Drinkers In Danger Of Being Eaten By Their Own Enzymes
Sydney Morning Herald
Thursday March 24, 1994
HEAVY drinking can do the strangest things to a man. Apart from causing peculiar behavioural changes and a range at degenerative diseases, it can also make his pancreas eat itself. This can be extraordinarily painful.
The pancreas is a small gland which produces powerful enzymes used in the digestion of food. Through a complex process, alcohol allows these enzymes to turn on the pancreas itself and begin digesting it, as if it too were food.
Once started, this process becomes self-perpetuating and can lead to a lifetime of debilitating pain, sometimes so severe that the only remedy is for the man to become a registered narcotic addict to ensure he receives a regular supply of painkillers.
This kind of alcohol-induced chronic pancreatitis can change men's lives. It can turn gregarious men anti-social, transform men with wide interests into entirely disease-focused individuals, and it has been known to drive men to suicide.
While damage to the actual pancreatic tissue cannot be reversed, with treatment the cannibalising process can be arrested and further destruction prevented.
Although there are other causes of chronic pancreatitis, such as gall stones, pancreatic obstructions and hereditary factors, alcohol is by far the most common single cause in men.
Professor John Saunders, head of the Centre for Drug and Alcohol Studies at Royal Prince Alfred Hospital, says: "This condition occurs after years of unrelenting heavy drinking, of having about eight drinks a day for 10 or 20 years or more. "There is a considerable variation in susceptibility to the consequences of alcohol and this disease is not inevitable; however, the risk of it increases once consumption exceeds four drinks a day."
Professor Saunders says there are no reliable early warning signs for chronic pancreatitis and that, as a disease, it has a reputation for being difficult to treat.
Diseases such as this have caused a shift in the emphasis on treating alcoholism. Years ago efforts were concentrated on trying to cure these diseases. Now much energy is going into trying to prevent them developing.
He says that among people with this disease there is a high level of dependence on opiate drugs. The combination of this severe dependence and chronic pancreatitis can dominate or even destroy their lives.
Professor Miles Little, Professor of Surgery at the University of Sydney, says two-thirds of the cases of chronic pancreatitis in Australia are because of alcohol. In Sydney about 70 per cent of sufferers are male and the average at diagnosis is 47.
In western Sydney, about three people out of every 100,000 get it each year. This is fairly low compared with overseas. The disease is very difficult to diagnose.
Chronic pancreatitis may start dramatically with an abdomen so painful that the person requires hospitalisation. Although these attacks can be fatal, most men recover and many continue drinking.
Dr Harding Burns, medical director of the Specialist Advisory Services of NSW, says they continue because they are unable to break entrenched drinking patterns and may be alcohol dependent.
Although they have just experienced a violent attack and have been clearly warned about the consequences, they manage to block all this out.
"It seems to be a feature of alcohol-related problems that people deny the severity of them," Dr Burns says. "They rationalise, minimalise and medicalise the problem and say that if they really thought there was something wrong, they would do something about it."
A series of acute attacks can lead to the chronic, ongoing form of the disease.
The disease may also begin insidiously with the man losing condition, feeling unwell, experiencing vague indigestion, dyspepsia and abdominal pain which seems to travel through to the back. He may lose a lot of weight.
In its early stages, chronic pancreatitis may be mistaken for ulcers, irritable bowel syndrome, gall stones or chronic indigestion. When the pain becomes more severe doctors who are suspicious of the disease and know what to look for, find it.
Professor Little says diagnosis is complex and specialised and this may explain why the disease tends to be diagnosed so late.
The pain pattern is unpredictable but blood tests, x-rays, CAT scans, ultra-sound and endoscopic procedures may be used to reach a firm diagnosis.
Chronic pancreatitis does not occur in all men who drink excessively. A genetic predisposition to the disease must be present.
Professor Little says special pancreatic enzymes can be given to take the demand off the pancreas and the diabetes which often results from pancreas damage can be controlled.
If pain persists, nerves supplying the gland may be blocked off or a number of surgical procedures may be performed from operating on the main duct to removing the entire gland. These offer varying degrees of success.
"If we take a group of people with chronic pancreatitis and treat them as vigorously we can, at the end of the second year about 50 per cent will be better off and the other 50 per cent may be the same or worse," Professor Little says. "This is one of the most depressing conditions to look after."
© 1994 Sydney Morning Herald