Pancreatic Insufficient Patients Research Articles

Development of clinical screening tool for exocrine pancreatic insufficiency in patients with definite chronic pancreatitis

Background/ObjectivesNo simple, accurate diagnostic tests exist for exocrine pancreatic insufficiency (EPI), and EPI remains underdiagnosed in chronic pancreatitis (CP). We sought to develop a digital screening tool to assist clinicians to predict EPI in patients with definite CP. MethodsThis was a retrospective case-control study of patients with definite CP with/without EPI. Overall, 49 candidate predictor variables were utilized to train a Classification and Regression Tree (CART) model to rank all predictors and select a parsimonious set of predictors for EPI status. Five-fold cross-validation was used to assess generalizability, and the full CART model was compared with 4 additional predictive models. EPI misclassification rate (mRate) served as primary endpoint metric. Results274 patients with definite CP from 6 pancreatitis centers across the United States were included, of which 58 % had EPI based on predetermined criteria. The optimal CART decision tree included 10 variables. The mRate without/with 5-fold cross-validation of the CART was 0.153 (training error) and 0.314 (prediction error), and the area under the receiver operating characteristic curve was 0.889 and 0.682, respectively. Sensitivity and specificity without/with 5-fold cross-validation was 0.888/0.789 and 0.794/0.535, respectively. A trained second CART without pancreas imaging variables (n = 6), yielded 8 variables. Training error/prediction error was 0.190/0.351; sensitivity was 0.869/0.650, and specificity was 0.728/0.649, each without/with 5-fold cross-validation. ConclusionWe developed two CART models that were integrated into one digital screening tool to assess for EPI in patients with definite CP and with two to six input variables needed for predicting EPI status.

Features of exocrine pancreatic insufficiency in patients with non-alcoholic fatty liver disease in combination with type 2 diabetes and COVID-19.

Aim: The aim of the research was to study the features of pancreatic exocrine insufficiency (EPI) in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (DM) at COVID-19. Materials and Methods: 72 patients with NAFLD and COVID-19 were examined. The patients have been divided into two groups: group 1 included 42 patients with NAFLD and insulin resistance (IR); group 2 consisted of 30 patients with NAFLD in the combination with type 2 DM. EPI was detected by 13С-mixed triglyceride breath test (13С-MTBT) in all the patients. Results: The result of 13С-MTBT indicates EPI in the examined subjects of the 2 group. A significant decrease in the maximum concentration of 13СО2 between 150 and 210 min was also diagnosed in group 1 patients. research (up to 8.2 ± 0.9% - p < 0.05), however, the total concentration of 13СО2 at the end of 360 min. the study reached only 27.7 ± 1.1% (p < 0.05). Conclusions: Based on the results of laboratory-instrumental methods of research, patients with NAFLD and type 2 diabetes with COVID-19 were diagnosed with severe EPI. The results of 13С-MTBT in NAFLD and IR with COVID-19 indicate a decrease in the functional reserves of the pancreas and the formation of its EPI.

Exocrine and endocrine pancreatic insufficiency in patients with a history of acute pancreatitis and it’s correlation with severity of pancreatitis

Exocrine and endocrine pancreatic insufficiency in patients with a history of acute pancreatitis and it’s correlation with severity of pancreatitis

Peculiarities of the formation of exocrine pancreatic insufficiency in patients with primary osteoarthritis under conditions of comorbidity

Summary. The comorbidity of primary OA and diseases of the gastrointestinal tract, which EPI accompanies, is an extremely relevant, complex, and unstudied problem of modern medicine, as it has a number of unsolved problems both in the treatment and rehabilitation of such patients. Common pathogenetic mechanisms of the progression of such comorbidity often have a mutually aggravating effect, which requires further study.&#x0D; The aim of the study is to analyze the changes in indicators of exocrine pancreatic insufficiency (EPI) in patients with primary OA under the conditions of comorbidity with diseases of the gastrointestinal tract (GI).&#x0D; Research material and methods. 304 patients with primary OA in comorbidity with diseases of the gastrointestinal tract accompanied by non-exacerbation EPI were examined. The comparison group consisted of 30 practically healthy individuals who did not have clinical, anamnestic, and instrumental signs of diseases of the gastrointestinal tract and joints.&#x0D; Results and discussion. It was established that in patients with primary OA in comorbidity with diseases that are accompanied by EPI, the levels of EPI indicators were statistically significantly different depending on the etiology of EPI.&#x0D; Conclusion. Post hoc analysis established the ranking of the pathology of the gastrointestinal tract, accompanied by EPI, according to the indicators of EPI in primary OA, which was located as follows, starting from the highest: CP ˃ T2DM ˃ chronic non-calculous cholecystitis and functional diseases of the gallbladder and biliary system ˃ chronic gastroduodenitis (p ˂0.05).

