Pancreatic Insufficient Patients Research Articles

Practical use of modern guidelines for the diagnosis and treatment of exocrine pancreatic insufficiency in patients with chronic pancreatitis

The article presents a review of current European and Russian guidelines on diagnostics and treatment of exocrine pancreatic insufficiency in patients with chronic pancreatitis. Results of our own comparative study on treatment of 55 chronic pancreatitis patients with low and adequate doses of pancreatic enzyme replacement therapy (PERT) confirm the need for usage of recommended doses of modern micronized polyenzyme drugs since it improves both clinical manifestation and nutritional status in such patients unlike the lower doses. Our research findings show that the optimal criterium for PERT efficacy assessment is the normalization of antropometric and biochemical nutritional markers.

Relationships between adipocytokinemia and exocrine pancreatic insufficiency in patients with combined course of type 2 diabetes mellitus and chronic pancreatitis

Relationships between adipocytokinemia and exocrine pancreatic insufficiency in patients with combined course of type 2 diabetes mellitus and chronic pancreatitis

Effect of cooking methods and intestinal conditions on lipolysis, proteolysis and xanthophylls bioaccessibility of eggs

Digestibility of macro and micronutrients depends on the ingested food as well as on gastrointestinal conditions, being those suboptimal in exocrine pancreatic insufficiency (EPI) patients. Under this scenario, oral enzyme supplementation improves enzymatic hydrolysis of nutrients. In this study, a static in vitro model was used to assess lipids and protein digestibility as well as lutein and zeaxanthin bioaccessibility of eggs cooked differently and submitted to different intestinal conditions. Boiled, poached and omelette eggs were digested under different intestinal conditions of pH (6 or 7), bile concentration (1 or 10 mM) and doses of the enzyme supplement (1000–4000 LU/g fat). Results showed that poaching resulted in higher digestibility of lipids and proteins, compared to boiling or omelette preparations, under gastrointestinal conditions of EPI (pH 6, bile 1 mM). Concerning xanthophylls bioaccessibility, boiling and poaching led to higher bioaccessibility of lutein and zeaxanthin than omelette under EPI conditions.

1064 - Selenium Deficiency is Associated with Exocrine Pancreatic Insufficiency in Patients with Chronic Pancreatitis

1064 - Selenium Deficiency is Associated with Exocrine Pancreatic Insufficiency in Patients with Chronic Pancreatitis

PGI24 - Economic Impact of Treatment Adherence in Exocrine Pancreatic Insufficiency (EPI) Patients Treated with Pancreatic Enzyme Replacement Therapy (PERT)

PGI24 - Economic Impact of Treatment Adherence in Exocrine Pancreatic Insufficiency (EPI) Patients Treated with Pancreatic Enzyme Replacement Therapy (PERT)

Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up. PANCR-EVOL Study

Exocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL). This was a cross-sectional, multicenter Spanish study. CP patients without follow-up by a gastroenterologist or surgeon in at least 2 years were included. EPI was defined as fecal elastase test <200 mcg/g. For nutritional assessment, laboratory and anthropometric data were obtained. QoL was investigated using the EORTC QLQ-C30 questionnaire. 64 patients (mean age 58.8 ± 10.3 years, 85.9% men) from 10 centers were included. Median time since diagnosis of CP was 58.7 months [37.7–95.4]. Forty-one patients (64.1%) had EPI. Regarding nutritional status, the following differences were observed (EPI vs. Non-EPI): BMI (23.9 ± 3.5 kg/m2 vs. 25.7 ± 2.5, p = 0.03); glucose (121 [96–189] mg/dL vs. 98 [90–116], p = 0.006); HbA1c 6.6% [6.0–8.4] vs. 5.5 [5.3–6.0], p = 0.0005); Vitamin A (0.44 mg/L [0.35–0.57] vs. 0.53 [0.47–0.63], p = 0.048) and Vitamin E (11.2 ± 5.0 μg/ml vs. 14.4 ± 4.3, p = 0.03). EPI group showed a worse EORTC QLQ-C30 score on physical (93.3 [66.7–100] vs. 100 [93.3–100], p = 0.048) and cognitive function (100 [83.3–100] vs. 100 [100–100], p = 0.04). Prevalence of EPI is high in patients with CP without follow-up. EPI group had higher levels of glucose, lower levels of vitamins A and E and worse QoL. la insuficiencia pancreática exocrina (IPE) es una importante complicación de la pancreatitis crónica (PC). Las guías recomiendan el seguimiento de la IPE en PC, para identificar a aquellos pacientes que puedan beneficiarse del tratamiento enzimático sustitutivo. El objetivo de este estudio fue evaluar la prevalencia de IPE en pacientes con PC sin seguimiento en los últimos 2 años y describir su estado nutricional y calidad de vida (QoL). estudio trasversal, multicéntrico, español. Se incluyeron pacientes con PC sin seguimiento por un gastroenterólogo/cirujano en los últimos 2años. Se definió IPE como elastasa fecal<200mcg/g. Se recogieron parámetros de laboratorio y datos antropométricos para el análisis nutricional. Para la evaluación de QoL se utilizó el cuestionario EORTC QLQ-C30. se incluyeron prospectivamente 64 pacientes (58,8±10,3 años, media 85,9%) de 10 centros. Tiempo medio desde el diagnóstico de PC: 58,7meses [37,7-95,4]. 41 pacientes (64,1%) tenían IPE. Estado nutricional: se observaron las siguientes diferencias (IPE vs No-IPE): IMC (23,9±3,5 kg/m2 vs. 25,7±2,5,p=0,03); glucosa 121 [96-189] mg/dL vs. 98 [90-116];p =0,006); HbA1c 6,6% [6,0-8,4] vs. 5,5 [5,3-6,0],p=0,0005); Vitamina-A (0,44 mg/L [0,35-0,57] vs. 0,53 [0,47-0,63],p=0,048), Vitamina-E (11,2±5,0 μg/ml vs. 14,4±4,3,p=0,03). El grupo de IPE mostró una peor puntuación en el EORTC QLQ-C30 en las funciones física (93,3 [66,7-100] vs. 100 [93,3-100], p=0,048) y cognitiva (100 [83,3-100] vs. 100 [100-100],p=0,04). la prevalencia de IPE en pacientes con PC sin seguimiento es elevada. En el grupo de IPE se observaron niveles elevados de glucosa, bajos de vitaminas A y E y peor calidad de vida.

Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up. PANCR-EVOL Study

Background/objectivesExocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL). MethodsThis was a cross-sectional, multicenter Spanish study. CP patients without follow-up by a gastroenterologist or surgeon in at least 2 years were included. EPI was defined as fecal elastase test <200mcg/g. For nutritional assessment, laboratory and anthropometric data were obtained. QoL was investigated using the EORTC QLQ-C30 questionnaire. Results64 patients (mean age 58.8±10.3 years, 85.9% men) from 10 centers were included. Median time since diagnosis of CP was 58.7 months [37.7–95.4]. Forty-one patients (64.1%) had EPI. Regarding nutritional status, the following differences were observed (EPI vs. Non-EPI): BMI (23.9±3.5kg/m2 vs. 25.7±2.5, p=0.03); glucose (121 [96–189] mg/dL vs. 98 [90–116], p=0.006); HbA1c 6.6% [6.0–8.4] vs. 5.5 [5.3–6.0], p=0.0005); Vitamin A (0.44mg/L [0.35–0.57] vs. 0.53 [0.47–0.63], p=0.048) and Vitamin E (11.2±5.0μg/ml vs. 14.4±4.3, p=0.03). EPI group showed a worse EORTC QLQ-C30 score on physical (93.3 [66.7–100] vs. 100 [93.3–100], p=0.048) and cognitive function (100 [83.3–100] vs. 100 [100–100], p=0.04). ConclusionsPrevalence of EPI is high in patients with CP without follow-up. EPI group had higher levels of glucose, lower levels of vitamins A and E and worse QoL.

Evidence-based pancreatology 2016–2017 (review of results of research on chronic pancreatitis)

The article reviews the European recommendations on diagnostics and treatment of chronic pancreatitis, pain relief upon chronic pancreatitis. The results of evidenceased studies on risk factors of functional pancreatic insufficiency in patients with chronic pancreatitis, assessments of the informative value of various imaging methods, treatment of pancreatic insufficiency, markers of pancreatic fibrosis are analyzed. A conclusion is drawn on the need for further conduction of evidence-based research.

Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up: Nutritional status and quality of life. PANCR-EVOL study

Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up: Nutritional status and quality of life. PANCR-EVOL study

Practical approaches to diagnostic and treatment of exocrine pancreatic insufficiency in patients with diabetes mellitus

In the review the state-of-the-art practical approaches to diagnostics and treatment of exocrine pancreatic insufficiency in patients with diabetes mellitus are discussed. It has underlined potencial pathogenetic mechanisms of development of exocrine pancreatic insufficiency and its frequency in patients with diabetes mellitus, recognized using modern diagnostic methods, such as determination of fecal elastase 1 level and 13С-triglyceride breath test. In details it has discussed the principles of correction of exocrine pancreatic insufficiency, use of modern drugs and the main causes of failure of pancreatic enzyme replacement therapy in patients with diabetes mellitus.

