Serum Pancreatic Amylase Research Articles

Pathophysiological Effects of Pancreatic Sympathetic Denervation in Acute Necrotizing Pancreatitis in Dogs

The aim of this study was to investigate the influence of the greater splanchnic nerve (GSN) transection on the pathophysiological process of acute necrotizing pancreatitis (ANP). The dogs were divided into a sham operation (SO) group, ANP group, and ANP with bilateral GSN transection (GSNT) group. Dogs in the GSNT group underwent bilateral GSNT immediately after ANP induction. The levels of serum pancreatic amylase (AMY), calcium, high-sensitivity C-reactive protein (HCRP), tumor necrosis factor α (TNF-α), interleukin 10 (IL-10), and neutrophile granulocyte (NEU) counts were monitored dynamically, and the pathological examinations of the pancreas was performed at postoperative day 7. All the parameters among the 3 groups showed no differences before the experiment (P > 0.05). At different postoperative times, the NEU count and serum AMY, TNF-α, HCRP, and IL-10 were significantly increased; however, the serum calcium had decreased in the ANP group versus SO (P < 0.05). The postoperative serum IL-10 and calcium levels were higher, and TNF-α, HCRP, and NEU counts were lower in the GSNT group compared with those in the ANP group (P < 0.05); as for AMY, no significant difference was found between the 2 groups (P > 0.05). The pancreas pathological scoring of the GSNT group was lower versus the ANP group (P < 0.05). Greater splanchnic nerve transection can alleviate development of pathophysiological processes in ANP.

Total amylase, pancreatic amylase and lipase levels in children with epilepsy on valproic acid

Acute pancreatitis associated with valproic acid (VPA) treatment is reported in literature. Amylases however are not specifically originated in the pancreas. Other organs, such as salivary glands, may be involved in causing higher serum activity. Thus, we aimed to investigate whether serum total amylase and particularly its pancreatic isoenzyme and lipase levels are altered in the course of treatment with VPA in children with epilepsy. The study was conducted on 45 children with epilepsy on VPA monotherapy. Trough serum VPA, serum total amylase, lipase, and pancreatic amylase levels were evaluated in the patients and results were compared to a matched control group. Though all patients were asymptomatic for acute pancreatitis, serum total amylase levels were elevated in 40%. Patients with increased levels of total amylase did not differ from the rest of patients regarding the characteristics of epilepsy syndrome or the degree of seizure control. Nevertheless, there was significant positive correlation between total amylase and VPA trough serum levels. Five patients had simultaneous elevation of total amylase, pancreatic isoenzyme and lipase levels, though in none of them reaching three folds the upper limit. They had no symptoms suggestive of acute or intermittent pancreatitis and their ultrasonic examination was normal. Follow up showed normalization of their serum levels. In conclusion, our results demonstrate the limited specificity of total amylase level as a marker for pancreatic injury. Whenever there is suspicion, a workup including pancreatic isoenzymes is advisable. The implication of asymptomatic elevation of pancreatic isoenzymes needs to be further investigated.

Macroamylasemia; a Dilemma in Morbidity.

