Fat and calorie output in exocrine pancreatic insufficiency - The role of pancreatic enzymes

Pancreatology ◽  
2018 ◽  
Vol 18 (4) ◽  
pp. S114
Author(s):  
Friedemann Erchinger ◽  
Anne Kristine N. Øvre ◽  
Marita Malene Aarseth ◽  
Trond Engjom ◽  
Ingeborg Brønstad ◽  
...  
Keyword(s):  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Enzymes

scholarly journals Role of Fibre in Nutritional Management of Pancreatic Diseases

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2219 ◽  
Author(s):  
Emanuela Ribichini ◽  
Serena Stigliano ◽  
Sara Rossi ◽  
Piera Zaccari ◽  
Maria Carlotta Sacchi ◽  
...  
Keyword(s):  
Current Knowledge ◽  
Multiorgan Failure ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Intestinal Barrier ◽  
Fibre Surface ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Enzymes ◽  
Nutritional Management

The role of fibre intake in the management of patients with pancreatic disease is still controversial. In acute pancreatitis, a prebiotic enriched diet is associated with low rates of pancreatic necrosis infection, hospital stay, systemic inflammatory response syndrome and multiorgan failure. This protective effect seems to be connected with the ability of fibre to stabilise the disturbed intestinal barrier homeostasis and to reduce the infection rate. On the other hand, in patients with exocrine pancreatic insufficiency, a high content fibre diet is associated with an increased wet fecal weight and fecal fat excretion because of the fibre inhibition of pancreatic enzymes. The mechanism by which dietary fibre reduces the pancreatic enzyme activity is still not clear. It seems likely that pancreatic enzymes are absorbed on the fibre surface or entrapped in pectin, a gel-like substance, and are likely inactivated by anti-nutrient compounds present in some foods. The aim of the present review is to highlight the current knowledge on the role of fibre in the nutritional management of patients with pancreatic disorders.

scholarly journals Evidence-based pancreatology 2018 (review of research results on diseases and exocrine pancreatic insufficiency)

2019 ◽  
Vol 43 (2) ◽  
pp. 4-14
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
A. Ye. Klochkov ◽  
G. M. Lukashevich ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Bacterial Overgrowth ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Tumors ◽  
Research Results ◽  
Enzyme Replacement ◽  
Pancreatic Pathology

The article presents a detailed review of the research results in the field of pancreatology published in 2018. Certain parts of the review are devoted to the pathogenesis, diagnostics, course of pancreatitis, its treatment, as well as autoimmune, hereditary pancreatitis, pancreatic pathology in children, as well as treatment. In studying the pathogenesis of pancreatitis, attention is paid to genetic markers of pancreatitis along with a role of bacterial overgrowth syndrome in the small intestine, both in terms of worsening of the course of pancreatitis and the lack of effectiveness of enzyme replacement therapy. The study of the role of alcohol abuse and smoking in the pathogenesis of pancreatic pathology is still in progress. Diagnostics is going on. Endosonography remains the most informative method. A number of studies have been devoted to the studying of exocrine and endocrine pancreatic insufficiency both upon pancreatitis, pancreatic tumors, and in functional dyspepsia and HIV infection. Autoimmune pancreatitis is increasingly being diagnosed, a number of studies are devoted to its diagnostics and treatment. Pancreatic diseases in children develop mainly on the background of genetic predisposition, while functional pancreatic insufficiency occurs in adult patients. The study of the peculiarities of the effect of enzyme replacement therapy continues. The immediate and remote results of the surgical treatment of pancreatic pathology are assessed.

scholarly journals Los criterios de Rosemont en ultrasonografía endoscópica: ¿son predictores de insuficiencia pancreática exocrina?

2021 ◽  
Vol 51 (2) ◽  
Author(s):  
Marianela Arramón ◽  
Agustina Redondo ◽  
Pablo Cura ◽  
Fernando Baldoni ◽  
Ana Brizio ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Endoscopic Ultrasonography ◽  
Pancreatic Insufficiency ◽  
Descriptive Study ◽  
Exocrine Pancreatic Insufficiency ◽  
Diagnostic Methods ◽  
Fat Quantification ◽  
Morphologic Characteristics ◽  
Morphologic Changes

