Fecal Elastase-1 Test Research Articles

Diagnostic Transitions of Cystic Fibrosis and CRMS Compared After 12 Years of Newborn Screening in California

To compare the long-term diagnostic transitions for cystic fibrosis (CF) and CF-Related Metabolic Syndrome (CRMS) side-by-side during follow-up since the onset of newborn screening in California. Using real-world data, we conducted a retrospective cohort study to compare long-term observations of CRMS and CF in California and the diagnostic transitions from one to the other using clinical and diagnostic metrics. The California Genetic Disease Screening Program (GDSP) newborn screening for CF employs an immunoreactive trypsinogen tier-1 laboratory test, followed by molecular testing. This approach captures CF and CRMS, a diagnosis of "watchful waiting" among infants at risk for CF but with signs and symptoms that may emerge outside the screening window. Waiting entails periodic diagnostic reviews that can continue for many years; GDSP routinely conducts five years of follow-up for each child identified with a disorder. We utilized categorial logistic regression to compare the transitions with CRMS. After screening 5,944,700 newborns between July 2007 and July 2019, 694 CF cases and 1,258 CRMS cases were identified. Of the 1,258 CRMS cases, 66 (5.2%, 95% CI=3.9%,6.4%) transitioned from CRMS to CF (CRMS2CF) at a mean age of 3.3 years (median=2.9 years). CRMS2CF cases had longer follow-up periods and were more likely later to develop positive sweat chloride and fecal elastase test results after 6 months of life than other CRMS cases. These results suggest that children who have a CRMS2CF transition are more likely to develop positive biochemical markers than other CRMS patients and have few clinical indications during the first five years of follow-up.

Nutritional status in advanced pancreatic cancer

Background. Exocrine pancreatic insufficiency (EPI) occurs in most patients with advanced pancreatic cancer (PC) and even more often when a tumor is localized in the head of the pancreas. However, insufficient attention is paid to the diagnosis of EPI and assessment of nutritional status, which negatively affects the results of treatment.
 Materials and methods. One hundred fifty eight patients with primary diagnosed locally advanced and metastatic PC were included in the retrospective study. We used the calculation of the odds ratio with 95% CI with an assessment of the p value using the Pearson ÷2 test to compare the incidence of clinical and laboratory parameters of nutritional status with values below the lower limit of normal (LLN) depending on the location of the tumor in the pancreas.
 Results. Fecal elastase test was performed in only 19 (12%) patients. In this group, the incidence of EPI was 73.6%. Pancreatic enzyme replacement therapy in the minimal sufficient dose was prescribed in 17.1% of the general cohort. The level of hemoglobin, erythrocytes and albumin below the LLN was found in patients with the tumor in the pancreatic head, respectively, 2.742 (95% CI 1.27–5.92), 3.788 (95% CI 1.554–9.232) and 9.767 (95% CI 1.255–76.027) times more often than in patients with cancer in the body-tail of the pancreas. In patients with the tumor in the pancreatic head, the lower levels of hemoglobin (median 125 g/l vs 132 g/l, respectively), erythrocytes (4.19 mil/μl vs 4.51 mil/μl), total protein (69.6 g/l vs 71.5 g/l), and albumin (40.1 g/l vs 42 g/l), as well as the values of nutritional indices: prognostic nutritional index, nutritional risk index, hemoglobin, albumin, lymphocyte and platelet ratio index, and prognostic immune nutritional index were observed.
 Conclusion. Diagnosis and treatment of EPI remains inadequately attended. The values of nutritional status parameters in patients with PC in the head are lower than in patients with a tumor in the body-tail of the pancreas, which reflects the contribution of EPI.