To the Editor, A one-year-old boy was referred for randomly detected hyperamylasemia. Physical examination was completely normal, including growth parameters. Medical history and family history were unremarkable. In laboratory, the repeated serum amylases were found elevated with the values of 280 IU/mL, 290 IU/mL and 310 IU/mL (N: 10–90 IU/mL) together with a lower urine amylase level of 10.5 IU/mL (N: 25–500 IU/mL). The complete blood count, acute-phase reactants, liver–renal–thyroid functional tests, serum lipase and immunoglobulins were normal. Antibodies against endomysium, gliadin, thyroglobulin, thyroid peroxidase, nucleus and dsDNA were negative. Abdominal ultrasonography and computed tomography (CT) scans were normal. According to these normal findings, hyperamylasemia due to macroamylasemia (MA) was found in patient. An informed consent form to research was obtained from parents. At analysis for MA, a precipitated activity was 87% at polyethylene glycol (PEG) precipitation (MA>60%) (1). Macroenzymes are complexes of serum enzymes commonly with immunoglobulins or lipoproteins that have a higher moleculer weight. Macroamylase is the most common macroenzyme, in which pancreatic or salivary amylase binds to plasma proteins and cannot be excreted by renal glomeruli. Macroamylasemia may be seen either isolated or associated with a variety of disorders, such as IgA deficiency, celiac disease, lymphoma, carcinoma, systemic lupus erithematosus, rheumatoid arthritis, liver disease and various autoimmune diseases (2–4). The pathogenesis of macroenzyme formation in these diseases is estimated by ‘antigen-driven’ theory: a self-antigen is altered or released from a sequestered site in the body and cross-reacts with an antibody initially formed against a foreign antigen. A second theory is the ‘dysregulation of immune tolerance, which is likely to occur in autoimmune disorders (4). The cross-reactivity to either gluten-related or other antigens resulting in autoantibody formation against pancreatic serum amylase at intestinal level is considered (5). The elevated serum amylase, low 24-hour urine amylase and reduced ratio of amylase clearance / creatinine clearance are important at diagnosis. It has been shown that PEG precipitation is also a precise method in the detection of MA by purifying protein from macromolecules more easily and quickly (1). Due to the problem at urine collection, PEG precipitation was preferred in this case. It was considered as isolated MA due to the absence of associated disorders. In conclusion, MA is generally a benign condition, but associated potential disorders should be considered at follow-up. The case highlights the dilemma of additional invasive explorations and unnecessary treatments by differentiating MA from other situations associated to hyperamylasemia.

Factors affecting pancreatic hyperamylasemia in patients undergoing peroral single-balloon enteroscopy.

Acute pancreatitis following balloon-assisted enteroscopy is a rare but serious complication. The causative mechanism is uncertain and prevention strategies are not established. We conducted a retrospective study to clarify the risk factors for pancreatic hyperamylasemia. Eighty-four patients undergoing peroral single-balloon enteroscopy (SBE) were enrolled in this study. Serum pancreatic and salivary amylase levels were measured 2 h after endoscopic examination. We experienced three patients with post-SBE pancreatitis. Factors predicting pancreatic hyperamylasemia were: (i) elderly patients; (ii) deeper insertion; and (iii) clockwise insertion. In contrast, younger age at examination was a significant factor observed in salivary hyperamylasemia. It is important to measure pancreatic amylase and not total amylase after SBE. When carrying out peroral SBE, the distance of insertion should be reduced especially if the scope traces a clockwise loop or the subject is elderly.

Effects of oleuropein on serum inflammatory cytokines and histopathological changes in rats with pancreatitis.

Acute pancreatitis is a severe debilitating disease with high morbidity and mortality. The severity of the disease is largely due to the actions of various inflammatory mediators. No specific therapy is indicated for AP and its treatment remains largely supportive. This study investigated the effect of oleuropein on serum inflammatory cytokines and distant organ injury in rats with acute pancreatitis induced by bile-pancreatic duct obstruction. Thirty adult male Wistar rats were randomly assigned to 3 groups of 10 rats each: group I: sham, group II: pancreatitis and group III: pancreatitis+oleuropein. Rats in Group III received oleuropein 20 mg/kg intragastrically during 10 days before surgery. The rats were sacrificed at 24 h after surgery and venous blood, pancreatic and lung tissue samples were obtained for analysis. A statistically significant difference was found between groups regarding serum amylase, LDH, lipase, pancreatic amylase, IL-6, IL-10 and TNF-α values with a Kruskal-Wallis test (p<0.05). No statistically significant difference was found between Group II and III regarding pairwise comparison of amylase, LDH, lipase, pancreatic amylase, IL-6, IL-10 and TNF-α value by using pairwise comparisons with a Mann-Whitney U test (p>0.01). A statistically significant difference between groups was found regarding edema, inflammation, hemorrhage and acinar cell necrosis in histopathological examination of the pancreas (p<0.05). No difference was found between group II and III (p>0.01). A difference was found between the groups in terms of lung tissue edema (p<0.05) but no difference was found regarding hemorrhage and inflammation (p>0.05). No statistically significant difference was found between group II and III with pairwise comparison (p>0.01). The experimental model used in this study showed to be appropriate for creation of acute pancreatitis. It was concluded that oleuropein as a prophylactic treatment has no protective effect on serum proinflammatory and anti-inflammatory cytokines as well as pancreatic tissue.