Pancreatic Enzyme Replacement Therapy and Coefficient of Fat Absorption in Children and Adolescents With Cystic Fibrosis.

Pancreatic enzyme replacement therapy (PERT) is the proven therapy to substantially reduce fat malabsorption in patients with cystic fibrosis (CF). Few details of the daily practice regarding PERT and the resulting coefficient of fat absorption (CFA) are known. We therefore recorded the PERT and CFA in a large cohort of pancreatic insufficient pediatric patients with CF. We retrospectively studied 1719 completed 3-day dietary food records, including the pancreatic enzyme intake registrations, and 1373 CFA assessments of 224 patients with CF, ages 0-17 years. The clinical characteristics, PERT, expressed as an intake of lipase unit (LU) per gram of fat per day and LU per kilogram per day, and the CFA were described for the group as a whole and separately for those on enteral tube feeding. Cross-sectional relationship between the CFA and the LU per gram of fat per day and LU per kilogram per day were determined for each year of age. We also addressed the effect of the interventions done in patients with CFA outcomes <85%. The LU per gram of fat per day was relatively stable throughout the age groups, whereas the LU per kilogram per day fell markedly with age. The median CFA in the age group 17 varied between 86% and 91%, however, with a CFA below 85% in 325 of 1373 (24%) of the measurements. No relationship was found between PERT and CFA. The patients with persistent CFA less than 85% had significant lower z scores weight for age and weight for height (P = 0.01) than those with CFA at least 85%. In this study population, no correlation between an enzyme dosage and the degree of fat malabsorption was found; however, a CFA below 85% was found in 24% of the measurements.

239 Intake of pancreatic enzymes: Consistent with the guidelines?

Objectives Pancreatic enzyme (PE) replacement therapy is required in pancreatic insufficient CF patients to prevent malnutrition, nutrient deficiency and control abdominal maldigestion symptoms. This study evaluates and compares the actual PE intake with current expert recommendations (ER). Methods The dietary intake, measured by a 3-day dietary diary with PE intake (Creon® 10000, 25000 and 40000) for each meal was reviewed during a dietary consult. Intake is compared to the ER expressed as lipase units (IU)/g fat, /kg body-weight (BW)/day and /kgBW/meal. Results are presented as median (range). Results 54 patients [age 12.8 y (1, 50); 27 males] with BMI z-score –0.3 (–1.9, 1.5) and FEV1% 85.7 (31.8,114.1) (n = 43) were included. Results are presented in the table. TableComparison of PE intake with expert recommendationsGuidelineNumber of patientsTotalIntake greater than advised intakeIn accordance with advised intaken (%)Intake, median (range)n (%)Intake, median (range)Child: 400–800 IU/g fat2424 (100%)5,885 (1,106–13,875)–Adolescent-adult: 4,000 IU/g fat3026 (87%)7,316 (3,220–16,888)4 (13%)2,983 (2,857–3,135)10,000 IU/kgBW/d5440 (74%)18,753 (10,110–36,194)14 (26%)6,996 (2,455–9,711)2,000 IU/kgBW/meal5442 (78%)4,445 (2,210–8,691)12 (22%)1,398 (1,052–1,973) Conclusion The majority of our patients has a pancreatic enzyme intake above the current recommendations without known side effects. Research is needed to formulate recommendations based on achieving optimal digestion rather than using a protective dosing strategy.

295 Cognition in adult patients with cystic fibrosis (CF) with and without cystic fibrosis related diabetes (CFRD)

Objectives Impaired glucose tolerance (IGT), type 1 (T1DM) and type 2 diabetes mellitus (T2DM) have deleterious effects on cognitive performance. Hence, patients with cystic fibrosis related diabetes (CFRD) are hypothesized to show similar impairment. This study aimed to elucidate the nature and severity of any cognitive impairment in patients with CFRD compared to non-diabetic patients with CF and healthy controls matched as closely as possible for age, gender and education level. Patients with CF were also matched as closely as possible on CFTR genotype. Methods Adult (>16 years old), pancreatic insufficient patients registered to the Leeds CF Unit who had adequate verbal and written English were eligible. To date, 45 patients with insulin-treated CFRD and 47 non-diabetics who had received a normal oral glucose tolerance test (OGTT) within the past 12 months were included. 10 healthy controls were recruited to date from relatives of patients and the general population. Cognitive performance was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Results Preliminary findings show that matched controls perform better than both groups of patients with CF on tests of visual memory and learning, verbal memory, visual sustained attention and executive function. Patients with CFRD performed worse than controls on tests of mental flexibility and visual sustained attention, which is consistent with the pattern of impairment shown in T1DM, and on verbal memory, which is consistent with the pattern of impairment shown in T2DM. Conclusion Like T1DM and T2DM, CFRD may have a negative impact on cognitive performance and needs to be explored.

