Pancreatic Fibrosis (Early Chronic Pancreatitis) as Emerging Diagnosis in Structural Causes of Dyspepsia: Evidence from Endoscopic Ultrasonography and Shear Wave Elastography.

Chung-Tsui Huang,Cheng-Kuan Lin,Yao-Jen Liang,Yi-Feng Yang,Tzong-Hsi Lee,Chao-Yi Chen

doi:10.3390/diagnostics11071252

Chung-Tsui Huang, Cheng-Kuan Lin + Show 4 more

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https://doi.org/10.3390/diagnostics11071252

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Abstract

A new concept for the diagnosis and management of non-functional dyspepsia in guidelines was lacking in the past decade. Medical advancement has proven pancreatic fibrosis (essential image evidence of early chronic pancreatitis) to be a cause of dyspepsia and related to pancreatic exocrine dysfunction. This study aimed to analyze the clinical picture, biomarker, and percentage of pancreatic fibrosis in the dyspeptic population. A total of 141 consecutive patients were retrospectively enrolled. They were diagnosed with peptic ulcer disease, 9.2% (n = 13); pancreatic fibrosis, 17% (n = 24); pure Helicobacter pylori infection, 19.9% (n = 28); functional dyspepsia, 53.2% (n = 75); and chronic pancreatitis, 0.7% (n = 1). Among those with pancreatic fibrosis, (n = 24), 11 were diagnosed on the basis of a pancreatic acoustic radiation force impulse exceeding 1.4 m/s, and the remaining 13 were diagnosed with early chronic pancreatitis with at least three of the Japanese endoscopic ultrasonography criteria. The anatomic distribution of parenchymal criteria of early chronic pancreatitis was head, 53%; body, 38%; and tail, 9%. There were 17 cases (71%, 17/24) without Helicobacter pylori and whose dyspepsia improved after pancreatic enzyme replacement with a ratio of 82.3% (14/17). Of the 141 cases, 19 received gastric emptying scintigraphy and Western blot analysis of chromogranin-A in duodenal mucosa. Delayed gastric emptying was more common in functional dyspepsia and chromogranin-A was expressed more in pancreatic fibrosis. In conclusion, pancreatic fibrosis (including early chronic pancreatitis) outnumbered peptic ulcer disease in the dyspeptic population and pancreatic enzyme therapy was effective for 82% of cases. In early chronic pancreatitis, pancreatic fibrosis is dominant in the head location, and duodenum mucosa chromogranin-A is a potential biomarker with increased expression in an age-matched manner.

Highlights

Among the 141 enrolled patients, 13 had endoscopic ultrasonography (EUS)-diagnosed early chronic pancreatitis, 11 had pancreatic fibrosis diagnosed by pancreatic ARFI > 1.4 m/s, and 1 had typical sonographic findings of chronic calcified pancreatitis
In the pancreatic fibrosis subgroup (n = 24), the risk factors included alcoholic drinking, smoking, hyper-triglyceridemia with history of acute pancreatitis, type 2 diabetes mellitus, and gallstones [23]; only three cases were without an overt risk factor
In this this study study on on the the dyspeptic dyspeptic population, population, early early chronic chronic pancreatitis pancreatitis was was defined as pathologically pathologically equivalent equivalent to to pancreatic pancreatic fibrosis

Summary

Introduction

Dyspepsia refers to upper abdomen discomfort or indigestion with a prevalence in approximately 20% of the general population [1,2]. It can be etiologically categorized as functional or organic, and around 20% of all causes are attributable to the structural pathogenesis of digestive organs [1,3]. According to Rome IV criteria, there are two types of dyspeptic symptoms: epigastric pain syndrome and postprandial distress syndrome [4]. Peptic ulcer disease is traditionally regarded as a leading cause of organic dyspepsia [1,5]

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