Beneficial effect of splanchnic nerve transection and harmful effect of vagotomy on acute necrotizing pancreatitis in the dog.

The nervous system interacts dynamically with the immune system to modulate inflammation through humoral and neural pathways. However, the influence of visceral nerve (VN) on acute necrotizing pancreatitis (ANP) has drawn little attention. To investigate the influence of VN on the pathophysiological process of ANP in dogs. The dogs were divided into a sham operation (SO) group, ANP group, ANP + vagal nerve trunk transection (VNTT) group, and ANP + greater splanchnic nerve transection (GSNT) group. The VNTT and GSNT groups underwent VNTT and GSNT respectively immediately after ANP induction. The levels of serum pancreatic amylase (AMY), calcium, high-sensitivity C-reactive protein (HCRP), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-10 (IL-10) were monitored dynamically and the pathological examinations of the pancreas was performed at postoperative day 7. All serum parameters among the four groups showed no differences before the experiment (p > 0.05). At different postoperative times, the serum TNF-α, IL-1β, HCRP, and AMY were significantly increased, however, the serum calcium and IL-10 had dropped in the ANP group versus SO group (p < 0.05); an alike variation trend occurred between the VNTT group and ANP group (p < 0.05); an opposite variation trend occurred between the GSNT group and the ANP group (p < 0.05). The pancreas pathological scoring of VNTT group was highest in the four groups (p < 0.05) and GSNT group was lower versus ANP group (p < 0.05). The GSNT has been shown to alleviate development of ANP, however, VNTT may exacerbate the ANP.

Protective effect of Emilia sonchifolia on azaserine-induced pancreatic dysplasia

The present study was undertaken to investigate the effect of Emilia sonchifolia on azaserine (O-diazoacetyl-L-serine)-induced pancreatic dysplasia in Wistar albino rats. Administration of azaserine [30 mg/kg body weight intraperitoneal (i.p.) weekly for 1 month] to male Wistar albino rats resulted in pancreatic dysplasia, which was evident from the histopathological studies. A significant decrease of pancreatic and hepatic enzymatic antioxidants like superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST), and non-enzymatic antioxidants like vitamin C, glutathione (GSH) content, and a significant increase in pancreatic serum amylase and lipase, and hepatic marker enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were found. Treatment of rats with the n-hexane extract of Emilia sonchifolia for 16 weeks resulted in a concomitant reduction in pancreatic and hepatic damage. The results suggest that Emilia sonchifolia can be used as a therapeutic agent against precancerous lesions which could prevent pancreatic dysplasia.

Elevation of serum pancreatic amylase and distortion of pancreatic cyto-architecture in type 1 diabetes mellitus rats treated with Ocimum gratissimum.

