Hypertriglyceridaemia and abnormalities of triglyceride catabolism persisting after pancreatitis

Thirty-three patients referred consecutively following an attack of pancreatitis at least six weeks earlier (acute pancreatitis in 10 patients and chronic pancreatitis in 23 patients) had an intravenous fat tolerance test to determine their capacity to catabolise circulating triglycerides. Hypertriglyceridaemia was present in 14 patients (42%), including 5 with acute pancreatitis and 9 with chronic pancreatitis. the highest serum triglyceride level was 6.2 mmol/l and none of the patients had chylomicronaemia at the time of examination. Four of the patients with hypertriglyceridaemia had impaired triglyceride clearance (29% of those with hypertriglyceridaemia, representing 12% of the patients as a whole). These four patients were indistinguishable from the others with hypertriglyceridaemia on clinical or routine biochemical grounds. Although triglyceride clearance in the other 10 patients with hypertriglyceridaemia was lower on average (P<0.04) than in the subgroup of patients with normal levels of serum triglycerides, the clearance values were within the normal range and did not correlate with the serum triglyceride levels. We conclude that an intravenous lipid tolerance test is a useful means of identifying patients with a defect in triglyceride catabolism, who might be vulnerable to a further attack of pancreatitis due to massive hypertriglyceridaemia in certain circumstances. In the majority of patients found to have hypertriglyceridaemia after an attack, the serum lipid disturbance is unlikely to be the direct cause of the attack, but may be an epiphenomenon of some process that is linked to acute and chronic pancreatitis.