S6 Treatment of Exocrine Pancreatic Insufficiency in Patients with Chronic/Recurrent Acute Pancreatitis Improves Treatment Satisfaction and Decreases Healthcare Utilization: Interim Findings from the PACT-CP Registry

S6 Treatment of Exocrine Pancreatic Insufficiency in Patients with Chronic/Recurrent Acute Pancreatitis Improves Treatment Satisfaction and Decreases Healthcare Utilization: Interim Findings from the PACT-CP Registry

S83 Prevalence of Pancreatic Insufficiency in Patients With Type 2 Diabetes Mellitus Using Sociodemographic Variables: A Nationwide Analysis in the United States

S83 Prevalence of Pancreatic Insufficiency in Patients With Type 2 Diabetes Mellitus Using Sociodemographic Variables: A Nationwide Analysis in the United States

Evaluation of the Frequency of Exocrine Pancreatic Insufficiency in Patients With Diabetes Mellitus

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The influence of exocrine pancreatic function on the exposure and pharmacokinetics of ivacaftor in people with cystic fibrosis

BackgroundCystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies target the underlying cause of cystic fibrosis (CF), and show robust treatment effects at group level. The individual effect however, is variable which might be (partially) related to differences in drug exposure. The profound influence of fat containing food compared to fasting on drug exposure gives need to investigate if the exocrine pancreatic function changes the degree and rate of absorption of ivacaftor and thereby may contribute to differences in drug exposure. MethodsPharmacokinetic parameters of ivacaftor were measured in 10 pancreatic sufficient (PS) and 10 pancreatic insufficient (PI) patients with CF on current treatment with tezacaftor/ivacaftor and compared between both groups. In PI patients pharmacokinetic parameters were investigated with and without the use pancreatic enzymes and compared in each individual. ResultsWe demonstrated that the pharmacokinetic parameters of ivacaftor did not differ significantly between PS and PI people with CF (pwCF). Pancreatic enzymes did not significantly change the absorption or exposure to ivacaftor in PI pwCF using tezacaftor/ivacaftor. ConclusionThe exocrine pancreatic function of pwCF does not significantly influence the absorption and exposure of ivacaftor. The use of pancreatic enzymes in PI pwCF does not change the absorption and exposure of ivacaftor. Therefore, the dosing advice as mentioned in the SmPC for ivacaftor can be maintained independent of the exocrine pancreatic function.

A Retrospective Real-World Evidence Evaluation of the Characteristics of Exocrine Pancreatic Insufficiency in Patients With Chronic Pancreatitis and Type 2 Diabetes Treated With Pancrelipase in the United States.

This retrospective real-world data analysis assessed clinical/health care professional characteristics of gastrointestinal symptom profiles in pancrelipase-treated patients with exocrine pancreatic insufficiency symptoms and chronic pancreatitis (CP) or type 2 diabetes (T2D). Data were from the Decision Resources Group Real-World Evidence Data Repository US database. Patients 18 years and older receiving pancrelipase (Zenpep) between index dates August 2015 and June 2020 were included. Gastrointestinal symptoms were assessed 6, 12, and 18 months post-index versus baseline. A total of 10,656 pancrelipase-treated patients with CP (n = 3215) or T2D (n = 7441) were identified. Significant/sustained reductions in gastrointestinal symptoms were observed in both cohorts after pancrelipase treatment (P < 0.001) versus baseline. Significantly fewer patients with CP compliant with treatment for more than 270 days (n = 1553) reported abdominal pain (P < 0.001) and nausea/vomiting (P < 0.05) versus those compliant for less than 90 days (n = 1115). Significantly fewer patients with T2D compliant with treatment for more than 270 days (n = 2964) reported abdominal pain (P < 0.001) and diarrhea/steatorrhea (P < 0.05) versus those compliant for less than 90 days (n = 2959). Pancrelipase reduced exocrine pancreatic insufficiency symptoms in patients with CP or T2D, with greater treatment compliance associated with improved gastrointestinal symptom profiles.

