Reversal of elevated pancreatic enzymes after Helicobacter pylori eradication

Chronic pancreatitis is a syndrome involving progressive inflammatory changes in the pancreas that result in permanent structural damage, and ultimately impairment of exocrine and endocrine function [1]. In the last 2 years we observed five patients referred for possible chronic pancreatitis based on moderately elevated levels of serum amylase and lipase and abnormal ultrasonographic imaging (Table 1). Family history of chronic pancreatitis (hereditary pancreatitis) was negative and none of the patients were receiving drugs known to cause pancreatic damage. Cessation of alcohol intake and small meals low in fat was the only treatment undertaken from the patients. All patients had active H. pylori infection, with a histological diagnosis of chronic active gastritis, without peptic ulcer disease. Eradication treatment was given with omeprazole, tetracycline-HCL, metronidazole and colloidal bismuth subcitrate taken with the midday and evening meals for 10 days [2]. C-Urea Breath test was repeated 4–6 weeks after the end of treatment and all patients resulted cured. Serum pancreatic amylase and lipase levels were re-evaluated after 3, 6 and 10–12 months in two different laboratories and resulted persistently normal (Table 1). A potential role of H. pylori infection in several extraintestinal pathologies has been suggested [3] and a link between gastric infection by H. pylori and autoimmune pancreatitis has been hypothesized [4]. Interestingly, in a recent study, Helicobacter DNA was detected in pancreas, including tumor tissue and surrounding pancreas of 75% of patients with pancreatic cancer, and 60% of patients with chronic pancreatitis, suggesting a possible role of H. pylori in the development of chronic pancreatitis and pancreatic