A Look Inside the Pancreas: The Endocrine-Exocrine Cross-talk?

Though the pancreas has traditionally been considered a combination of two separate organ systems, both the exocrine and endocrine portions are structurally and functionally interrelated. Disease processes diffusely involving the pancreas can give rise to both endocrine and exocrine dysfunctions and pancreatic diseases account for less than 0.5% of all cases of diabetes. Chronic pancreatitis and fibrocalculous pancreatic diabetes are the two most common diseases of the exocrine pancreas which can give rise to beta cell dysfunction and diabetes. On the contrary, prominent changes in the structure and functions of the exocrine pancreas have been identified in a significant number of the commonly encountered forms of diabetes, where exocrine insufficiency is unexpected otherwise. A number of hypotheses have been put forward by different workers at different time frames to explain the mechanisms of exocrine pancreatic insufficiency in patients with primary pancreatic endocrine dysfunction. Though the frequency of exocrine insufficiency seems quite high in the literature, paucity of data exists on the beneficial effect of enzyme supplementation in diabetes patients with/without exocrine abnormality.

Exocrine pancreatic insufficiency in patients with pancreatic or peri-ampullary cancer: A systematic review

Exocrine pancreatic insufficiency in patients with pancreatic or peri-ampullary cancer: A systematic review

Pancreatic endocrine and exocrine function in children following near-total pancreatectomy for diffuse congenital hyperinsulinism.

ContextCongenital hyperinsulinism (CHI), the commonest cause of persistent hypoglycaemia, has two main histological subtypes: diffuse and focal. Diffuse CHI, if medically unresponsive, is managed with near-total pancreatectomy. Post-pancreatectomy, in addition to persistent hypoglycaemia, there is a very high risk of diabetes mellitus and pancreatic exocrine insufficiency.SettingInternational referral centre for the management of CHI.PatientsMedically unresponsive diffuse CHI patients managed with near-total pancreatectomy between 1994 and 2012.InterventionNear-total pancreatectomy.Main Outcome MeasuresPersistent hypoglycaemia post near-total pancreatectomy, insulin-dependent diabetes mellitus, clinical and biochemical (faecal elastase 1) pancreatic exocrine insufficiency.ResultsOf more than 300 patients with CHI managed during this time period, 45 children had medically unresponsive diffuse disease and were managed with near-total pancreatectomy. After near-total pancreatectomy, 60% of children had persistent hypoglycaemia requiring medical interventions. The incidence of insulin dependent diabetes mellitus was 96% at 11 years after surgery. Thirty-two patients (72%) had biochemical evidence of severe pancreatic exocrine insufficiency (Faecal elastase 1<100 µg/g). Clinical exocrine insufficiency was observed in 22 (49%) patients. No statistically significant difference in weight and height standard deviation score (SDS) was found between untreated subclinical pancreatic exocrine insufficiency patients and treated clinical pancreatic exocrine insufficiency patients.ConclusionsThe outcome of diffuse CHI patients after near-total pancreatectomy is very unsatisfactory. The incidence of persistent hypoglycaemia and insulin-dependent diabetes mellitus is very high. The presence of clinical rather than biochemical pancreatic exocrine insufficiency should inform decisions about pancreatic enzyme supplementation.

Vitamin D Status in Children with Cystic Fibrosis. Associations with Inflammation and Bacterial Colonization

