Cholestasis in alcoholic chronic pancreatitis. Diagnostic value of the transaminase ratio for differentiation between extra- and intra-hepatic cholestasis.

In our long-term study of alcoholic chronic pancreatitis (median follow-up time, 10.4 years) 84 of 173 patients (48.6%) developed transient or persistent cholestasis with or without hyperbilirubinemia. We studied the discriminative value of the ASAT/ALAT ratio to differentiate intrahepatic (IHC) and extrahepatic cholestasis (EHC; due to stenosis of the distal common bile duct) in 75 of these patients. In 45 patients with persistent or recurrent cholestasis (group A) the cause of cholestasis was documented by accurate morphological methods. Thirty of the other 39 patients with transient cholestasis (group B) were classified on the basis of the overall clinical evaluation. Of 37 patients with IHC 36 had an ASAT/ALAT ratio of 1.5 or higher (one patient had normal values for both transaminases). Out of 38 patients classified as EHC 29 had an ASAT/ALAT ratio of 1.4 or lower (9 with normal transaminases being excluded). One patient with cholangitis secondary to EHC had a transient elevation of the ASAT/ALAT ratio to above 2.5. Thus our data suggest that in alcoholic chronic pancreatitis associated with cholestasis an ASAT/ALAT ratio of 1.4 or lower (or normal transaminases) usually indicates EHC. Diagnostic study and surgical decompression is mandatory in these cases if EHC persists.