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Associations with pancreatic exocrine insufficiency:An United Kingdom single-centre study

World Journal of Clinical Cases 2021年第31期9卷 9469-9480页

作者： Benjamin M Shandro Joshua Chen Jennifer Ritehnia Andrew Poullis Department of Gastroenterology St George's University Hospitals NHS Foundation TrustLondon SW170QTUnited Kingdom

BACKGROUND Pancreatic exocrine insufficiency(PEI)is said to be associated with numerous conditions both within and outside the gastrointestinal(GI)*** majority of research has been concerned with conditions that reduce the volume of functioning pancreatic tissue or prevent adequate drainage to the small bowel,such as chronic pancreatitis,cystic fibrosis,pancreatic cancer and pancreatic ***,the evidence base supporting an association with extrapancreatic conditions,such as coeliac disease,diabetes mellitus and congestive cardiac failure,is *** To strengthen the evidence base by studying all previously reported associations with PEI in a large cohort of *** A single-centre retrospective study was *** gastroenterology outpatients tested for PEI with faecal elastase-1(FE1)were identified and information retrieved from the electronic patient *** was defined as FE1<200μg/*** already taking pancreatic enzyme replacement therapy were *** imputation was used to handle missing *** logistic regression was used to study which presenting symptoms predicted *** logistic regression was used to explore the relationship between all previously reported associations and *** Of 1027 patients were included.182 patients(17.7%)were diagnosed with ***[odds ratios(OR):2.51,95%confidence intervals(CI):1.58-3.98]and weight loss(OR:1.49,95%CI:1.08-2.06)were the only presenting symptoms that predicted *** pancreatitis(OR:7.98,95%CI:3.95-16.15),pancreatic cancer(OR:6.58,95%CI:1.67-25.98),upper GI surgery(OR:2.62,95%CI:1.32-5.19),type 2 diabetes(OR:1.84,95%CI:1.18-2.87),proton pump inhibitor therapy(OR:1.87,95%CI:1.25-2.80)and Asian ethnicity(OR:2.11,95%CI:1.30-3.42)were significantly associated with PEI in the multivariable *** of the other historically reported associations with PEI were significant after adjustment for the other variable

关键词： Exocrine pancreatic insufficiency Chronic pancreatitis Pancreatic elastase steatorrhoea Proton pump inhibitors

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Comparing acid steatocrit and faecal elastase estimations for use in M-ANNHEIM staging for pancreatitis

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World Journal of Gastroenterology 2017年第12期23卷 2217-2222页

作者： M Ganesh Kamath C Ganesh Pai Asha Kamath Annamma Kurien Department of Physiology Melaka Manipal Medical CollegeManipal University Department of Gastroenterology and Hepatology Kasturba Medical CollegeManipal University Department of Community Medicine Kasturba Medical CollegeManipal University Department of Pathology Melaka Manipal Medical CollegeManipal University

AIM To compare two tests for exocrine pancreatic function(EPF) for use in M-ANNHEIM staging for pancreatitis. METHODS One hundred and ninety four consecutive patients with acute pancreatitis(AP; n = 13), recurrent acute pancreatitis(RAP; n = 65) and chronic pancreatitis(CP; n = 116) were enrolled. EPF was assessed by faecal elastase-1(FE-1) estimation and stool fat excretion by the acid steatocrit method. Patients were classified as per M-ANNHEIM stages separately based on the results of the two tests for comparison. Independent Student's t-test, χ~2 test, Kruskal-Wallis test, Mann-Whitney U test and Mc Nemar's test were used as appropriate. RESULTS Sixty-one(52.5%) patients with CP had steatorrhoea when assessed by the acid steatocrit method; 79 (68.1%) with CP had exocrine insufficiency by the FE-1 test(χ~2 test, P < 0.001). The results of acid steatocrit and FE-1 showed a significant negative correlation(Spearman's rho =-0.376, P < 0.001). A statistically significant difference was seen between the M-ANNHEIM stages as classified separately by acid steatocrit and the FE-1. Thirteen(6.7%), 87(44.8%), 89(45.8%) and 5(2.5%) patients were placed in M-ANNHEIM stages 0,?Ⅰ, Ⅱ, and Ⅲ respectively, with the use of acid steatocrit as against 13(6.7%), 85(43.8%), 75(38.6%), and 21(10.8%) respectively by FE-1 in stages 0,?Ⅰ, Ⅱ, and Ⅲ thereby altering the stage in 28(14.4%) patients(P < 0.001, Mc Nemar's test). CONCLUSION FE-1 estimation performed better than the acid steatocrit test for use in the staging of pancreatitis by the M-ANNHEIM classification since it diagnosed a higher proportion of patients with exocrine insufficiency.