S9 Development of a Clinical Screening Tool for Exocrine Pancreatic Insufficiency in Patients With Chronic Pancreatitis

Introduction: No accurate diagnostic tests exist for exocrine pancreatic insufficiency (EPI). As a result, EPI is misdiagnosed, including in chronic pancreatitis (CP), and there is an unmet need for clinical tools to help clinicians evaluate patients with CP at risk for EPI. The aim of this study was to generate a simple clinical tool to predict EPI in patients with CP. Methods: 49 variables from medical records of CP patients with or without EPI were entered into a Classification and Regression Tree (CART) model using the unimputed full analysis set and 4 other models (Logistic Regression with Least Absolute Shrinkage and Selection Operator regularization, Support Vector Machine, Random Forest, and Gradient Boosting Machine) using imputed full analysis set. EPI misclassification rate (mRate) served as primary metric to train the 5 prediction models. Each model’s generalizability was assessed using 5-fold cross-validation and the model that was best suited for clinician use based on mRate and other characteristics was selected. Results: Records of 274 patients with CP from 6 pancreatitis centers across the US were included. Among the 160 (58%)/114 (42%) patients with EPI/without EPI, 48%/55% were female, mean age was 55/52 years, 76%/69% were white, 29%/52% were never smokers, and 39%/53% were never alcohol users. All 5 prediction models demonstrated similar EPI mRates. The CART model was selected. The final CART decision tree includes 10 variables (in order of importance): smoking, pancreatic atrophy, steatorrhea, alcohol use, hemoglobin, serum vitamin D, pancreatic duct contour change, serum albumin, pancreatic parenchymal calcifications, and use of opioid analgesics. The mRate without and with 5-fold cross-validation of the CART was 0.153 (training error) and 0.314 (prediction error), and the area under the receiver operating characteristic curve was 0.889 and 0.682, respectively (Figure 1). Sensitivity/specificity without/with 5-fold cross validation was 0.888/0.789 and 0.794/0.535, respectively. Conclusion: A parsimonious set of 10 variables associated with EPI in CP was identified. The CART decision tree demonstrated good prediction performance for EPI and was selected as the most practical screening tool to aid clinicians in the assessment of EPI in patients with CP. Further external validation of the EPI screening tool is planned.Figure 1.: AUC-ROC of the CART model trained on the full analysis set and after 5-fold cross-validation. AUC, area under the curve; CART, classification and regression tree; CV, cross-validation; ROC, receiver operating characteristic.

The Prevalence and Characteristics of Exocrine Pancreatic Insufficiency in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis.

Background Exocrine pancreatic insufficiency (EPI) is common in patients with type 2 diabetes. However, the prevalence of EPI varies significantly in different studies. Untreated EPI in these patients can adversely affect their nutrition and metabolism. The aim of this study is to estimate the pooled prevalence of EPI in patients with type 2 diabetes and to explore the potential risk factors. Methods A systematic search was performed in PubMed, Web of Science, and Embase, which included studies meeting inclusion criteria from 1960 to 1 April 2022. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of “Type 2 diabetes” and “pancreatic exocrine insufficiency.” The Stata 16.0 software was used for data analyses. The random-effects model was used to estimate the pooled prevalence rates and 95% CI using “metaprop program.” Results The pooled prevalence of EPI was 22% (95% CI: 15%–31%) in patients with type 2 diabetes and 8% (95% CI: 4%–14%) of them developed severe pancreatic insufficiency. In the subgroup analyses, the prevalence of EPI in type 2 diabetes was correlated with geographic location. The prevalence in Asian countries (35%, 95% CI: 22%–49%) is higher than in Europe (18%, 95% CI: 10%–29%) and Australia (9%, 95% CI: 4%–16%). Furthermore, patients with higher insulin requirements, who are more likely to be insulin-deficient, have a higher prevalence of EPI. The pooled prevalence was 27% (95% CI: 17%–37%) in type 2 diabetes with higher insulin requirement (1 group) and 15% (95% CI: 1%–40%) in patients with lower insulin requirement (2 group). In addition, the morbidity of severe EPI in the higher insulin requirement group (12%, 95% CI: 7%–19%) was sextuple as much as the lower insulin requirement group (2%, 95% CI: 0%–13%). EPI was more common in subjects younger than 60 compared with elderlies (25% vs. 19%). Conclusion The prevalence of EPI in type 2 diabetes may be overestimated. Furthermore, the higher prevalence may be closely related to β-cell function. Endocrine disease therapy would potentially represent a novel therapeutic approach for patients with type 2 diabetes and EPI.

