Factors contributing to infectious diarrhea-associated pancreatic enzyme alterations.
OBJECTIVE
Several pathogens have been involved as etiologic agents of acute pancreatitis. We studied 59 patients presenting acute infectious diarrhea in order to determine the incidence as well as to identify factors which may contribute to the occurrence of pancreatic enzyme alteration or true acute pancreatitis.


METHODS
Patients were evaluated for serum lipase and amylase, and 24-hours urinary amylase. Clinical and biological parameters were noted. Abdominal sonography and rectosigmoidoscopy were performed.


RESULTS
Pancreatic enzyme alteration was found in 24% of patients. Twelve had salmonellosis and 2 Campylobacter jejuni infection. They had more prolonged diarrhea, more frequent renal impairment and increased triglyceridemia. Triglyceridemia was correlated to blood amylase, inflammatory syndrome and renal impairment. Serum amylase was linked to serum urea and creatinine and to biological markers of inflammation. Three patients had true acute pancreatitis.


CONCLUSIONS
Patients presenting dysentery-like infectious diarrhea and upper abdominal pain should be investigated for concomitant pancreatic reaction or acute pancreatitis which seems more frequent in patients with enterocolitis due to enteroinvasive microbes, mostly non-typhoidal Salmonella. Pancreatic disturbances are related to the severity of these infections. However, overt infectious diarrhea-associated pancreatitis is a rare event.
Reimund
Jean-Marie
JM
Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex. reimund-jm@chu-caen.fr
Muller
Christian D
CD
Finck
Grégory
G
Escalin
Guy
G
Duclos
Bernard
B
Baumann
René
R
D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood / Q000652:urine; D015415:Biomarkers / Q000032:analysis; D002169:Campylobacter Infections / Q000175:diagnosis*; D016123:Campylobacter jejuni / Q000302:isolation & purification; D003404:Creatinine / Q000097:blood; D003967:Diarrhea / Q000382:microbiology*; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007674:Kidney Diseases / Q000209:etiology; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000201:enzymology*; D010195:Pancreatitis / Q000175:diagnosis / Q000382:microbiology*; D011446:Prospective Studies; D012480:Salmonella Infections / Q000175:diagnosis*; D014280:Triglycerides / Q000097:blood; D014508:Urea / Q000097:blood
D015415:Biomarkers; D007375:Interleukin-1; D015850:Interleukin-6; D014280:Triglycerides; D014508:Urea; D003404:Creatinine; D008049:Lipase; D000681:Amylases