Individual susceptibility to alcoholic pancreatitis: still an enigma

Evidence is increasing that individuals vary in their susceptibility to alcoholic pancreatitis. Numerous investigators have attempted to account for this individual susceptibility by studying associations between alcoholic pancreatitis and potential risk factors. Those studies, reviewed here, have focused on the amount, type, and pattern of alcohol consumption, genetic markers (such as blood groups, HLA phenotypes, alpha 1-antitrypsin, and alcohol dehydrogenase isoenzyme distribution), diet, hypertriglyceridemia, tobacco consumption, and pancreatic ischemia. Associations between pancreatitis and several of these factors have been reported, but many studies offer conflicting conclusions. A number of studies are difficult to interpret because of methodologic problems, particularly with regard to inadequate controls and small numbers of index subjects. At present, the evidence is insufficient for one to conclude that any of the above-mentioned factors are well-established risk factors for pancreatitis. As a result, individual susceptibility to alcoholic pancreatitis remains unexplained. Clarification of potential risk factors may ultimately lead to the ability to prevent this relatively common disorder, but additional, appropriately designed studies are required.