Background:Diabetes mellitus has been shown to cause severe impairment in exocrine pancreatic function and cyto-architecture. Ocimum grattissimum has been reported to lower blood glucose levels in experimental diabetic animals. This study, therefore, aims to investigate if treatment with O. grattissimum can alleviate these pancreatic complications of diabetes mellitus. The phytoconstituents and median lethal dose of the plant extract were determined.Materials and Methods:Eighteen rats were divided into three groups of six rats each. Diabetes mellitus was induced by single intraperitoneal injection of 65 mg/kg streptozotocin. Group 1 was the control and were given normal feed only; Group 2 was of diabetic untreated rats, while Group 3 was O. grattissimum-treated diabetic rats at a dose of 1,500 mg/kg. After 28 days, blood was collected by cardiac puncture of the anaesthetised animals and the serum was obtained for analysis of serum pancreatic amylase. Permanent preparations using routine biopsy method were employed for histological preparations.Results:Results showed that the level of pancreatic serum amylase in the test groups (diabetic and diabetic-treated) were significantly higher (P < 0.05) than the control group, while the diabetic-treated group was significantly lower than the diabetic group. Atrophic acinar tissue without β-cells was noted in the diabetic and diabetic-treated groups. Patchy areas of necrosis, oedematous interstitium, haemorrhagic and necrotic acinar cells were present in diabetic-treated groups.Conclusion:Direct association exists between the hyperglycaemic state caused by diabetes mellitus and the elevation of the serum pancreatic amylase and distortion of pancreatic cyto-achitecture. O. grattissimum-treatment reduced serum pancreatic amylase level to near normal and limit the extent of structural damage.

Gastric ectopic pancreas: not always an innocent bystander.

A 38-year-old male patient presented to the emergency room due to acute epigastric pain, nausea and vomiting. Physical examination revealed tenderness in the upper abdomen. Body temperature was 37.3°C. C-reactive protein was 113 mg/L (reference range: 0-3 mg/L) and his white blood cell count was raised (15.5 x109/L; reference range: 3.5-8.8 x109/L). Renal and liver function tests and serum pancreatic amylase were normal. He was otherwise healthy and was not taking any medications. Upper gastrointestinal endoscopy showed a subepithelial lesion in the gastric antrum (Figure 1). Abdominal computed tomography scan revealed a heterogeneous 4 cm malignant-looking lesion in the gastric antrum with suspected invasion of the perigastric fat (Figure 2). Endoscopic ultrasound (EUS) confirmed the presence of a subepithelial lesion in the antrum, that had heterogeneous appearance and involved all subepithelial layers of the gastric wall (Figure 3). An EUS-led fine needle aspiration (FNA) showed inflammatory cells only. The patient recovered symptomatically and blood tests normalized within 5 days. However, on the grounds of the imaging findings, malignancy could not be excluded and distal gastrectomy was performed. Histopathology of the surgical specimen confirmed the presence of ectopic pancreas in the gastric antrum (Figure 4a) but showed no cancer. However, there was both chronic and acute inflammation with neutrophil infiltration (Figure 4b). Twelve months following surgery he was asymptomatic.

Increased variability and abnormalities in pancreatic enzyme concentrations in otherwise asymptomatic subjects with type 2 diabetes

BackgroundRecent studies have demonstrated an increased incidence of pancreatitis in patients with type 2 diabetes compared with obese nondiabetic individuals. Serum lipase and pancreatic amylase concentrations are used in conjunction with clinical findings to diagnose pancreatitis.MethodsIn two large clinical trials of overweight/obese nondiabetic and type 2 diabetic subjects, lipase and pancreatic amylase were measured at screening and 2–5 weeks later at baseline (prior to treatment with study medication).ResultsLipase and pancreatic amylase concentrations were above the upper limit of normal (ULN) in 13% and 6% of type 2 diabetic subjects, respectively, and were approximately three-fold (3 ×) higher than the proportion of nondiabetic subjects with levels above ULN. Elevations exceeding ULN were seen in many subjects asymptomatic for pancreatitis; however, elevations >2 × ULN and >3 × ULN were uncommon, and elevations >3 × ULN were often associated with a history of dyslipidemia, hyperlipidemia, and gastrointestinal disorders. Additionally, enzyme concentrations varied within this 2–5-week screening period, including shifts between elevated and normal levels.ConclusionResults from this post hoc analysis suggest that, although pancreatic enzymes can be a useful marker for pancreatitis within the proper clinical context, diagnosis of pancreatitis may be confounded in populations known to have asymptomatic elevations associated with disease, such as type 2 diabetes. Further effort is needed to clarify the etiology and epidemiology of pancreatic enzyme elevations in type 2 diabetes.

