Brief Article
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World J Gastroenterol. Jun 28, 2013; 19(24): 3819-3823
Published online Jun 28, 2013. doi: 10.3748/wjg.v19.i24.3819
Is alcoholic pancreatitis associated with enteroviral infection?
Jahangir Khan, Isto Nordback, Hanna Seppänen, Riitta Lappalainen-Lehto, Satu Järvinen, Sami Oikarinen, Sisko Tauriainen, Sari Räty, Heikki Hyöty, Juhani Sand
Jahangir Khan, Isto Nordback, Hanna Seppänen, Riitta Lappalainen-Lehto, Satu Järvinen, Sari Räty, Juhani Sand, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33521 Tampere, Finland
Sami Oikarinen, Sisko Tauriainen, Heikki Hyöty, Department of Virology, School of Medicine, University of Tampere, 33014 Tampere, Finland
Heikki Hyöty, Department of Microbiology, Center of Laboratory Medicine, Tampere University Hospital, 33521 Tampere, Finland
Author contributions: Räty S, Seppänen H, Lappalainen-Lehto R and Järvinen S recruited the patient and control material and contributed to the design of the study; Oikarinen S and Tauriainen S performed the enteroviral analysis and contributed to the analysis of the data; Khan J analyzed the data; Khan J, Nordback I, Hyöty H and Sand J wrote the paper and designed the study.
Correspondence to: Juhani Sand, MD, PhD, Director, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, PO Box 2000, 33521 Tampere, Finland. juhani.sand@pshp.fi
Telephone: +358-3-31166375 Fax: +358-3-31164358
Received: April 24, 2012
Revised: September 29, 2012
Accepted: October 30, 2012
Published online: June 28, 2013
Abstract

AIM: To investigate whether enteroviral infection might trigger acute pancreatitis in patients made susceptible due to high alcohol consumption.

METHODS: Patients with alcohol-induced acute pancreatitis were analyzed for signs of simultaneous or preceding enteroviral infection. We studied the serum samples of 40 patients hospitalized for alcohol-induced acute pancreatitis and 40 controls recruited from an alcohol detoxification center. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect enterovirus RNA and diagnose acute viremia. Immunoglobulin G (IgG), immunoglobulin A (IgA) and immunoglobulin M (IgM) enteroviral antibodies were measured using enzyme immunoassay to detect subacute and previous infections. The samples were considered positive when the antibody titers were ≥ 15 IU. Furthermore, using RT-PCR, we studied pancreatic biopsy samples obtained during surgery from nine patients with chronic pancreatitis, one patient with acute pancreatitis and ten control patients with pancreatic carcinoma for evidence of persisting enteroviral RNA in the pancreatic tissue.

RESULTS: No enterovirus RNA indicating acute viremia was detected by RT-PCR in the serum samples of any patient or control. A high incidence of positive antibody titers was observed in both study groups: IgM antibodies had positive titers in 5/40 (13%) vs 4/40 (10%), P = 0.723; IgG in 15/40 (38%) vs 19/40 (48%), P = 0.366; and IgA in 25/40 (63%) vs 33/40 (83%), P = 0.045, patients and controls, respectively. Ten (25%) patients had severe pancreatitis and two (5%) required treatment in intensive care. The median length of hospitalization was 7 d (range: 3-47 d). The severity of acute pancreatitis or the length of hospitalization was not associated with enteroviral IgM, IgG or IgA antibodies. Five pancreatic biopsy samples tested positive with RT-PCR, three (8%) in the control group and two (5%) in the patient group (P = 0.64).

CONCLUSION: The rate of enteroviral infection is not increased in patients with alcohol-induced acute pancreatitis when compared to alcoholics with similar high alcohol use.

Keywords: Pancreatitis; Alcoholic; Pancreatitis; Acute necrotizing; Enterovirus