Nutrition support in children and adolescents with cystic fibrosis: Is there a difference between pancreatic sufficient and insufficient patients?

1. Nagy R, Gede N, Ocskay K, et al. Association of Body Mass Index With Clinical Outcomes in Patients With Cystic Fibrosis: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(3):e220740. doi:10.1001/jamanetworkopen.2022.0740 CrossRef Google Scholar

Fat-Soluble Vitamins in Standard vs. Liposomal Form Enriched with Vitamin K2 in Cystic Fibrosis: A Randomized Multi-Center Trial.

Background: We aimed to assess a liposomal fat-soluble vitamin formulation containing vitamin K2 with standard treatment in cystic fibrosis (CF). Methods: A multi-center randomized controlled trial was carried out in 100 pancreatic-insufficient patients with CF. The liposomal formulation contained vitamin A as retinyl palmitate (2667 IU daily) and beta-carotene (1333 IU), D3 (4000 IU), E (150 IU), K1 (2 mg), and K2 as menaquinone-7 (400 µg). It was compared with the standard vitamin preparations in the closest possible doses (2500 IU, 1428 IU, 4000 IU, 150 IU, 2.14 mg, respectively; no vitamin K2) over 3 months. Results: Forty-two patients finished the trial in the liposomal and 49 in the control group (overall 91 pts: 22.6 ± 7.6 years, 62.6% female, BMI 19.9 ± 2.8 kg/m2, FEV1% 70% ± 30%). The main outcome was the change of vitamin status in the serum during the study (liposomal vs. standard): all-trans-retinol (+1.48 ± 95.9 vs. −43.1 ± 121.4 ng/mL, p = 0.054), 25-hydroxyvitamin D3 (+9.7 ± 13.4 vs. +2.0 ± 9.8 ng/mL, p = 0.004), α-tocopherol (+1.5 ± 2.5 vs. −0.2 ± 1.6 µg/mL, p < 0.001), %undercarboxylated osteocalcin (−17.2 ± 24.8% vs. −8.3 ± 18.5%, p = 0.061). The secondary outcome was the vitamin status at the trial end: all-trans-retinol (370.0 ± 116.5 vs. 323.1 ± 100.6 ng/mL, p = 0.045), 25-hydroxyvitamin D3 (43.2 ± 16.6 vs. 32.7 ± 11.5 ng/mL, p < 0.001), α-tocopherol (9.0 ± 3.1 vs. 7.7 ± 3.0 µg/mL, p = 0.037), %undercarboxylated osteocalcin (13.0 ± 11.2% vs. 22.7 ± 22.0%, p = 0.008). Conclusion: The liposomal fat-soluble vitamin supplement containing vitamin K2 was superior to the standard form in delivering vitamin D3 and E in pancreatic-insufficient patients with CF. The supplement was also more effective in strengthening vitamin K-dependent carboxylation, and could improve vitamin A status.

P-P14 A multi-centre retrospective cohort study exploring weight loss and nutritional interventions in severe acute pancreatitis

Abstract Background Acute pancreatitis is among the most common acute gastrointestinal diseases. Severe acute pancreatitis (SAP) develops in up to 20% of patients and is associated with increased morbidity and mortality. Patients may have long and complex hospital admissions; nutritional support is a cornerstone of management. Due to increased metabolic demands and development of pancreatic exocrine insufficiency (PEI) patients frequently endure excessive weight loss. There has been little research into the effect of SAP on nutritional status and necessary nutritional interventions. This project aimed to characterise weight loss in SAP, routes of feeding, and PEI - including pancreatic enzyme replacement therapy (PERT). Methods Participating centres were recruited via the Nutrition Interest group of PSGBI and were required to retrospectively recruit 5-10 consecutive patients admitted following January 1st 2018 using a predefined data collection tool. Inclusion criteria included; age ≥18 years and diagnosed SAP of any aetiology (defined by organ failure of &amp;gt; 48hrs). The exclusion criterion was where death occurred during hospital admission. Data were collected regarding, weight changes, anthropometric measures, nutritional interventions used, PERT administration and diabetic status, including insulin use. All analyses were performed with IBM SPSS 22 (IBM Corp. Armonk, NY), with p &amp;lt; 0.05 considered statistically significant. Results 34 patients (22 male) from five centres met the inclusion criteria and were included in data analysis. Most common aetiologies were gallstones (13/34) and alcohol (11/34). A mean weight reduction of 12.6% (SD ± 10.77) (p &amp;lt; 0.001) was observed. Multivariate analyses showed that higher premorbid weight (p = 0.02) and PERT administration with tube feeding (p = 0.005) were associated with weight loss. Most patients (29/34) received tube feeding; mean duration 56.8 (SD ± 58.29) days. There was a significant increase in patients with diabetes requiring insulin therapy from admission (n = 3) to discharge (n = 9) (p = 0.03). Most (29/31) patients required oral PERT prescription on discharge. Conclusions Patients with SAP lost significant weight during the course of their illness despite aggressive, extended nutritional support and the correction of PEI with PERT. The significant increase in insulin dependence among patients with diabetes, and the number of patients requiring PERT on discharge, reflects the destructive effect SAP has on pancreatic function. These multicentre findings could be used as a baseline for determining effectiveness of nutritional interventions in SAP and may provide a basis for further prospective research in this area.

