The incidence of acute pancreatitis did not rise during or immediately after "the world’s largest beer fair," Oktoberfest in Munich, even though an estimated 6.6 million liters of beer were consumed there in only 16 days, Dr. Veit Phillip and his colleagues reported in the November issue of Clinical Gastroenterology and Hepatology.
This unexpected result indicates that "acute attacks of alcoholic pancreatitis seem to be associated with long-term, heavy alcohol exposure rather than short-term, excessive alcohol drinking," the investigators wrote (Clin. Gastroenterol. Hepatol. 2011 [doi: 10.1016/j.cgh.2011.07.022]).
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The consumption of 6.6 million liters of beer over the 16 days of Oktoberfest did not result in increased acute attacks of alcoholic pancreatitis.
Noting that "little is known about the impact of short-term aggravation of alcohol consumption on the incidence of pancreatitis," Dr. Phillip and his associates assessed the affects of Oktoberfest by studying consecutive patients admitted to 27 of the 31 hospitals in the Munich area with acute pancreatitis during the celebration and during two control periods in 2008.
The more than 6 million L of beer imbibed between Sept. 20 and Oct. 5 at Oktoberfest that year contained 340 million g pure alcohol. Hospital admissions for acute pancreatitis from Sept. 20 through Oct. 7 were compared with those from the 18-day interval immediately preceding the study period and the 18-day interval immediately following it. Each period included 6 weekend days.
A total of 91% of the admitted patients were permanent residents of the Munich area rather than visitors. A total of 188 patients were admitted for acute pancreatitis during all 54 days of observation, for an overall incidence of 42.8/100,000 person-years.
This rate is 117% higher than the rate reported for another region of Germany in an earlier study. "Because our data are the first to be analyzed from this population, we do not know if there has been an increase [in acute pancreatitis] over the last few years," or if the discrepancy is due to different drinking habits between the two regions, said Dr. Phillip of Technische Universität München and his colleagues.
The incidence of acute pancreatitis admissions was not significantly different between Oktoberfest (42.3/100,000 person-years) and the two control periods (43.0/100,000 person-years).
In fact, slightly more cases developed during the first control period (37.2% of all cases) than during Oktoberfest (33.0%) or the second control period (29.8%). This may be because the first control period coincided with the end of the summer holidays in that region, the researchers said.
Alcohol was listed as the most common etiology for acute pancreatitis (36.7% of cases), including 15 cases of acute alcohol-induced attacks in patients who had longstanding chronic pancreatitis. A biliary etiology also was common (34.6% of cases).
Less common were post-ERCP [endoscopic retrograde cholangiopancreatography] pancreatitis (3.2%) and postsurgical pancreatitis (2.7%). Drug toxicity was cited as the etiology in 4.3% of cases, and was attributed to NSAIDs (four cases), azathioprine (two cases), 5-aminosalicylic acid (one case), and vinorelbine (one case).
"The Oktoberfest resulted neither in a significant increase in the absolute number of alcohol-induced acute pancreatitis [cases], nor in the percentage of alcohol-induced pancreatitis [cases], compared to other etiologies," Dr. Phillip and his associates said.
In an analysis of risk factors for admission with alcohol-induced acute pancreatitis, neither attendance at Oktoberfest nor hospitalization during the Oktoberfest period were significant predictors. In contrast, chronic alcohol intake, chronic nicotine intake, and number of previous episodes of pancreatitis all were predictive.
Forty of the 188 cases of acute pancreatitis in this study required intensive care, and five patients (2.7%) died during hospitalization. Overall, the mean duration of hospital stay was 12.3 days.
This study was not supported by any industry or other grants, and no financial conflicts of interest were reported for any of the authors.