Effect of short‐term propofol administration on pancreatic enzymes and lipid biochemistry in children between 1 month and 36 months

Use of propofol in pediatric age group has been marred by reports of its adverse effects like hypertriglyceridemia and acute pancreatitis, although a causal relation has not yet been established. This prospective, clinical trial was carried out to evaluate the effects of short-term propofol administration on serum lipid profile and serum pancreatic enzymes in children of ASA physical status I and II aged between 1month and 36months. Anesthesia was induced with Propofol (1%) in the dose of 3mg·kg(-1) intravenously and was maintained by propofol infusion (0.5%) at the rate of 12mg·kg(-1·) h(-1) for the first 20min and at 8mg·kg(-1·) h(-1) thereafter. The mean dose of propofol administered was 12.02±2.75mg·kg(-1) (fat load of 120.2±27.5mg·kg(-1) ). Lipid profile, serum amylase, and lipase were measured before induction of anesthesia, at 90min, 4h, and finally 24h after induction. Serum lipase levels (P<0.05), serum triglyceride levels (P<0.05), and serum very low-density lipoproteins VLDL levels (P<0.05) were raised significantly after propofol administration from baseline although remained within normal limits. Serum cholesterol levels and serum low-density lipoproteins LDL levels showed a statistically significant fall over 24h. No significant changes in serum pancreatic amylase levels were seen (P>0.05). None of the patients developed any clinical features of pancreatitis in the postoperative period. We conclude that despite a small, transient increase in serum triglycerides and pancreatic enzymes, short-term propofol administration in recommended dosages in children of ASA status I and II aged between 1month and 36months does not produce any clinically significant effect on serum lipids and pancreatic enzymes.

Pancreatic exocrine function and cardiac iron in patients with iron overload and with thalassemia

Patients with β-thalassemia major at risk of cardiac iron overload have to be identified to undergo myocardial iron measurements by magnetic resonance imaging (MRI), especially, in areas and centers with restricted access to MRI. Measurements of heart iron, liver iron, and pancreatic exocrine function were performed in 44 patients by MRI-R2* [the transverse relaxation rate R2* (= 1/T2*) characterizes the magnetic resonance decay from protons not being in phase with each other in contrast to R2 (= 1/T2)], biomagnetic liver susceptometry (LIC), and pancreatic serum amylase (PAM) and lipase (LIP), respectively. ROC analysis (area: 0.88) for detecting patients with cardiac R2* > 50 sec(-1) (T2* < 20 msec) by LIP revealed a cut-off level of 19 U/L. In conclusion, patients at risk of elevated cardiac iron levels could be identified by the exocrine pancreatic lipase and amylase function parameters.

Agenesis of the dorsal pancreas: a rare cause of diabetes

A 19-year-old Japanese man visited our department presenting with glycosuria that had been detected during a routine school urinalysis. The patient had undergone cardiac surgery at the age of 4 years for atrial and ventricular septal defects, and pulmonary artery stenosis. He denied any history of abdominal trauma, drug or alcohol intake, or gastrointestinal problems. His maternal grandmother had mild diabetes that began in middle age; whereas, his parents had no significant medical history including diabetes. The physical examination revealed an emaciated young man with a body mass index of 19.3, but otherwise a normal examination. Laboratory studies were: fasting hyperglycaemia of 19.7 mmol/l (354 mg/dl) without ketosis. The HbA1c was 12.1%, urinary excretion of C-peptide 43.9 lg/day (normal range 50–100 lg/day). The anti-islet cell and anti-glutamic acid decarboxylase antibodies were negative. The serum total amylase level was normal, 49 U/l (normal range 40–180 U/l); whereas, the levels of serum pancreatic enzymes p-type amylase, lipase, trypsin and phospholipase A2 were decreased to 8 U/l (normal range 17–50 U/l), 10 U/l (13–49 U/l), 50 U/l (100–550 U/l) and 100 U/l (130–400 U/l), respectively. Ultrasonography (US) of the abdomen could not identify the body of the pancreas, although the head and uncus were clearly visible. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed that most of the body and the tail of the pancreas were absent, and that the pancreatic head was slightly enlarged (Fig. 1). Magnetic resonance cholangiopancreatography (MRCP) revealed that the dorsal pancreatic duct was absent. Based on these findings, a diagnosis of agenesis of the dorsal pancreas was made. Insulin replacement therapy was initiated, and currently, the diabetes is well controlled with 4 U of insulin per day. There are no signs of any diabetes-related renal, retinal or neurological changes. His blood glucose levels have improved after beginning insulin therapy, and he is being followed up as a hospital outpatient.

