Following an initial hospitalization for acute alcohol-associated pancreatitis, repeated visits to an outpatient gastrointestinal clinic for brief motivational alcohol counseling sessions more effectively reduces further episodes than does a single standardized anti-alcohol message delivered to the patient at hospital discharge, a study from Finland shows.
"The fact that recurrent acute pancreatitis during the first few years after the first episode of alcohol-associated acute pancreatitis is still a major problem speaks for the need of improved methods," Dr. Isto Nordback and colleagues from Tampere University Hospital note in the current issue of Gastroenterology.
The investigators randomly assigned 120 patients with a first episode of alcohol-associated acute pancreatitis to repeated anti-alcohol conversations or a one-time only conversation (comparison group.) A registered nurse delivered the initial 30-minute anti-alcohol message in both groups before discharge, and then repeated it in the test group at 6-month intervals during scheduled outpatient clinic visits.
Three key messages were imparted during these conversations: alcohol is toxic to the pancreas; a change in drinking habits is needed, and it is the patient's responsibility to change. The social and economic problems that can result from drinking were also stressed.
The repeated anti-alcohol intervention, which is "easily adaptable to clinical practice," Nordback and colleagues say, led to a decrease in recurrent bouts of acute pancreatitis.
During a 2-year follow up period, there were 9 recurrent acute pancreatitis episodes in 5 patients in the repeated-intervention arm compared with 20 episodes in 13 patients in the comparison group, they found.
During the first 6 months, recurrence rates were similar in both intervention groups (4 vs 5 episodes), after which the repeated-intervention group had fewer recurrences than the comparison group (5 vs 15 episodes).
In addition, among 84 patients interviewed at 2 years — 39 in the repeated-intervention arm and 45 in the comparison group — significantly more patients in the repeated-intervention arm than the control arm had a "clear reduction" in dependency on alcohol, based on scores on the Short Alcohol Dependency Data questionnaire.
"Often medical attention focuses on the physical consequences of chronic alcohol intake and neglects the fundamental disease of alcohol dependence," note the authors of an accompanying editorial. Dr. Manfred V. Singer and co-authors at University of Heidelberg, Mannheim, Germany,
The current study, by Singer et al., "is remarkable because it is one of the few scientific investigations in internal medicine and gastroenterology that targets both the underlying alcohol abuse and the alcohol-associated disease."
"Treating alcohol dependency is an act of humanity as well as of economic necessity," they conclude. "Even if the course of alcoholic pancreatitis cannot be definitely changed, the diminution of alcohol intake serves additional goals such as risk reduction regarding other alcohol-related...disorders, increase in social functioning, psychic stabilization, and enhancement of quality of life."
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