Occupational chemicals and pancreatitis: a link?

The rising trend of idiopathic pancreatitis, and our demonstration that cytochromes P450 are 'induced' in most patients, prompted a search for enzyme inducers in their work environments. The findings in 19 patients (chronic pancreatitis 15, acute pancreatitis 4) are described. In the initial series of 12 consecutive patients with idiopathic pancreatitis, the enquiry revealed regular exposure to diesel exhaust fumes in 6 patients (of whom one had also been exposed to ozone and metal oxides), perchloroethylene or trichloroethylene in 3, paint solvents in a further 3. A second series included the next 7 patients with pancreatitis who drank alcohol on a daily basis for several years before their first symptom, but whose attacks continued although they had become, and remained, teetotal: their current occupations involved regular exposure to diesel exhaust fumes in 5 patients, to paint solvents in 1, and to trichloroethylene in 1. The wide variation in the duration of exposure before the first symptom, 2-21 yr, may reflect the net effect on cytochromes P450 of other xenobiotics (e.g. alcohol, cigarettes, caffeine). In several patients, symptoms stopped on removal from exposure to volatile chemicals but recurred on re-exposure. These preliminary findings suggest that occupational exposure to aromatic or chlorinated hydrocarbons may be relevant not only in idiopathic pancreatitis but also in alcohol-related pancreatic disease.