Risk factors associated with elevated serum pancreatic amylase levels during hemodialysis

Elevated levels of serum pancreatic enzymes are frequently observed in hemodialysis (HD) patients. The complex hemodynamic, biochemical, and physiological alterations in uremia were speculated to cause excessive release of pancreatic enzymes beyond decreased renal clearance. However, hemodynamic factors are seldom explored in this aspect. We performed the study to evaluate the association between intradialytic hemodynamic change and elevated serum pancreatic amylase (SPA). Eighty-three prevalent HD patients without any clinical evidence of acute pancreatitis underwent pre-HD and post-HD blood sampling for serum pancreatic enzyme levels. Demographic, biochemical, and hematological data were collected from patient record review. Hemodialysis information including intradialytic blood pressure changes and ultrafiltration (UF) amount were collected and averaged for 1 month before the blood sampling day. Patients with elevated SPA during the HD session had greater mean systolic blood pressure and mean arterial pressure reduction, greater UF volume, greater pre-HD blood urea nitrogen and serum creatinine, higher serum phosphorus, lower pre-HD serum total CO2, and lower left ventricle ejection fraction (LVEF). Using multivariate linear and logistic regression analysis, the independent predictors of elevated SPA were determined to be mean arterial pressure reduction during HD, mean UF amount, pre-HD serum total CO2, and LVEF. Greater blood pressure reduction during HD, greater UF volume, lower pre-HD serum total CO2, and lower LVEF were significantly associated with elevated SPA during HD. This suggests that hemodynamic factors contribute to elevated serum pancreatic enzymes in HD patients.

The Effects of Propofol Infusion on Hepatic and Pancreatic Function and Acid-Base Status in Children Undergoing Craniotomy and Receiving Phenytoin

In this study, we investigated the effects of propofol infusion on hepatic and pancreatic enzymes and acid-base status compared with baseline values in children undergoing craniotomy who were receiving phenytoin for antiepileptic prophylaxis. In this prospective clinical study, we measured the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), pancreatic amylase, lipase, and triglyceride levels of 30 children ranging from 4 to 12 yr. All children received propofol anesthesia and were taking phenytoin for antiepileptic prophylaxis. Patients already receiving phenytoin were continued on their medication. Peroral 5 mg x kg(-1) x d(-1) phenytoin was started in patients who were not receiving phenytoin. Serum AST, ALT, GGT, ALP, bilirubin, pancreatic amylase, lipase, and triglyceride levels were studied on admission to the hospital, 1 day before surgery, and on postoperative Days 1, 3, 5, and 7. Arterial blood gas samplings were taken after tracheal intubation, during the operation (2nd and 4th h), just after extubation, and 1, 2, 6, and 12 h after extubation. Serum AST, ALT, GGT, ALP, pancreatic amylase, lipase, and triglyceride levels were increased significantly in the postoperative period compared with baseline with a peak value on postoperative Day 1 and returned to normal values within a week. Base excess levels after extubation were significantly decreased compared with baseline. They were in the normal range, however, and returned to baseline values by 6 h after surgery. There were no clinical signs of hepatitis or pancreatitis. Bilirubin levels were normal. None of the children developed complications related to the liver or pancreas during the 4-6 mo after surgery. Despite the slightly increased pancreatic and hepatic enzyme levels during the postoperative period, anesthesia maintenance with propofol in children undergoing craniotomy had no significant clinical effect on the acid-base status or pancreas or liver enzymes.