关键词： Chronic pancreatitis Pancreatic function tests Pancreatic elastase Staging steatorrhoea

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Nutritional and vitamin status in patients with neuroendocrine neoplasms

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World Journal of Gastroenterology 2019年第10期25卷 1171-1184页

作者： Dominique SVM Clement Margot ET Tesselaar Monique E van Leerdam Rajaventhan Srirajaskanthan John K Ramage Neuroendocrine Tumour Unit King’s College Hospital ENETS Centre of Excellence Department of Medical Oncology Netherlands Cancer Institute ENETS Centre of Excellence Department of Gastrointestinal Oncology Netherlands Cancer Institute Department of Gastroenterology King’s College Hospital

Symptoms of gastroenteropancreatic located neuroendocrine neoplasms(GEPNENs) are often related to food intake and manifest as abdominal pain or diarrhoea which can influence patients nutritional status. Malnutrition is common in cancer patients and influences quality of life, treatment options and survival but is also present in up to 40% of patients with GEP-NENs. As part of malnutrition there are often deficiencies in fat-soluble vitamins, mainly vitamin D. Little knowledge exists on trace elements. Several factors influence the development of malnutrition such as size and localisation of the primary tumour as well as metastases, side effects from treatment but also hormone production of the tumour itself. One of the main influencing factors leading to malnutrition is diarrhoea which leads to dehydration and electrolyte disturbances. Treatment of diarrhoea should be guided by its cause. Screening for malnutrition should be part of routine care in every GEP-NEN patient. Multidisciplinary treatment including dietician support is necessary for all malnourished patients with GEP-NENs.

关键词： Neuroendocrine neoplasm Nutrition Malnutrition Vitamin deficiency Diarrhoea steatorrhoea

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Pancreatic exocrine insufficiency after pancreaticoduodenectomy: Current evidence and management

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World Journal of Gastrointestinal Pathophysiology 2020年第2期11卷 20-31页

作者： Adithya M Pathanki Joseph A Attard Elizabeth Bradley Sarah Powell-Brett Bobby V M Dasari John R Isaac Keith J Roberts Nikolaos A Chatzizacharias Department of HPB and Liver Transplantation Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152THUnited Kingdom Department of Nutrition and Dietetics Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152THUnited Kingdom

Pancreaticoduodenectomy(PD)is the commonest procedure performed for pancreatic *** exocrine insufficiency(PEI)may be caused or exacerbated by surgery and remains underdiagnosed and *** aim of this review was to ascertain the incidence of PEI,its consequences and management in the setting of PD for indications other than chronic pancreatitis.A literature search of databases(MEDLINE,EMBASE,Cochrane and Scopus)was carried out with the MeSH terms“pancreatic exocrine insufficiency”and“Pancreaticoduodenectomy”.Studies that analysed PEI and its complications in the setting of PD for malignant and benign disease were *** reporting PEI in the setting of PD for chronic pancreatitis,conference abstracts and reviews were *** incidence of PEI approached 100%following PD in some *** pre-operative incidence varied depending on the characteristics of the patient cohort and it was higher(46%-93%)in series where pancreatic cancer was the predominant indication for *** was also recorded with regards to the method used for the diagnosis and evaluation of pancreatic function and *** enzyme replacement therapy is the mainstay of the *** is common and remains undertreated after *** studies are required for the identification of a welltolerated,reliable and reproducible diagnostic test in this setting.

关键词： Pancreatic exocrine insufficiency Pancreaticoduodenectomy Pancreatic enzyme replacement therapy Pancreatic cancer Malabsorption steatorrhoea

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Challenges in the management of pancreatic exocrine insufficiency

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2018年第5期9卷 39-46页

作者： Benjamin Myles Shandro Rani Nagarajah Andrew Poullis Department of Gastroenterology St George’s University Hospitals NHS Foundation Trust

Pancreatic exocrine insufficiency(PEI) occurs when the insufficient secretion or function of pancreatic enzymes leads to maldigestion, most commonly as a result of chronic pancreatitis and pancreatic cancer. The condition is associated with significant morbidity and reductions in quality of life, even in milder forms. The challenges in approaching this condition include the non-specific presentation of mild to moderate PEI, and the lack of a convenient, accurate diagnostic test in this cohort. Classical symptoms appear late in the disease, and the diagnosis should be considered before steatorrhoea develops. Direct pancreatic function tests are the reference standard for diagnosis, but are invasive and not widely available. The faecal elastase-1(FE-1) stool test is widely available and has been shown to be as effective as the 13 C-mixed triglyceride breath test in more advanced disease. We recommend a pragmatic diagnostic approach that combines clinical history, assessment of nutritional status and measurement of FE-1. The critical first step is to consider the diagnosis. Once the diagnosis is confirmed, pancreatic enzyme replacement therapy should be initiated. The variety of enzyme preparations and recommended dosing regimens can present a challenge when selecting an adequate initial dose. Non-response should be actively sought and addressed in a systematic manner. This article discusses these challenges, and presents a practical approach to the diagnosis and management of PEI.

关键词： Pancreatic exocrine insufficiency Chronic pancreatitis steatorrhoea Pancreatic function tests Pancreatic enzyme replacement therapy

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