The Role of Essential Amino Acids, Micronutrients and Antioxidant Status in Alcoholic and Tropical Chronic Pancreatitis

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This investigation was undertaken to examine the role of essential amino acids, micronutrients and antioxidant status in alcoholic and tropical chronic pancreatitis and to compare with healthy controls. A further goal is to estimate serum rhodanese, thiocyanate and urinary inorganic sulfate/cratinine ratio as a measure of detoxification of cyanogens.
Chronic pancreatitis is an inflammatory disease associated with irreversible exocrine insufficiency, which in due course may cause fibrosis and diabetes mellitus and with significantly increased risk of developing pancreatic cancer.
• History
Chronic pancreatitis has been on the clinical map for more than 200 years. In 1788 Cawley (Cawley T, 1788) described a patient with calcific chronic pancreatitis. The classification of chronic pancreatitis as a separate disease was reported in 1946 by Comfort et al (Comfort M et al, 1946) published their work on “chronic relapsing pancreatitis” and provided for the first time a thorough analysis of its clinical features, etiological factors, and pathology.
In 1878 Friedreich (Friedreich N et al, 1878) described pancreatitis in relation with alcohol. More than 100 years ago, it was proposed that pancreatitis is essentially a disease in which the pancreas is auto-digested.

• Prevalence and epidemiology
The prevalence of chronic pancreatitis in autopsy materials ranges from 0.04 to 5 % (Sarles H, 1973; Skyhoj Olsen T, 1978). Epidemiologic studies based on clinical data are few. The prospective study conducted on the incidence and prevalence of chronic pancreatitis in Copenhangen, Denmark in 1978 to 1979 showed 8.2 new cases /100,000 inhabitants /year and a prevalence of 26.4 cases/ 100,000 inhabitants (Copenhagen Pancreatic Study, 1981)...

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... acinar atrophy.
In 1983, the Cambridge classification (Sarner M et al, 1984) depicted broad-based subsets of chronic pancreatitis by considering new imaging and function tests and described as chronic pancreatitis, chronic calcific pancreatitis, and chronic obstructive pancreatitis. The Japan pancreatic society classification for chronic pancreatitis (1997) attempted to standardize diagnostic elements, but etiologic and pathogenic features were not included (Homma T et al, 1997). In the year 2001, mid-west multi center pancreatic study group drafted a new classification system (i.e. TIGAR-O) (Table-4.3) to categorize risk factors for CP according to mechanism and prevalence. This system includes toxic metabolic risk, idiopathic, genetic risk, auto-immune associated risk, recurrent and severe acute pancreatitis, and obstructive pancreatitis (Etemad B et al, 2001).

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