Recurrent acute pancreatitis caused by intra-ampullary carcinoid tumor

View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image A 59-year-old nurse with a history of cholecystectomy for cholelithiasis and 2 episodes of moderate abdominal pain associated with nausea 3 months previously was referred to our department for ERCP; 2 isolated serum pancreatic amylase values were 795 and 820 IU/L (normal <30 IU/L). MRCP demonstrated dilation of the pancreatic duct but not of the common bile duct. ERCP revealed an enlarged yellowish ampulla and a bit of pale tissue protruding from the papillary orifice (A). Moreover, a small choledochoduodenal fistula was observed in the base of the papilla, explaining why the common bile duct was not dilated. Endoscopic sphincterotomy opened the ampulla and revealed a small polypoid tumor (B). The tumor was inadvertently sectioned by the sphincterotome, causing bleeding that was easily stopped by injection of 4 mL of adrenaline solution (1:10,000). The tumor was collected with a small Roth net, and histologic evaluation showed a nest of neuroendocrine cells (C, H&E orig. mag. ×40). Chromogranin (D, orig. mag. ×40) and synaptophysin (E, orig. mag. ×40) stains confirmed the diagnosis. All margins were negative for tumor infiltration. EUS, performed 1 month later, revealed no residual tumor or ductal obstruction. The patient recovered uneventfully and remained well for the next 4 months. View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image

Probiotic Agent Saccharomyces boulardii Reduces the Incidence of Lung Injury in Acute Necrotizing Pancreatitis Induced Rats

Acute necrotizing pancreatitis is a severe acute inflammatory disease of the pancreas that can lead to extrapancreatic organ involvement. Supervening lung injury is an important clinical entity determining the prognosis of the patient. Probiotics are dietary supplements known to reduce or alter inflammation and inflammatory cytokines. In the present study, we hypothesize that probiotics may reduce lung injury by reducing bacterial translocation, which results in reduced infection, inflammation, and generation of proinflammatory cytokines in an experimental model of acute necrotizing pancreatitis. Pancreatitis was induced by concomitant intravenous infusion of cerulein and glycodeoxycholic acid infusion into the biliopancreatic duct. Saccharomyces boulardii was used as the probiotic agent. Rats were divided into three groups: sham, pancreatitis-saline, which received saline via gavage at 6 and 24 h following the pancreatitis, pancreatitis-probiotics, which received probiotics via gavage method at 6 and 24 h following the pancreatitis. The rats were sacrificed at 48 h, venous blood, mesenteric lymph node, pancreatic and lung tissue samples were obtained for analysis. Serum pancreatic amylase, lactate dehydrogenase, secretory phospholipase A(2), and IL-6 were found to be increased in pancreatitis-saline group compared with the other groups (P < 0.05). Histological analyses revealed that edema, inflammation, and vacuolization as well as polymorphonuclear leukocyte infiltration in the lung tissue was significantly reduced in the probiotic treated group. Bacterial translocation was significantly reduced in the probiotic treated group compared with the other groups (P < 0.05). These results suggest that Saccharomyces boulardii reduce the bacterial translocation. As a result of this, reduced proinflammatory cytokines and systemic inflammatory response was observed, which may be the reason underlying reduced lung injury in acute necrotizing pancreatitis.