Prevalence of Post–Glucose Challenge Hypoglycemia in Adult Patients With Cystic Fibrosis and Relevance to the Risk of Cystic Fibrosis–Related Diabetes

ObjectivesThe clinical relevance of fasting and postprandial hypoglycemia in patients with cystic fibrosis (CF) is poorly characterized. Our aim in this study was to characterize the prevalence of hypoglycemia in adult patients during oral glucose tolerance test (OGTT) screening and determine its impact on the risk of developing CF-related diabetes (CFRD). MethodsWe analyzed 2 cohorts of pancreatic insufficient patients with CF exposed to comparable treatment recommendations in France (Lyon CF cohort [DIAMUCO]) and Canada (Montréal CF cohort [MCFC]). Patients were classified into 3 groups based on hypoglycemia absence or presence as well as its severity at baseline. We defined the groups as follows: level 2 hypoglycemia (L2H; plasma glucose [PG]<3.0 mmol/L), level 1 hypoglycemia (L1H; PG 3.0 to <4.0 mmol/L) and no hypoglycemia (NH) during an OGTT. ResultsA total of 153 MCFC and 114 DIAMUCO subjects were included in the study. In total, 22% of the patients experienced hypoglycemia, with 5% having it on 2 or more OGTTs. The L1H and L2H groups tended to have a lower 2-hour glucose and higher early-phase insulin secretion (insulin area under the curve at 0 to 30 minutes) compared with NH patients. In both cohorts, a greater proportion of men and patients with normal glucose tolerance had hypoglycemia. Over a 5-year period, there were no cases of CFRD in the L2H group, whereas 4 subjects in the L1H group and 36 in the NH group developed CFRD. ConclusionsPatients with hypoglycemia were at lower risk of developing CFRD, but at higher risk of early-phase insulin secretion and unsuppressed insulin secretion. This could potentially lead to further hypoglycemia after the 2-hour OGTT, suggesting high clinical relevance.

CFTR modulators increase risk of acute pancreatitis in pancreatic insufficient patients with cystic fibrosis

Patients with pancreatic insufficient cystic fibrosis rarely develop acute pancreatitis due to insufficient acinar reserve. We describe a series of five patients under the age of 18 (range 8-16 years) with pancreatic insufficient cystic fibrosis who developed a phenotype in keeping with acute pancreatitis following initiation of CFTR modulator therapy. This occurred at a median of 30 months following CFTR modulator initiation. 3/5 of these patients also developed pancreatic sufficiency or at least an intermediary pancreas status, indicated by fecal elastases above 100 μg/g. This series highlights a mostly unrecognized potential side effect of this therapy as well as the potential of CFTR modulator therapies to improve exocrine pancreatic function, even in adolescent patients.