Emerging trends in disturbed function of the pancreas and dyspepsia: an Indian perspective

Disturbed function of the pancreas, especially exocrine pancreatic insufficiency (EPI) results in inadequate synthesis or delivery of the pancreatic enzyme leading to maldigestion. Due to the lack of specific symptoms and overlapping manifestations of EPI, it often goes undiagnosed and untreated. Dyspepsia is another common condition characterized by upper gastrointestinal symptoms caused by a heterogeneous group of disorders. This consensus aims at providing a comprehensive overview of the diagnosis and management of disturbed function of the pancreas and dyspepsia. A total of 95 gastroenterologists participated in expert group meetings organized via virtual focus group discussions. Recent evidence elaborating various aspects like diagnosis and management of EPI and dyspepsia, including the use of pancreatic enzyme replacement therapy (PERT) and issues with compliance were discussed. The experts emphasized that clinical symptoms of maldigestion should not be ignored, and physicians should not wait to diagnose EPI until steatorrhea occurs. Fecal elastase (FE) test and imaging should be performed to confirm diagnosis. If EPI is diagnosed or the patient experiences weight loss or steatorrhea, PERT should be initiated while ensuring compliance. Reducing pill burden, active education, monitoring, and support from healthcare programs may help ensure compliance. EPI is also a cause of dyspepsia. Further, consuming lipid-rich foods worsens symptoms of dyspepsia. First-line treatment includes dietary changes and lifestyle modifications. Digestive enzyme supplements play a significant role in alleviating symptoms of indigestion. Routine enzyme supplementation is beneficial in managing dyspepsia caused by EPI, such as, in patients with EPI due to pancreatitis or diabetes.

Utilising Pancreatic Exocrine Insufficiency in the Detection of Resectable Pancreatic Ductal Adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed late, leading to a high mortality rate. Early detection facilitates better treatment options. The aim of this UK-based case-control study was to determine whether two validated tests for pancreatic exocrine insufficiency (PEI), namely, the 13C-mixed triglyceride breath test (13C-MTGBT) and a faecal elastase (FE-1) test, can discriminate between patients with resectable PDAC versus healthy volunteers (HVs) along with a comparison group with chronic pancreatitis (CP). Discrimination between disease states and HVs was tested with receiver operator characteristic (ROC) curves. In total, 59 participants (23 PDAC (16 men), 24 HVs (13 men) and 12 CP (10 men)) were recruited, with a similar age in each population, and a combined median (IQR) age of 66 (57-71). The areas under the ROC curve for discriminating between PDAC and HVs were 0.83 (95% CI: 0.70-0.96) for the 13C-MTGBT, and 0.85 (95% CI: 0.75-0.95) for the FE-1 test. These were similar to CP vs. HV. In conclusion, PEI occurs in resectable PDAC to a similar extent as in CP; further large-scale, prospective studies using these tests in the primary care setting on high-risk groups are warranted.

Diagnostic accuracy of faecal elastase-1 test for the diagnosis of pancreatic exocrine insufficiency: A systematic review and meta-analysis

Diagnostic accuracy of faecal elastase-1 test for the diagnosis of pancreatic exocrine insufficiency: A systematic review and meta-analysis

Diagnostic accuracy of faecal elastase-1 test for the diagnosis of pancreatic exocrine insufficiency: a systematic review and meta-analysis

Diagnostic accuracy of faecal elastase-1 test for the diagnosis of pancreatic exocrine insufficiency: a systematic review and meta-analysis

