Célio E. D Nogueira

Etiology of chronic calcifying pancreatitis in Brazil: a report of 329 consecutive cases.

SummaryThe authors observed 329 consecutive cases of chronic calcifying pancreatitis (CCP) from January 1963 to January 1986. Alcoholism was the etiological agent in 282 cases (86%). In 34 patients (10%) no cause was detectable (idiopathic). Malnutrition was responsible for 10 cases (3%) and chronic familial pancreatitis was diagnosed in 3 cases (0.9%). The mean age at the apparent onset of symptoms was 36.5 ± 10.5 for the alcoholics, 22.6 ± 15.4 in the idiopathic cases and 7.3 ± 3.0 for the nutritional etiology patients. Mean age differences are statistically significant for the 3 groups. Pancreatic calcifications were found in 224 alcohol-induced cases (79%), in 32 idiopathic cases (94%), in 8 patients with malnutrition (80%) and in one patient with familial pancreatitis (33%). All cases of nutritional etiology presented severe protein-caloric deficiences with edema, and none complained of pain, but 9 had pancreatic insufficiency. Mean daily ethanol intake for the alcohol-addicted patients was 396.6 ± 286 g (range 80–1664 g) with the onset of alcoholism at 19.1 ± 6.8 yr old and 20.8 ± 8.3 (4–44) yr of alcohol indulgence. Pancreatic carcinoma developed in 7 cases. Six cases of chronic pancreatitis were seen among relatives in the group with CCP of alcoholic etiology.

Immunological Participation in Chronic Calcifying Pancreatitis

Immunological studies performed in 12 patients with chronic calcifying pancreatitis show significant increase in serum concentrations of IgA and IgM. Presence of autoantibodies to smooth muscle, mitochondria, antinuclear, gastric parietal cells and IgG was not frequent. Immune complexes were detected in the sera of 11 patients. Normal numbers of B lymphocytes and a significant decrease in T-active and total T lymphocytes were observed in peripheral blood. These results suggest an immunologic participation in chronic calcifying pancreatitis and may explain the persistence and progressive nature of the disease.