Reversal of elevated pancreatic enzymes after Helicobacter pylori eradication

Chronic pancreatitis is a syndrome involving progressive inflammatory changes in the pancreas that result in permanent structural damage, and ultimately impairment of exocrine and endocrine function [1]. In the last 2 years we observed five patients referred for possible chronic pancreatitis based on moderately elevated levels of serum amylase and lipase and abnormal ultrasonographic imaging (Table 1). Family history of chronic pancreatitis (hereditary pancreatitis) was negative and none of the patients were receiving drugs known to cause pancreatic damage. Cessation of alcohol intake and small meals low in fat was the only treatment undertaken from the patients. All patients had active H. pylori infection, with a histological diagnosis of chronic active gastritis, without peptic ulcer disease. Eradication treatment was given with omeprazole, tetracycline-HCL, metronidazole and colloidal bismuth subcitrate taken with the midday and evening meals for 10 days [2]. C-Urea Breath test was repeated 4–6 weeks after the end of treatment and all patients resulted cured. Serum pancreatic amylase and lipase levels were re-evaluated after 3, 6 and 10–12 months in two different laboratories and resulted persistently normal (Table 1). A potential role of H. pylori infection in several extraintestinal pathologies has been suggested [3] and a link between gastric infection by H. pylori and autoimmune pancreatitis has been hypothesized [4]. Interestingly, in a recent study, Helicobacter DNA was detected in pancreas, including tumor tissue and surrounding pancreas of 75% of patients with pancreatic cancer, and 60% of patients with chronic pancreatitis, suggesting a possible role of H. pylori in the development of chronic pancreatitis and pancreatic

A Soft Pancreatic Remnant is Associated with Increased Drain Fluid Pancreatic Amylase and Serum CRP Levels Following Pancreatoduodenectomy

The aim of this prospective study was to clarify differences in postoperative changes of serum or drainage fluid pancreatic amylase levels and serum C-reactive protein (CRP) levels between patients with a soft pancreatic texture and those with a hard pancreatic texture undergoing pancreatoduodenectomy (PD) with pancreaticogastrostomy. A total of 61 consecutive patients with resectable periampullary tumors undergoing PD were recruited. This population was divided into 27 patients with a hard pancreatic texture and 34 patients with a soft pancreatic texture. Drainage fluid total amylase or pancreatic amylase levels, serum total amylase or pancreatic amylase levels, and serum CRP levels were measured postoperatively. Clinicopathological data were also compared between two groups. Postoperative complications more frequently occurred in patients with a soft pancreatic texture compared with those with a hard pancreatic texture (P = 0.029). Serum or drainage fluid pancreatic amylase levels and serum CRP levels of patients with a soft pancreatic texture were significantly higher than those of patients with a hard pancreatic texture after PD on postoperative days 1 and 2 (P < 0.05). A soft pancreatic texture was identified as an only independent predictive factor of increased drainage fluid pancreatic amylase levels (P = 0.006) and serum CRP levels (P = 0.047). A soft pancreatic texture is closely associated with increased drainage fluid pancreatic amylase and serum CRP levels after PD. More careful post-PD management is needed for patients with a soft pancreatic texture.

An increase in the serum amylase level in patients after peroral double-balloon enteroscopy: an association with the development of pancreatitis

Double-balloon enteroscopy (DBE) is a novel technique that allows the enteroscope to be inserted deep into the small intestine. The procedure has been thought to be safe, but cases of acute pancreatitis after peroral DBE have recently been observed. The aim of this study was to confirm the occurrence of hyperamylasemia after peroral DBE. Peroral DBE was carried out in 13 patients from July 2005 to February 2006. Blood samples were taken before and 3 h after the procedure, and serum pancreatic amylase levels were measured. The patients were also evaluated for pancreatic-type abdominal pain after the procedure. Hyperamylasemia after peroral DBE was defined as an elevation of the serum pancreatic amylase level to more than the upper normal limit and twice the level before the procedure. Pancreatitis was diagnosed on the basis of both pancreatic-type abdominal pain and hyperamylasemia. Hyperamylasemia after peroral DBE occurred in six patients (46.2 %). One of the six patients with hyperamylasemia had pancreatic-type abdominal pain after the procedure and developed acute pancreatitis. The average procedure time was 105 min (range 65 - 155 min) in the patients with hyperamylasemia, and did not significantly differ from that in the group without hyperamylasemia (99 min). Hyperamylasemia after peroral DBE occurs frequently and may be associated with development of pancreatitis.