Atypical form of cystic fibrosis in early childhood

Introduction: Cystic fibrosis (CF) is an autosomal recessive genetic disorder, more prevalent in the Caucasian population. The disease is the result of mutations in a gene that codifies a chloride channel called CFTR (cystic fibrosis transmembrane conductance regulator) at affects most critically the lungs, pancreas, sweat glands and wolffian ducts. The variety of mutations in the CFTR gene is in some way responsible for the clinical variations by having and presentation in its atypical forms. Other factors, such as environmental factors and other genetic modifiers, affect the clinical variability of the disease. Aim: The purpose of the case presentation is to show that CF is also presented with unusual signs and symptoms of the disease, causing it to be diagnosed late in time. Case report: An 8 years old child A.D. admitted to the University Hospital Center of Tirana with a history of hypertransaminasemia, hypergammaglobulinemia and hepatomegaly which were found after a routine check. From the laboratory tests which were normal, causes such as: HIV, Viral Hepatitis, CMV infection, Toxoplasmosis and Rubeola are excluded as causes of increased transaminases and hepatomegaly. Antibodies for autoimmunity and liver-specific antibodies were normal, so autoimmune pathologies were excluded as their cause. Based on the history, the girl had repeated history of pulmonary infections, defecation with a heavy and greasy smell, poor weight gain, mother with a history of two spontaneous abortions, so the cystic fibrosis was suspected. Also, changes with an inflammatory aspect were found in chest radiography. Two sweat tests were performed, which were positive within a period of two weeks. The positive fecal elastase test confirmed pancreatic insufficiency. The child was started therapy with vitamine ADEK and ursodeoxycholic acid and an improvement was observed in the laboratory values ​​of the examinations. Conclusion: Continue neonatal screening for cystic fibrosis. Since we have cases with atypical clinical presentation that are diagnosed late in time when we have cases with hepatic manifestations and the child has a history of repeated respiratory infections, steatorrhea, poor weight gain according to age, a differential diagnosis of hepatic pathologies should be made with Cystic Fibrosis. Since hepatic involvement can be the first manifestation that leads to the diagnosis of cystic fibrosis in its atypical forms.

Dynamics of clinical manifestations, functional state and structural changes of the pancreas, quality of life of patients with chronic pancreatitis in combination with chronic obstructive pulmonary disease under the influence of eradication of the syndrome of excessive bacterial growth in the small intestine

The lack of efficiency in the diagnosis and treatment of chronic pancreatitis (CP) is associated with a number of objective and subjective reasons, one of which is insufficient knowledge about the pathogenesis of the disease, especially when it is combined with other internal diseases, in particular, with chronic obstructive pulmonary disease (COPD). The frequent combination of COPD and CP is associated not only with the frequency of these diseases, but also with the common links of pathogenesis, and a significant place in the pathogenesis of both diseases is occupied by the syndrome of excessive bacterial growth in the small intestine (SIBO). Aim: to increase the effectiveness of the treatment of CP in combination with COPD based on the inclusion of rifaximin and probiotic Subalin in the complex therapy of concomitant diseases. Materials and methods. We examined 128 patients with CP in the stage of exacerbation in combination with COPD in the stage of mild exacerbation, which were divided into two groups: the main group and the comparison group. The basic treatment of CP was carried out according to the clinical recommendations of the Russian Gastroenterological Association. Patients of the main group, in addition to basic therapy, received rifaximin (Alfa Normix) for 10 days, and then Subalin-forte for 2 weeks. Patients in the comparison group received only basic therapy. Results. Due to the treatment with the inclusion of rifaximin and Subalin, there is a significant suppression of the phenomenon of “evasion” of the pancreatic-specific enzyme into the blood, an improvement in the exocrine function of the pancreas according to the results of the fecal elastase test and the response of the pancreas to food intake according to the dynamics of uroamylase flow rates and endogenous pancreozymin induction coefficients. Under the influence of the main treatment option, there is an increase in the frequency of normalization of the echogenicity of the pancreas and less often than with traditional therapy, an increase in the pancreas or part of it, blurring and unevenness of the contours persist. In addition, the indicators of ultrasonic histography of the pancreas are significantly improved, and a more pronounced positive dynamics of the clinical manifestations of COPD is observed. Thus, the eradication of SIBO provides a significant increase in the effectiveness of the treatment of patients with a combination of CP and COPD.

Regional gastrointestinal transit times in patients with chronic pancreatitis.