Endoscopic ultrasonography is the method of choice for detection of morphologic changes related to chronic pancreatitis. There are criteria, in the literature, that evaluate morphologic changes by endoscopic ultrasonography suggestive of chronic pancreatitis. The most widely used are the Rosemont criteria. Currently, the most effective diagnostic methods for exocrine pancreatic insufficiency are fat quantification (disused) and the 13C-mixed triglyceride breath test, not available in our country. However, the probability of diagnosis of pancreatic insufficiency can be estimated over the base of symptoms, malnutrition parameters, faecal elastase and signs of chronic pancreatitis in images. The aim of this study was to determine the correlation, probability and severity of exocrine pancreatic insufficiency, according to Rosemont criteria, in patients with chronic pancreatitis. A retrospective descriptive study was performed. Data were collected from patients between April of 2017 and April of 2018. The data gathered was based on pancreatic morphologic characteristics according to Rosemont criteria and related to the diagnosis of exocrine pancreatic insufficiency diagnosis based on the levels of stool elastase. Twenty one patients with chronic pancreatitis were included. The presence of hyperechogenic foci > 2 mm with posterior acoustic shadowing was associated with the presence of severe exocrine pancreatic insufficiency (p < 0.001). In our study, the association between parenchymal morphologic findings of chronic pancreatitis was significant in predicting exocrine pancreatic insufficiency. The role of endoscopic ultrasonography in predicting functional compromise in patients with chronic pancreatitis is promising.

Pancreatic enzymes for exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery

2013 ◽  
Vol 17 (4) ◽  
pp. 134-139
Author(s):  
Shu Gong ◽  
Wen-Wu Shen ◽  
Qiang Guo ◽  
Hui-Min Lu ◽  
Xu-Bao Liu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Surgery ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Enzymes

scholarly journals Bicarbonate Transport in Cystic Fibrosis and Pancreatitis

Cells ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 54
Author(s):  
Dora Angyal ◽  
Marcel J. C. Bijvelds ◽  
Marco J. Bruno ◽  
Maikel P. Peppelenbosch ◽  
Hugo R. de Jonge
Keyword(s):  
Cystic Fibrosis ◽  
Current Knowledge ◽  
Pancreatic Insufficiency ◽  
Anion Channel ◽  
Exocrine Pancreatic Insufficiency ◽  
Scaffolding Protein ◽  
Bicarbonate Transport ◽  
Human Pancreas ◽  
Ductal Cells

CFTR, the cystic fibrosis (CF) gene-encoded epithelial anion channel, has a prominent role in driving chloride, bicarbonate and fluid secretion in the ductal cells of the exocrine pancreas. Whereas severe mutations in CFTR cause fibrosis of the pancreas in utero, CFTR mutants with residual function, or CFTR variants with a normal chloride but defective bicarbonate permeability (CFTRBD), are associated with an enhanced risk of pancreatitis. Recent studies indicate that CFTR function is not only compromised in genetic but also in selected patients with an acquired form of pancreatitis induced by alcohol, bile salts or smoking. In this review, we summarize recent insights into the mechanism and regulation of CFTR-mediated and modulated bicarbonate secretion in the pancreatic duct, including the role of the osmotic stress/chloride sensor WNK1 and the scaffolding protein IRBIT, and current knowledge about the role of CFTR in genetic and acquired forms of pancreatitis. Furthermore, we discuss the perspectives for CFTR modulator therapy in the treatment of exocrine pancreatic insufficiency and pancreatitis and introduce pancreatic organoids as a promising model system to study CFTR function in the human pancreas, its role in the pathology of pancreatitis and its sensitivity to CFTR modulators on a personalized basis.

Role of nonpancreatic lipolytic activity in exocrine pancreatic insufficiency

1987 ◽  
Vol 92 (1) ◽  
pp. 125-129 ◽  
Author(s):  
Cynthia K. Abrams ◽  
Margit Hamosh ◽  
Sudhir K. Dutta ◽  
Van S. Hubbard ◽  
Paul Hamosh
Keyword(s):  
Lipolytic Activity ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency after esophagectomy: a systematic review of literature

2021 ◽  
Author(s):  
L Blonk ◽  
N J Wierdsma ◽  
E P Jansma ◽  
G Kazemier ◽  
D L van der Peet ◽  
...  
Keyword(s):  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Enzymes ◽  
Pancreatic Function ◽  
Study Quality ◽  
Fecal Elastase ◽  
Elastase 1 ◽  
Fecal Fat ◽  
Effect Of Treatment

Summary Complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are often attributed to an impaired exocrine pancreatic function. This review systematically summarizes all literature reporting on the presence of exocrine pancreatic insufficiency (EPI) after esophagectomy and the effect of treatment with pancreatic enzymes on gastrointestinal complaints, body weight, and quality of life. Databases of PubMed, Embase, and Wiley/Cochrane Library were searched systematically until July 2020. Studies reporting on EPI and pancreatic enzyme replacement therapy after esophagectomy were included. The Newcastle–Ottawa scale was used to assess study quality. Four studies, including 158 patients, were selected. The maximum score for study quality was six (range 4–6). Exocrine pancreatic function was investigated in three studies, measured by fecal elastase-1 and 72-hour fecal fat excretion. Fecal elastase-1 levels &lt;200 μg/g were reported in 16% of patients at 4 months, 18% at 6 months, and 31% at 18–24 months postoperatively. A decreased fecal fat absorption was noticed in 57% 1 month postoperatively. Treatment with pancreatic enzymes was reported in two studies. In patients with fecal elastase-1 levels &lt;200 μg/g, 90% of patients reported improvement in symptoms and 70% reported improvement in weight. In patients with complaints of steatorrhea, 87% noticed settlement of symptoms. Based on current literature, complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are common and can be related to an impaired exocrine pancreatic function. High-quality studies evaluating the presence of EPI and the effect of treatment with pancreatic enzymes after esophagectomy are needed to verify this conclusion.