Persistent Nutritional Deficiency in Pancreatic-Insufficient Children and Adolescents with Cystic Fibrosis Despite Therapeutic Intervention

Abstract Background Cystic fibrosis (CF) is caused by mutations in the gene encoding the CF Transmembrane Conductance Regulator (CFTR) protein, resulting in compromised pulmonary function, malabsorption, and pancreatic insufficiency. The sequelae of CF are heterogeneous, and contributing factors are multifactorial. Nutritional deficiencies, particularly in essential fatty acids (EFA) and vitamins, are known to alter the trajectory of CF unfavorably. The current treatment modalities focus on proactive management of the pulmonary, gastrointestinal, and pancreatic functions; however, information on the monitoring and treatment of nutritional deficiencies in CF patients is scant. The objective of our study was to evaluate the effects of pancreatic function and CFTR modulator therapy on pertinent nutritional deficiencies in children and adolescents diagnosed with CF. Methods The study was approved by our institutional IRB and included 77 non-fasted CF participants, 10.4 + 5.2 years of age (range: 4 months-18 years), and an equal ratio of both sexes. Participants were stratified as pancreatic sufficient (PS, n=6), and pancreatic insufficient with (PI, n=48) or without CFTR modulator treatment (PI-M, n=23). Twenty-two fatty acids were measured in plasma by GC-MS, including omega-6 linoleic acid (LA), and omega-3 α-linoleic acid (ALA). Medical records and 24-hour dietary recalls were reviewed to correlate biochemical and clinical findings. Vitamins A and E and zinc levels of the participants were also obtained. Data analyses were performed by one-way ANOVA and Tukey’s multiple comparisons using Prism software (LaJolla, CA). Results There were no significant differences in BMI and caloric intake among the groups. The concentrations of EFA, LA, and ALA were significantly higher in the PS group (3904±229 nmol/mL and 149±24 nmol/mL) compared to the PI (2387±89 nmol/mL and 53±4 nmol/mL, p&amp;lt;0.01) and PI-M (2335±159 nmol/mL and 58±7 nmol/mL, p&amp;lt;0.01) groups, respectively. Similarly, the biologically active omega-6 arachidonic acid and omega-3 docosahexaenoic acid were lower in the PI and PI-M groups compared to the PS group (p&amp;lt;0.05). Interestingly, EFA deficiency biomarkers, omega-9 mead acid, and the Triene:Tetraene ratio, were significantly higher in the PI group (17±2 nmol/mL and 0.033±0.003) vs PS group (13±3 nmol/mL and 0.019±0.002, p&amp;lt;0.05), respectively. Higher concentrations of vitamins A and E were observed in the PS group vs PI-M groups (p&amp;lt;0.05), and zinc concentrations were not different among the groups. There were no associations between the concentrations of EFA and BMI, age, total caloric intake, and % calories from fat in PS, PI, and PI-M patients. Conclusion While advances in CF therapeutics are remarkable, our data show the persistence of nutritional deficiencies in pancreatic insufficient CF patients regardless of CFTR modulator therapy and support the clinical utility of EFA and vitamins as potential adjuvant biomarkers to assess the severity and assist in the clinical monitoring of CF.

Analysis between vitamin D receptor Bsml polymorphism and exocrine pancreatic insufficiency in patients with comorbidity: chronic pancreatitis and chronic obstructive pulmonary disease

The objective of the research is to analyze the association of Bsml polymorphism of the vitamin D receptor gene in patients with comorbidity - chronic pancreatitis (CP) and chronic obstructive pulmonary disease (COPD), as well as to correct the serum vitamin D level.Material and methods. The study included 57 patients with CP with concomitant COPD, who were hospitalized in the gastroenterology department of the Chernivtsi Regional Clinical Hospital. COPD was in a state of stable or unstable remission. The average age of the examined patients was 52.36 ± 1.83 years. The inclusion criterion was vitamin D deficiency diagnosed in patients with chronic pancreatitis and chronic obstructive pulmonary disease. The exclusion criterion was another nosology that could cause disorders of vitamin D metabolism. Results. 57 patients had vitamin D deficiency. No patients with normal vitamin levels were recorded. Thus, the average level of vitamin D in respondents with vitamin D deficiency was 36.13 ± 7.61. After genotyping and distribution according to a specific genotype, a vitamin deficiency correction scheme was selected. Cholecalciferol at a dose of 6000 IU for 2 months was prescribed for the G/G genotype patients. Patients with G/A and A/A genotypes received the same drug at a dose of 8000 IU for 2 months, followed by determination of serum vitamin D levels.Conclusions. For patients with A allele (genotypes AA and AG), the genetic risk of developing vitamin D deficiency is higher than the average population level. For patients with moderate and severe exocrine pancreatic insufficiency and signs of malabsorption syndrome, it is recommended to check not only the level of 25 (OH) D in the serum, but also to determine the polymorphic variant of the VDR gene to approve further treatment tactics - determine the optimal dose and check its effectiveness.