The mechanisms behind disrupted gastrointestinal (GI) motor function in patients with chronic pancreatitis (CP) have not been fully elucidated. We compared regional transit times in patients with CP to those in healthy controls, and investigated whether they were associated with diabetes mellitus, exocrine dysfunction, opioid treatment or quality of life. Twenty-eight patients with CP and 28 age- and gender-matched healthy controls were included. Regional GI transit times were determined using the 3D-Transit system, which consists of an ingestible electromagnetic capsule and a detector worn in an abdominal belt for 5 days. Exocrine function was assessed using the fecal elastase-1 test, and quality of life was assessed using the European Organization for Research and Treatment of Cancer questionnaire. Transit times were analyzed for associations with diabetes mellitus, exocrine pancreatic insufficiency (EPI), opioid treatment and quality of life. Compared with healthy controls, patients with CP had prolonged transit times in the small intestine (6.6 ± 1.8 vs 4.8 ± 2.2 hours, P = .006), colon (40 ± 23 vs 28 ± 26 hours, P = .02), and total GI tract (52 ± 26 vs 36 ± 26 hours, P = .02). There was no difference in gastric emptying time (4.8 ± 5.2 vs 3.1 ± 1.3 hours, P = .9). No associations between transit times and diabetes, EPI, or opioid consumption were found (all P > .05). Quality of life and associated functional and symptom subscales were not associated with transit times, except for diarrhea (P = .03). Patients with CP have prolonged small intestinal and colonic transit times. However, these alterations do not seem to be mediated by diabetes, EPI, or opioid consumption.

DEPEND study protocol: early detection of patients with pancreatic cancer – a pilot study to evaluate the utility of faecal elastase-1 and 13C-mixed triglyceride breath test as screening tools in high-risk individuals

IntroductionPancreatic cancer (PC) is the fifth leading cause of cancer-related death in the UK. The incidence of PC is increasing, with little or no improvement in overall survival and the...

News of European Pancreatology (based on the materials of the 53rd meeting of the European Pancreatic Club)

The 53rd meeting of the European Pancreatic Club (online) took place in Verona (Italy) on June 9–11, 2021. The meeting was attended by 690 delegates from 40 countries. More than 400 oral and poster presentations were presented.
 The results of advances in the diagnosis and treatment of chronic pancreatitis, as well as the crucial research directions, were summarized in a lecture by E. de-Madaria et al. (Italy). The main medical and social characteristics of chronic pancreatitis (CP): chronic disease; often manifests itself in pain, which is often disabling; leads to complications, including pancreatic cancer; diagnosis and treatment are complex. Despite this, the number of randomized controlled trials (RCTs) on CP is significantly less than on acute pancreatitis, and in recent years, the annual number of studies on CP has even decreased. Problems to be solved: we do not have antifibrotic drugs, a “gold standard” for diagnosis, and we do not even have good methods for diagnosing early CP. The main etiological CP options are alcoholic and idiopathic ones. A more detailed analysis showed that toxic CP (alcoholic and smoking-induced) account for 46% of cases of the disease, idiopathic CP — 24%, genetically predisposed CP — 7%, obstructive CP — 7%, autoimmune CP — 2%, CP of other etiology — 12% of cases. We have made progress in the study of autoimmune pancreatitis, however, the frequency of pancreatic cancer due to autoimmune CP, features of the disease in children, increased accuracy of pancreas imaging and the effectiveness of treatment require further study in RCTs.
 Lithotripsy, endoscopy, and surgery are used to treat CP with dilated pancreatic ducts. There were 3 RCTs that showed the advantages of surgical treatment over endoscopic one (long-term pain relief, fewer complications, higher efficiency), but lithotripsy and endoscopy were not compared.
 “Small ducts disease” is treated by the blockade of the solar plexus and/or nn. splanchnici, V-shaped excision of the pancreas, pancreatectomy with autotransplantation of the islets of Langerhans (only in specialized centers). The effectiveness of these techniques requires further study. The main techniques for diagnosing exocrine pancreatic insufficiency (EPI) are: probe (laborious), fecal elastase test (low sensitivity in mild EPI), tests for assessing trophological status (low specificity), breath tests (not available everywhere and laborious).
 Thus, we need an more RCTs (international efforts), definition of early CP; we need to better understand the relationship between genetic and environmental factors, advance in understanding of the autoimmune pancreatitis, and understanding the role of endoscopy and lithotripsy in pain management; it is necessary to develop new techniques of treating pain in the “small ducts disease”; we need easy-to-perform, accurate and widespread tests to diagnose EPI.
 The article analyzes the results of studies on the diagnosis and treatment of pancreatitis, cysts and pancreatic tumors.

