JAHANGIR KHAN Infections and Lipids in Alcohol Induced Acute Pancreatitis

.................................................................................................................................. 5 TIIVISTELMÄ ............................................................................................................................. 7 LIST OF ORIGINAL COMMUNICATIONS .................................................................. 9 ABBREVIATIONS ................................................................................................................... 10 INTRODUCTION ................................................................................................................... 11 REVIEW OF THE LITERATURE ..................................................................................... 12 1 The human pancreas ....................................................................................................... 12 1.1 Basic anatomy and physiology of the human pancreas ............................... 12 1.2 Regulation of pancreatic function .................................................................. 13 2 Acute pancreatitis ............................................................................................................ 13 2.1 Etiology and epidemiology of acute pancreatitis .......................................... 14 2.2 Diagnosis of acute pancreatitis ......................................................................... 15 2.3 Pathophysiology ................................................................................................... 16 2.4 Premature trypsin activation ............................................................................. 16 2.5 Nuclear factor kappa-B activation .................................................................... 17 2.6 The inflammatory cascade in acute pancreatitis ........................................... 18 3 Alcohol induced acute pancreatitis .............................................................................. 18 3.1 Mechanisms of alcohol related pancreatic injury .......................................... 19 4 Acute gallstone pancreatitis .......................................................................................... 20 5 Post-ERCP acute pancreatitis ....................................................................................... 20 6 Hypertriglyceridemia-associated acute pancreatitis ................................................ 21 7 Hypercalcemia-associated acute pancreatitis ............................................................ 21 8 Infections as the cause of acute pancreatitis .............................................................. 22 8.1 Helicobacter pylori ............................................................................................. 22 8.2 Enteroviruses ....................................................................................................... 23 9 Other causes of acute pancreatitis ............................................................................... 24 10 Classifying and predicting the severity of acute pancreatitis ................................. 24 11 Alcohol and lipid metabolism ...................................................................................... 26 AIMS OF THE STUDY .......................................................................................................... 27 MATERIAL AND METHODS ........................................................................................... 28 1 Hypotheses and study setting ....................................................................................... 28 2 Recruitment of patients and controls ......................................................................... 29 3 Sample and data collection ............................................................................................ 30 4 Laboratory analysis .......................................................................................................... 31 5 Demographic data of patients and controls ............................................................... 32 6 Statistical testing ............................................................................................................. 32 7 Ethical aspects .................................................................................................................. 33 RESULTS ..................................................................................................................................... 34 1 The prevalence of Helicobacter pylori in patients with acute pancreatitis ......... 34 2 Helicobacter pylori and the severity of acute pancreatitis ...................................... 35 3 Enterovirus infections in acute pancreatitis .............................................................. 36 4 Serum fatty acid profile in acute pancreatitis ............................................................ 37 5 Serum lipids in acute pancreatitis ................................................................................ 38 DISCUSSION ............................................................................................................................. 40 1 Helicobacter pylori ......................................................................................................... 41 2 Enteroviruses .................................................................................................................... 41 3 Serum fatty acid profile .................................................................................................. 42 4 Serum lipids ...................................................................................................................... 43 5 Study strengths and limitations ................................................................................... 44 SUMMARY AND CONCLUSIONS .................................................................................. 45 ACKNOWLEDGEMENTS ................................................................................................... 46 REFERENCES ........................................................................................................................... 47 ORIGINAL COMMUNICATIONS .................................................................................. 63