Patients with cystic fibrosis (CF) have high rates of vitamin D insufficiency. The relation between vitamin D status and inflammation in patients with CF is poorly understood. To determine the prevalence of vitamin D deficiency and insufficiency in a young CF population and to examine correlations between vitamin D status, disease severity, and inflammatory markers. This was a retrospective chart review of patients with CF under the age of 12 years. Serum laboratory parameters, growth indices, pancreatic status, CFTR genetics, medications, microbiology, and presence of CF-related comorbidities were collected for patients who had fat-soluble vitamin levels measured between January 1, 2009 and December 31, 2011. Vitamin D deficiency was defined as a serum 25(OH)D less than 20 ng/ml and insufficiency as serum 25(OH)D 20 to 29.9 ng/ml. Associations between serum vitamin D concentration and clinical/inflammatory markers were assessed using Chi-square and t tests. Data were collected for 148 children. The mean serum 25(OH)D concentration was 32.4 ng/ml (SD, 8.9). Seven percent (10 of 148) were vitamin D deficient, and 36% (53 of 148) were vitamin D insufficient. Among the pancreatic-sufficient patients, 50% (14 of 28) were vitamin D insufficient/deficient, whereas among pancreatic-insufficient patients, 41% (49 of 120) were vitamin D insufficient/deficient. Pseudomonas aeruginosa was a more common pathogen in the patients who were vitamin D insufficient/deficient (18 of 63 vs. 11 of 85, P = 0.018). There was no difference between vitamin D-sufficient versus -insufficient groups in terms of other bacterial colonization or inflammatory markers. Overall, vitamin D insufficiency is common among young children with CF. Vitamin D insufficiency is prevalent even in children who are pancreatic sufficient. In this population, vitamin D insufficiency is associated with a history of Pseudomonas colonization but not with classic markers of systemic inflammation.

Low prevalence of exocrine pancreatic insufficiency in patients with diabetes mellitus

IntroductionExocrine pancreatic insufficiency (EPI) can occur in patients with diabetes mellitus (DM). Incidence of EPI and its clinical significance remain poorly defined. The aim of our study was to determine whether exocrine pancreatic function is impaired in patients with DM. Patients and methodsOne hundred and fifty consecutive patients, mean age 59.0 (±12.0 years), with DM lasting at least 5 years were included in the study. We included 50 patients with type 1 DM (DM1), 50 insulin-treated patients DM type 2 (DM2-insulin) and 50 non-insulin treated patients with DM type 2 (DM2 no-insulin). Diagnosis of DM was established from health records, lasting 15.0 ± 9.9 years on average. EPI was diagnosed with a fecal elastase-1 concentration (FE1) of less than 200 μg/g (ELISA). ResultsFE1 was reduced in 8 (5.4%) patients: mildly reduced (100–200 μg/g) in 4 patients (2.7%) and markedly reduced (<100 μg/g) in 4 patients (2.7%). Frequency of EPI was 3 in DM1, 5 in DM2(insulin) and none in DM2 (no-insulin) groups. ConclusionsEPI in DM occurred less frequently than in previous studies, probably due to our strict exclusion criteria (age, alcohol intake).

Risk of endocrine pancreatic insufficiency in patients receiving adjuvant chemoradiation for resected gastric cancer

BackgroundAdjuvant radiotherapy combined with 5-fluorouracil based chemotherapy has become the new standard after curative resection in high risk gastric cancer. Beside many complications due to surgery, the addition of chemotherapy and radiotherapy as adjuvant treatment may lead to both acute and late toxicities. Pancreatic tissue irradiation during this adjuvant treatment because of incidental and unavoidable inclusion of the organ within the radiation field may affect exocrine and endocrine functions of the organ. Materials and methodsFifty-three patients with gastric adenocarcinoma were evaluated for adjuvant chemoradiotherapy after surgery. While 37 out of 53 patients were treated postoperatively due to either serosal or adjacent organ or lymph node involvement, 16 patients without these risk factors were followed up regularly without any additional treatment and they served as the control group. Fasting blood glucose (FBG), hemoglobin A1c (HBA1c), insulin and C-peptide levels were measured in the control and study groups after the surgery and 6months and 1year later. ResultsAt the baseline there was no difference in FBG, HbA1c, C-peptide and insulin levels between the control and the study groups. At the end of the study there was a statistically significant decline in insulin and C-peptide levels in the study group, (7.5±6.0 vs 4.5±4.4IU/L, p: 0.002 and 2.3±0.9 vs 1.56±0.9ng/ml, p: 0.001) respectively. ConclusionsAdjuvant radiotherapy in gastric cancer leads to a decrease in beta cell function and insulin secretion capacity of the pancreas with possible diabetes risk. Radiation-induced pancreatic injury and late effects of radiation on normal pancreatic tissue are unknown, but pancreas is more sensitive to radiation than known. This organ should be studied extensively in order to determine the tolerance doses and it should be contoured during abdominal radiotherapy planning as an organ at risk.

Exocrine pancreatic insufficiency in patients with celiac disease

Exocrine pancreatic insufficiency in patients with celiac disease