Exocrine pancreatic insufficiency in long-term follow-up after curative gastric resection with D2 lymphadenectomy: A cross-sectional study

BackgroundExocrine pancreatic insufficiency (EPI) can be a problem following gastrectomies. This study aimed to reveal the EPI prevalence and its possible causes in gastric cancer patients that underwent subtotal or total gastrectomy, with completed oncological treatments, and with long-term disease-free survival success. Additionally, we also sought to determine whether there were any relations between EPI and blood biomarkers, weight change, malnutrition parameters, and quality of life after gastrectomy. MethodsA total of 69 gastric cancer patients whose oncological treatments had already been completed, with a minimum follow-up period of 16 months, were included in the study. Fecal samples were taken from all patients for the Fecal Elastase-1 Test, and patients were stratified into three groups based on the results: low (<100 μg/g), moderate (100–200 μg/g), and normal (>200 μg/g). These results were compared with patients’ clinical characteristics, blood nutrition biomarkers, Maastricht indexes (MI), Bristol stool scale, and Gastrointestinal Quality of Life Index (GIQLI) scores. ResultsFE-1 levels were low in 33 (47.8%) of the patients, moderate in 11 (15.9%), and normal in 25 (36.2%). The rate of patients receiving chemoradiotherapy (CRT) in the low FE-1 group was higher than the normal FE-1 and moderate FE-1 groups (P < 0.001 and P = 0.012, respectively). The serum total protein and lipase levels were lower in the low FE-1 group than in the normal FE-1 group (P = 0.023 and P < 0.001, respectively). When compared to the normal FE-1 group, the MI score of the low FE-1 group was higher (P = 0.018). The low FE-1 group had lower GIQLI gastrointestinal symptom scores than the normal FE-1 group (P = 0.046). ConclusionsDuring long-term follow-up, EPI can be seen in more than half of patients with gastric cancer after curative gastrectomy. Radiotherapy as an adjunct to adjuvant treatment in the postoperative period is considered a serious risk factor for EPI development. EPI contributes to malnutrition development after gastrectomy and negatively affects the patients’ quality of life, especially in terms of gastrointestinal symptoms.

Exocrine and endocrine functions and pancreatic volume in patients with pancreatic trauma.

Injury to the pancreas may lead to significant morbidity and mortality. We aim to assess pancreatic endocrine and exocrine functions and evaluated morphological regenerations of pancreas following partial pancreatectomy in patients with pancreatic trauma. The study was performed between June 2016 and December 2017. Endocrine functions were assessed at the time of admission and at 6months follow-up with 75g oral glucose tolerance test (OGTT), serum insulin and C-peptide levels and HbA1c estimation and exocrine functions were assessed with fecal elastase test. Pancreatic volumetry was done with imaging scan at 1month and 6months post discharge. Twenty patients were studied with a median age of 30years (range18-48) at the time of injury. All the patients were normoglycemic on admission; only one patient who underwent pancreatic resection developed diabetes mellitus at follow-up. Eight patients (40%) were found to be prediabetic by American Diabetes Association (ADA) criteria. Eleven patients (55%) had pancreatic exocrine insufficiency. Pancreatic volume increment, from the mean pancreatic volume of 48.65 to 54.29cm3, was noted in patients who underwent partial pancreatectomy. Patients with pancreatic trauma may develop biochemical endocrine and exocrine insufficiencies following pancreatic resection. Pancreatic volume increment requires further research in a larger study.

