Disproportionate steatorrhoea in alcohol-induced calcific pancreatitis

The pancreatograms, as assessed by endoscopic retrograde cholangiopancreatography, of 51 patients with alcohol-induced calcific pancreatitis (AICP), were compared after division of the patients into three groups according to their insufficiency patterns. The first group, consisting of 18 patients, was labelled as having 'disproportionate steatorrhoea' characterized either by overt steatorrhoea and mild or no diabetes or by mild steatorrhoea and a normal glucose tolerance test result. The second group of 15 patients had severe diabetes associated with overt, mild or no steatorrhoea and constituted the 'insufficiency' group. The third group consisted of 18 patients with little or no pancreatic insufficiency. Twelve of the 18 patients with disproportionate steatorrhoea had a proximal complete or incomplete obstruction of their main pancreatic ducts, compared with 3 out of 15 in the insufficiency group and 4 out of 18 in the group with little or no pancreatic insufficiency. In this study an increased incidence of complete or incomplete obstruction (P less than 0,002) was found in the patients with disproportionate steatorrhoea compared with the other two groups. This suggests that obstruction to pancreatic flow may account for the dominant clinical presentation of steatorrhoea in some patients with AICP.