title: Is alcoholic pancreatitis associated with enteroviral infection?
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  The rate of enteroviral infection is not increased in patients with alcohol-induced acute pancreatitis when compared to alcoholics with similar high alcohol use.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33521 Tampere, Finland.
authors.forename: Jahangir
authors.initials: J
authors.lastname: Khan
authors.forename: Isto
authors.initials: I
authors.lastname: Nordback
authors.forename: Hanna
authors.initials: H
authors.lastname: Seppänen
authors.forename: Riitta
authors.initials: R
authors.lastname: Lappalainen-Lehto
authors.forename: Satu
authors.initials: S
authors.lastname: Järvinen
authors.forename: Sami
authors.initials: S
authors.lastname: Oikarinen
authors.forename: Sisko
authors.initials: S
authors.lastname: Tauriainen
authors.forename: Sari
authors.initials: S
authors.lastname: Räty
authors.forename: Heikki
authors.initials: H
authors.lastname: Hyöty
authors.forename: Juhani
authors.initials: J
authors.lastname: Sand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000097:blood / Q000453:epidemiology*; D000914:Antibodies, Viral / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D004198:Disease Susceptibility / Q000097:blood / Q000453:epidemiology*; D004770:Enterovirus / Q000235:genetics / Q000276:immunology; D004769:Enterovirus Infections / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism / Q000473:pathology; D019512:Pancreatitis, Alcoholic / Q000097:blood / Q000453:epidemiology*; D012367:RNA, Viral / Q000378:metabolism; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral
keywords: Acute necrotizing; Alcoholic; Enterovirus; Pancreatitis