Chronic Use of Long-Acting Somatostatin Analogues (SSAs) and Exocrine Pancreatic Insufficiency (EPI) in Patients with Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs): An Under-recognized Adverse Effect

Somatostatin Analogues (SSAs) are used to treat Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and acromegaly. Side effects of SAAs usually include biliary disorders, gastrointestinal disorders, injection-site pain and hyperglycemia. Exocrine Pancreatic Insufficiency (EPI) is often misdiagnosed as disease progression or failure to SAAs or diagnosed after a delay in patients receiving SAAs. We present our experience with EPI developing in patients following use of SAAs. We reviewed chart and pharmacy records of 110 GEP-NETs patients who received SSAs. Data was collected including demographics, pathology, stage, dose/duration of long and short-acting SA, use of antidiarrheal, pancreatic enzyme replacement (PER), proton pump inhibitors (PPI) or H2 blockers). Laboratory data include chromogranin-A (CgA), urine 5-HIAA and quantitative fecal fat test (QFFT) or fecal elastase test (FE). EPI was defined by a FE below normal level OR by a reduction of ≥ 21.2% or steatorrhea on QFFT. Patients who were identified to develop EPI were treated with pancreatic exocrine replacement therapy (PERT). Among, 110 GEP-NETs patients, 104 received LA Octreotide and 6 Somatuline Depot Injection. Of these, 23 received short-acting SSA for worsening diarrhea, 96 had intensification of antidiarrheal and 1 got telotristat ethyl. QFFT confirmed EPI in 19, 11 based on clinical symptoms, and 16 had sample error or refusal to collect specimen. CTCAE 4.0 grades of EPI were: grade 2(69%), grade 3(22%) and grade 4(9%). Median time to development of EPI was 12 months (95%CI 3 - 23). Except 1, all patients received PERT either with concomitant PPI (13) or later if no improvement with PERT (6) and 2 on H2 blockers. 37% of the patients had improvement in EPI within 4-8 weeks. Deficiency of vitamins and trace elements was found in 11 of 19 patients, who received supplementation. Our experience constitutes the first and the largest study addressing EPI as a rare but serious complication of chronic use of SAAs. Although SAAs are used to treat diarrhea, paradoxically they can worsen diarrhea secondary to EPI. Early recognition and diagnosis of this under-diagnosed and under-reported side effect of SAAs, such as EPI, can improve not only diarrhea and weight loss in these patients but also can reduce cost of using short-acting SAAs and antidiarrheal.

Pancreatic atrophy and exocrine insufficiency associate with the presence of diabetes in chronic pancreatitis patients, but additional mediators are operative

Objectives Diabetes mellitus is a frequent complication of chronic pancreatitis (CP) and has traditionally been considered to develop as a consequence of pancreatic islet cell loss. However, additional mechanisms may be operative including accumulation of pancreatic fat and fibrosis. We used advanced magnetic resonance imaging (MRI) to study pancreatic morphology and exocrine function in a reference population and in CP patients with and without diabetes. Methods This was a cross-sectional mono centre study. All subjects underwent advanced MRI including assessment of pancreatic ductal parameters (Cambridge classification and main pancreatic duct diameter), parenchymal parameters (DIXON technique and diffusion weighted imaging as proxies for pancreatic fat content and fibrosis, as well as pancreatic volume segmentation). Pancreatic exocrine function was determined as duodenal secretion following secretin stimulation and by the faecal elastase test. Results The study included 76 patients with definite CP of whom 23 (30.1%) had diabetes and 23 sex- and age matched healthy volunteers. Compared to their non-diabetic counterparts, diabetic patients were characterised by a low pancreatic volume (20 vs. 36 ml; p = .02) and impaired pancreatic exocrine function (faecal elastase 19 vs. 48 µg/g; p = .008), while no difference between patients with and without diabetes were seen in relation to MRI derived proxies for fibrosis and pancreatic fat accumulation and pancreatic duct parameters. A large proportion of non-diabetic patients (49%) had similar morphological and functional characteristics as patients with diabetes. Conclusion Pancreatic atrophy and exocrine insufficiency are present in most CP patients with diabetes, but additional mediators seem to be operative in post pancreatitis diabetes mellitus.

