreatitis has rarely been studied. The aim of this study was to investigate the effect of different types of alcoholic beverage in causing acute pancreatitis.
Methods:  A follow-up study was conducted, using the Swedish Mammography Cohort and Cohort of Swedish Men, to study the association between consumption of spirits, wine and beer and the risk of acute pancreatitis. No patient with a history of chronic pancreatitis was included and those who developed pancreatic cancer during follow-up were excluded. Multivariable Cox proportional hazards models were used to estimate rate ratios.
Results:  In total, 84,601 individuals, aged 46-84 years, were followed for a median of 10 years, of whom 513 developed acute pancreatitis.  There was a dose–response association between the amount of spirits consumed on a single occasion and the risk of acute pancreatitis.  After multivariable adjustments, there was a 52 per cent (risk ratio 1·52, 95 per cent confidence interval 1·12 to 2·06) increased risk of acute pancreatitis for every increment of five standard drinks of spirits consumed on a single occasion.  The association weakened slightly when those with gallstone-related pancreatitis were excluded.  There was no association between consumption of wine or beer, frequency of alcoholic beverage consumption including spirits, or average total monthly consumption of alcohol (ethanol) and the risk of acute pancreatitis.
Conclusion:  The risk of acute pancreatitis was associated with the amount of spirits consumed on a single occasion but not with wine or beer consumption.
Forum Summary
A very well-done analysis from scientists in Sweden has related the type of alcoholic beverage, and the amount consumed per occasion, to the risk of acute pancreatitis.  The study suggests that a greater number of drinks per occasion (“binge drinking”) of spirits increases the risk of acute pancreatitis, but no such relation was seen for the consumption of beer or wine.  Forum reviewers suggested that a faster rate of drinking, with a greater rise in BAC, for spirits drinkers may be an important factor in the observed higher risk of pancreatitis; the increased risk may not necessarily be due to lower levels of antioxidants or to the presence of other toxic substances in spirits.
In any case, the average total alcohol consumption did not affect the risk of pancreatitis; instead, it was the number of drinks consumed per occasion (of spirits, in this study) that was associated with an increase in risk.  Residual confounding by the pattern of drinking, diet, or by other lifestyle factors could still be operating, and it will require replication of these results in other studies to support the conclusions of the authors.
For the full critique of this paper by members of the International Scientific Forum on Alcohol Research, visit www.bu.edu/alcohol-forum/critique-051-types-of-alcohol-in-relation-to-acute-pancreatitis-11-august-2011/
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