Reprinted from Eating Disorders Review
July/August 2008 Volume 19, Number 4
©2008 Gürze Books
When an otherwise healthy 25-year-old woman finally sought help for worsening epigastric pain radiating to her back, physicians discovered that she had a significant problem with alcohol, a history of restrictive type anorexia nervosa, and, finally, chronic pancreatitis (JOP. J Pancreas Online 2008; 9:327).
Malnutrition was the key to the diagnosis, according to Dr. Russell N. Wesson and colleagues at Chris Hani Baragwanath Hospital, Johannesburg, South Africa. As they recently reported, cases of acute pancreatitis have been documented with malnutrition seen in patients with anorexia nervosa, bulimia nervosa, and depression; pancreatitis has also been noted with refeeding of anorexic individuals. This patient’s lowest recorded body mass index was 12.5 mg/kg.
A history of alcoholism is found in from 70% to 80% of patients with pancreatitis. In this case, however, the patient’s history of malnutrition due to anorexia nervosa also played an important role in the development of pancreatitis. It is speculated that protein energy depletion may lead to acute and chronic pancreatitis through mechanisms such as oxidative damage in a system with poor antioxidant reserves, with damage affecting the cytokines interleukin 1 and 6 ( IL1, IL6) and tumor necrosis factor- alpha (TNF-alpha). This results in activation of pancreatic stellate cells with ongoing inflammation and fibrosis, and as a result, chronic pancreatitis.