La insuficiencia pancreática exocrina: estado actual de su conocimiento entre los profesionales de Argentina

Background. Exocrine pancreatic insufficiency is defined as the inability to maintain pancreatic secretion or maintain normal food digestion. It is an underdiagnosed entity. Objective. To collect information from the health professionals of different specialties in our country on the current state of knowledge of exocrine pancreatic insufficiency. Material and method. During the period comprising from August to November 2018, an anonymous survey was conducted. The survey was sent by e-mail. 447 professionals responded from a total of 2054 surveys sent. Results. We observed that a significant proportion of professionals did not relate exocrine pancreatic insufficiency with various etiologies that may cause it. Typical exocrine pancreatic insufficiency symptoms such as diarrhea-steatorrhea (96.2%) and the weight loss (85%) were the most chosen. Regarding diagnostic methods, digestive symptoms (60.6%) and the fecal elastase test (59.5%) were the most selected options. Regarding treatment, most chose to indicate the intake of the PERT capsules during food ingestion (61.3%). Only the 37.4% chose the initial dose recommended by most guidelines. A varied diet without fat restriction was indicated by the 40% of the respondents. In relation to the control of response to treatment, the improvement of symptoms (87.5%) and anthropometry (59.7) were the most used parameters. Most professionals do not use clinical guidelines for the management of these patients and only 22% used the guidelines. Conclusion. Based on the data obtained in this survey, we observed that a significant proportion of professionals do not know the relevant aspects in relation to the etiology, the clinical manifestations, the diagnosis, and the nutritional and pharmacological management of exocrine pancreatic insufficiency.

Comparison of pancreatic function and quality of life between patients with infected pancreatitis necrosis undergoing open necrosectomy and minimally invasive drainage: A long-term study.

The present study aimed to determine whether a difference in pancreatic function and quality of life (QoL) is present between patients with infected pancreatitis necrosis (IPN) undergoing open necrosectomy (ON) and minimally invasive drainage (MID). The medical records of patients with IPN discharged from Jinling Hospital were retrospectively analyzed. Pancreatic function and QoL were compared between patients treated with ON and MID. Pancreatic endocrine and exocrine function were assessed using the oral glucose tolerance test and fecal elastase-1 (FE-1) test, respectively. The standard Short Form 36 health questionnaire was used to evaluate the QoL of patients. The analysis included 101 patients who underwent either ON (n=40, 39.6%) or MID (n=61, 60.4%). There were no significant differences in exocrine and endocrine pancreatic function between the two groups evaluated based on FE-1, fasting blood glucose, glycated hemoglobin and 2-h plasma glucose (P<0.05). The scores of the QoL questionnaire were significantly higher in patients treated with MID than in patients treated with ON, including the scores of general health perception (19.39±3.07 vs. 17.37±3.63, P=0.003), vitality (18.93±2.88 vs. 17.57±3.47, P=0.035), social role functioning (8.85±1.43 vs. 8.15±1.98, P=0.042), emotional role functioning (5.33±1.07 vs. 4.82±1.25, P=0.034), mental health (24.21±3.31 vs. 22.57±3.91, P=0.026) and the total QoL score (125.12±13.16 vs. 116.50±16.94, P=0.005). In conclusion, although the initial health of the patient may have influenced the treatment provided, patients with IPN who received MID achieved a better post-treatment QoL than those treated with ON. No significant differences between the two groups were observed regarding the endocrine and exocrine functions of the pancreas.

