Sulfur amino acid metabolism in chronic relapsing pancreatitis

Sulfur amino acid (SAA) metabolism was studied in patients with chronic relapsing pancreatitis (CRP) before and during treatment and compared with results from patients with uncomplicated cholelithiasis, before and after surgery, receiving an identical nutritional support. CRP resulted in decreased total sulfur and inorganic sulfate excretions. Although the nutritional therapy per se accentuated these results, a reduced ability to convert SAAs to inorganic sulfate was seen during the whole investigation. Initially, CRP patients showed a raised serum concentration of inorganic sulfate, implicating an altered renal handling of the compound. Increased outputs of SAAs, N-acetylcysteine and mercaptolactate were seen in CRP patients parallel to a raised leukocyte methionine level, probably a consequence of the catabolic state and a limited utilization of SAAs. During therapy a normalization was achieved. Reduced total and free glutathione concentrations in leukocytes were found in CRP, and it was more pronounced for the free form. This result could be due to a reduced synthesis and increased intracellular oxidation of glutathione as a result of the decrease in ethanol.