scholarly journals The Role of Sphere Size in the Context of Pancreatin Therapy for Exocrine Pancreatic Insufficiency: A Systematic Review

2021 ◽  
Author(s):  
Karl-Uwe Petersen ◽  
Malfertheiner Peter ◽  
Mössner Joachim
Keyword(s):  
Systematic Review ◽  
Gastric Emptying ◽  
Scientific Evidence ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Current Guideline ◽  
Sphere Size ◽  
Enteric Coated ◽  
The Individual

While lipase content and appropriate acid protection of pancreatin preparations (PP) are well defined determinants of an effective therapy of exocrine pancreatic insufficiency, the optimal sphere size of PP has remained a matter of discussion. We performed a systematic review to assess the optimal sphere size of enteric coated pancreatin products that may best guarantee coordinated delivery of PP and food to the duodenum. PubMed was searched for studies on gastric emptying of indigestible spheres in the digestive phase, using overlapping search algorithms; identified sources were searched for further leads, extending the investigation to Google Scholar. Of 739 screened publications, 26 were included in the final assessment. Contrary to current guideline recommendations, no scientific evidence was found to support a 2 mm diameter threshold for gastric emptying of indigestible particles. There is no documented advantage of ≤2 mm spheres regarding duodenal delivery and restoring maldigestion. The evolving picture is that of a gradation of sizes, over which gastric emptying becomes slower and more variable as particle size increases. Even 7 mm particles may be emptied from the stomach in conjunction with nutrient uptake. In conclusion sphere size of PP is not the essential parameter for selecting an effective PP fitting all patients. A variety of brands offer different lipase contents and sphere sizes that allow the physician to tailor treatment to the individual patient`s needs.

scholarly journals Nutritional status of patients undergoing pancreatic resection

2022 ◽  
pp. 60-65
Author(s):  
M. V. Malykh ◽  
E. A. Dubtsova ◽  
L. V. Vinokurova ◽  
M. A. Kiryukova ◽  
D. S. Bordin
Keyword(s):  
Quality Of Life ◽  
Nutritional Status ◽  
Pancreatic Resection ◽  
Pancreatic Insufficiency ◽  
Clinical Manifestations ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Enzymes ◽  
Exocrine Function

Changes in the exocrine function of the pancreas often develops after proximal and distal resections. Exocrine pancreatic insufficiency (EPI) is characterized by a reduced secretion of pancreatic enzymes, because of which the digestion and absorption of nutrients is impaired. Clinical manifestations of EPI and, as a consequence, changes in nutritional status significantly affect the quality of life of patients.

scholarly journals Chronic pancreatitis: what should be considered in diagnosis, treatment, and prognosis

2020 ◽  
Vol 49 (4) ◽  
pp. 64-72
Author(s):  
T. N. Khristich
Keyword(s):  
Chronic Pancreatitis ◽  
Metabolic Disorders ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Ducts ◽  
Proper Treatment ◽  
Internal Organs ◽  
Exocrine Insufficiency ◽  
Acute Nature

The aim of the literature review is to draw attention of doctors to the need of considering not only well-known etiological factors, but also pathogenetic ones that have an impact on the progression, chronicity of the process, treatment, prevention, and prognosis. The role of alcohol, mechanism of obstruction of the pancreatic ducts in the occurrence of abdominal pain in chronic pancreatitis, and the development and progression of exocrine pancreatic insufficiency are discussed in detail.The issues of the onset of chronic pancreatitis in elder age, comorbidity with other diseases of the internal organs, with a lack of certain vitamins are considered. It is necessary to remember that exocrine insufficiency can be associated with the progression of glandular fibrosis, metabolic disorders, food intolerance, allergic syndrome, which provoke acute attacks.The author draws attention to the fact that the syndrome of inflammatory, enzymatic intoxication and the syndrome of disseminated intravascular coagulation should not be missed out in the acute nature of the process. Above-listed recommendations will help to correctly evaluate the clinical picture and prescribe the proper treatment, as well as to prevent the development of complicationsin time.

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