Pancreatitis crónica

Chronic pancreatitis is a chronic inflammatory disease of the pancreas that is accompanied by parenchymal fibrosis and loss of functional tissue, which in advanced phases leads to the onset of exocrine and endocrine pancreatic insufficiency. There are various causes that are currently summarised in the TIGAR-O classification, the most common of which is toxic-metabolic (alcohol and tobacco). The most common clinical manifestations are abdominal pain and symptoms resulting from exocrine pancreatic insufficiency. The diagnosis of chronic pancreatitis is based on detecting a) morphological abnormalities (with endoscopic ultrasonography and cholangiopancreatography by magnetic resonance imaging with secretin and magnetic resonance imaging with gadolinium) and/or b) functional abnormalities (with the secretin test). Exocrine pancreatic insufficiency is analysed through the faecal elastase test, combined with a complete nutritional study or with methods such as the 13C-mixed triglyceride breath test. Treatment for the disease is focused on treating the cause, controlling the symptoms (mainly pain) and managing its functional (e.g., exocrine and endocrine pancreatic insufficiency) and morphological complications (e.g., pseudocyst, pseudoaneurysm and pancreatic cancer).

Clinical characteristics and genetic analysis of cystic fibrosis transmembrane conductancereseptor-related disease.

Cystic fibrosis (CF) transmembrane conductance receptor (CFTR)-related disease is diagnosed in patients affected by CFTR dysfunction who do not fully meet the CF diagnostic criteria. Only 2% of all CF patients have CFTR-related disease. We define the demographic characteristics of such patients, described the performance of mutational analyses, and describe the clinical findings. Twenty-four patients were followed-up for CFTR-related disease. Patients with CF symptoms but who did not completely fulfil the CF diagnostic criteria were enrolled. Age, body mass index at the times of diagnosis and admission, symptoms, pulmonary function and fecal elastase test results, gene analyses, and clinical findings during follow-up were evaluated. Ten patients (42%) were female and 14 (58%) male. Their mean age was 15.3years (minimum-maximum 6-20years). The mean age at diagnosis was 8.5years (minimum-maximum 3-14years) and the most common presenting complaint was a cough (n = 19). During follow up, chronic sinusitis developed in 15 patients, bronchiectasis in 13, nasal polyposis in six, failure to thrive in three, recurrent pancreatitis in two, asthma in one, and congenital bilateral absence of the vas deferens in one. Fecal elastase levels were low in only one of the three patients who failed to thrive. In terms of CFTR gene mutations, two were found in 10 patients, one in eight patients, and none in six. Cystic fibrosis transmembrane conductance receptor-related disease presents with various clinical findings. Serious symptoms may develop later in life. Late diagnosis significantly compromises the quality and duration of life in such patients.

Pancreatic exocrine insufficiency and Crohn's disease.

According to the European evidence-based consensus, published by European Crohn's and Colitis Organization (ECCO), diseases of the pancreas are included as extra-intestinal manifestations in IBD in the forms of acute pancreatitis (AP), chronic pancreatitis (CP), autoimmune pancreatitis (AIP), pancreatic duct abnormalities and pancreatic exocrine insufficiency (PEI). Presence of pancreatic autoantibodies directed against the exocrine of the pancreas has been reported in about one-third of CD. However, association between CD and PEI is not fully elucidated. Patients with a diagnosis of CD were recruited at the Department for Digestive Diseases at Karolinska University Hospital in Stockholm, Sweden. Demographic, clinical and laboratory data were analyzed. Fecal elastase-1 (FE-1) measurements were performed using the enzyme-linked immunosorbent assay (ELISA) method. There were 20 patients included in the study, 13 (65%) males and 7 (35%) females, mean age 48.3±1.4 years (range 29-67 years). Mean duration of CD was 15.7±2.1 years (range 1-40 years). There were 11 (55%) patients without history of bowel surgery and 9 (45%) patients after ileocecal resection. FE-1 test was normal in all patients, among them 15 (75%) patients with the values of FE-1>500. Fecal elastase-1 level was normal in all patients with CD strongly indicated absence of PEI in this group of patients.