Fecal elastase levels in children diagnosed with functional abdominal pain-not otherwise specified.

Although the exact pathophysiology of functional gastrointestinal diseases remains unclear, numerous etiologies have been blamed, including visceral hypersensitivity, gastrointestinal motility disorders, psychological factors, intestinal mucosal inflammation, intestinal microbiota, and post-infectious syndromes. In the present study, we aimed to evaluate pancreatic insufficient patients diagnosed with functional abdominal pain-not otherwise specified (FAP-NOS) according to Rome IV criteria. The study included a total of 110 patients aged 4-17 years who were diagnosed with FAP-NOS according to Rome IV criteria. The control group consisted of 80 patients with no gastrointestinal disorders and chronic diseases. Glucose, amylase, lipase, pancreatic amylase, immunoreactive trypsinogen (IRT) and fecal elastase (FE-1) levels were examined for each patient. No significant difference was found between the two groups with regard to lipase, pancreatic amylase, IRT, and serum glucose levels. However, the amylase levels were significantly higher and the FE-1 levels were significantly lower in the study group compared to the control group (p=0.007 and p < 0.001). The cut-off value detected in in ROC analysis for the diagnostic value of FE-1 in predicting FAP-NOS was found to be 140.107 μg/g. Based on this value, the sensitivity, specificity, PPV, and NPV of FE-1 were 82.1%, 66.2%, 77%, 73%, respectively. Accordingly, the likelihood of FE-1 in providing a positive value in patients with FAP-NOS was almost 9 times higher than in individuals without FAP-NOS. FE-1 levels were significantly lower in children diagnosed with FAP-NOS and we consider that this difference could be attributed to malabsorption secondary to dysbiosis as there is not enough data.

Оцінка ефективності замісної ферментної терапії зовнішньосекреторної недостатності підшлункової залози у хворих на цукровий діабет та хронічний панкреатит

The study of the combined course of chronic pancreatitis and diabetes mellitus present a particular interest. The purpose of the study was to determine the effectiveness of correction of exocrine pancreatic insufficiency of the pancreas in patients with chronic pancreatitis and diabetes mellitus types 1 and 2 with using of different forms and doses of polyenzyme drugs. Material and methods. 126 patients with diabetes mellitus and chronic pancreatitis were examined. The patients were divided into 2 groups: 1 group included 62 patients with type 1 diabetes mellitus, and 2 group comprised 64 patients with type 2 diabetes. All surveyed patients underwent general clinical, anthropometric, instrumental and laboratory methods of investigation. Patients of both groups were divided into subgroups depending on the method of correction of exocrine pancreatic insufficiency, namely 1.1 and 2.1 subgroups received tableted polyenzyme preparation with minimal lipase activity of 10000 IU as enzyme therapy, and 1.2 and 2.2 subgroups received mini-tableted polyenzyme preparation with minimal lipase activity of 25000 IU. Results and discussion. The use of mini-tableted polyenzyme preparation with minimal lipase activity of 25000 IU according to the results of C13-mixed triglyceride and C13-amylase breath tests was an effective method for the correction of exocrine insufficiency of the pancreas in patients with chronic pancreatitis and diabetes mellitus types 1 and 2. We detected a statistically significant increase of the maximally concentration of 13CO2 between 150 and 210 minutes of the study (up to 9.2±0.4% 1.2 subgroup and up to 9.7±0.5% in patients 2.2 subgroup), as well as the total concentration of 13CO2 in at the end of 360 minutes of the study (up to 19.7±0.6% and up to 27.3±1.1%) according to the results of C13-mixed triglyceride breath tests, p&lt;0,05. Conclusion. The use of a mini-tableted polyenzyme preparation with a minimum lipase activity of 25000 IU was a more effective method for correction of exocrine pancreatic insufficiency in patients with chronic pancreatitis and type 1 and 2 diabetes mellitus, than using a tableted polyenzyme preparation in a dose of 20000 IU per main meal. The study results showed that using C13-mixed triglyceride and C13-amylase breath test were highly informative methods for evaluating the effectiveness of enzyme replacement therapy in exocrine pancreatic insufficiency in patients with chronic pancreatitis and type 1 and 2 diabetes. The use of a mini-tablet polyenzyme drug in patients with chronic pancreatitis and type 1 and 2 diabetes mellitus is an effective means to normalize the manifestations of malabsorption in terms of α1-antitrypsin clearance