Bacterial overgrowth syndrome and exocrine pancreatic insufficiency in chronic pancreatitis

The article presents in-depth analysis of literature data on the multifaceted effects of lactulose and the opportunities for its practical use. History of the study of lactulose therapeutic effects is described. Currently, lactulose as a medicine is registered in more than 100 states. Indications are constipation and hepatic encephalopathy, in some countries — treatment of salmonella carriage. However, the prospects and possibilities for the clinical use of lactulose are very broad. In 2005, lactulose was officially recognized as the first choice for chronic constipation from the point of view of evidence-based medicine. Mechanism of lactulose action in case of constipation is analyzed; literature data on its safety in pregnant women, children and the elderly are presented. Lactulose is superior to other treatment options for hepatic encephalopathy. It has been successfully used for any stage of severity of this condition, including latent encephalopathy and hepatic coma. The effectiveness and safety of lactulose in hepatic encephalopathy is confirmed by a large number of high-evidential studies. Possible indications are: as a prebiotic for the treatment of bacterial overgrowth syndrome, primary and secondary prevention of gallstone disease, for the elimination of endotoxemia in hepatorenal syndrome, exocrine pancreatic insufficiency, hypercholesterolemia. Despite its sweet taste, lactulose is not contraindicated, but, on the contrary, is useful in diabetes. Contraindications to treatment with lactulose are limited. The article also presents authors’ own data demonstrating the effectiveness of Medulak in a prebiotic dose in the treatment of chronic pancreatitis with exocrine pancreatic insufficiency combined with bacterial overgrowth syndrome.

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Excessive Bacterial Growth Syndrome and Exocrine Pancreatic Insufficiency in Chronic Pancreatitis

Effective Pharmacotherapy ◽

10.33978/2307-3586-2020-16-30-56-64 ◽

2020 ◽

Vol 16 (30) ◽

pp. 56-64

Author(s):

A.I. Levchenko ◽

◽

Yu.V. Osipenko ◽

Yu.A. Kucheryavy ◽

D.S. Bordin ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Clinical Symptoms ◽

Pancreatic Insufficiency ◽

Pancreatic Enzyme ◽

Bacterial Overgrowth ◽

Exocrine Pancreatic Insufficiency ◽

Diagnostic Methods ◽

Narcotic Analgesics ◽

Potential Risk Factors ◽

Fat Soluble Vitamins

Bacterial overgrowth syndrome (BOS) is characterized by clinical symptoms similar to those of exocrine pancreatic insufficiency (EPI) in chronic pancreatitis (CP). This phenomenon complicates differential diagnosis, especially when BOS and CP combined with EPI. BOS can contribute to the development of malabsorption and impaired digestion. As a result, it occurs diarrhea, steatorrhea, the lack of fat-soluble vitamins, as well as bloating and weight loss can be noticed. Pancreatic enzyme deficiency, alcohol abuse, use of narcotic analgesics to relieve abdominal pain, and proton pump inhibitors (PPIS) that cause drug hypochlohydria are predictors of the weakening of the gastroduodenal antibacterial barrier, and therefore potential risk factors for the development of BOS in CP, especially complicated by EPI. The lack of standard protocols and unified diagnostic methods does not provide the complete picture of the incidence of BOS in CP, and the available data are contradictory and heterogeneous. However, the verification of BOS in CP and way to correct it requires further research. Standardization of research methods and interpretation of results will allow implementing more specific and targeted treatment

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News of European pancreatology (by materials of the 51st Meeting of the European Pancreatic Club)

Herald of Pancreatic Club ◽

10.33149/vkp.2019.04.01 ◽

2019 ◽

Vol 45 (4) ◽

pp. 6-16

Author(s):

N. B. Gubergrits ◽

N. V. Byelyayeva ◽

G. M. Lukashevich ◽

A. Ye. Klochkov ◽

P. G. Fomenko ◽

...

Keyword(s):

Pancreatic Cancer ◽

Chronic Pancreatitis ◽

Pancreatic Insufficiency ◽

Bacterial Overgrowth ◽

Basic Research ◽

Exocrine Pancreatic Insufficiency ◽

Pancreatic Tumors ◽

Modern Theory ◽

Genetic Characteristics ◽

Randomized Controlled Studies

This article presents an overview of the results of practical and basic research in the field of pancreatology, which were presented during the 51st Meeting of the European Pancreatic Club (2019). Achievements of leading European pancreatologists in the study of the etiology, pathogenesis, diagnosis, treatment of pancreatitis, pancreatic tumors are briefly described. The article presents clinical features of acute and chronic pancreatitis, depending on the variety of concomitant pathology, genetic characteristics, bad habits, drugs taken. New opportunities for the differential diagnosis of chronic pancreatitis and pancreatic cancer using miRNA are considered, as well as the feasibility of determining the soluble urokinase-type plasminogen activator receptor (suPAR) in order to differentiate benign and malignant pancreatic tumors. Approaches to the diagnosis of abdominal pain, use of computed tomography for the diagnosis of sarcopenia are described. Results of basic research analyzing the mechanisms of pancreatic cancer development are presented. Modern theory on the role of microbiota and syndrome of bacterial overgrowth in the pancreatic oncogenesis processes is revealed. Pathogenetic features of the formation of exocrine pancreatic insufficiency and effectiveness of its correction via enzyme replacement therapy with the use of modern drugs are emphasized. Results of randomized controlled studies that proved effectiveness and safety of microtablet preparation in correction of exocrine pancreatic insufficiency in patients undergoing pancreatoduodenectomy are presented.

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Bile Acid Malabsorption or Disturbed Intestinal Permeability in Patients Treated with Enzyme Substitution for Exocrine Pancreatic Insufficiency Is Not Caused by Bacterial Overgrowth

Pancreas ◽

10.1097/00006676-200303000-00007 ◽

2003 ◽

Vol 26 (2) ◽

pp. 130-133 ◽

Cited By ~ 16

Author(s):

Jan Lysgård Madsen ◽

Jesper Graff ◽

Else Kirstine Philipsen ◽

Ole Scharff ◽

Jüri Johannes Rumessen

Keyword(s):

Bile Acid ◽

Intestinal Permeability ◽

Pancreatic Insufficiency ◽

Bacterial Overgrowth ◽

Exocrine Pancreatic Insufficiency ◽

Bile Acid Malabsorption

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Early chronic pancreatitis: is a clinical diagnosis possible?

Herald of Pancreatic Club ◽

10.33149/vkp.2019.03.03 ◽

2019 ◽

Vol 44 (3) ◽

pp. 33-41

Author(s):

N. B. Gubergrits ◽

N. V. Byelyayeva ◽

A. Ye. Klochkov ◽

G. M. Lukashevich ◽

V. S. Rachmetova

Keyword(s):

Chronic Pancreatitis ◽

Diagnostic Criteria ◽

Pancreatic Insufficiency ◽

Exocrine Pancreatic Insufficiency ◽

Diagnostic Methods ◽

Test Results ◽

International Consensus ◽

Financial Costs ◽

Increased Risk ◽

Antifibrotic Drugs

A “fatal chain” in pancreatology is discussed in the present article; peculiar attention is paid to an early chronic pancreatitis (CP), being one of the little-studied “links” in this range and corresponding to the latent period of CP(persistence of inflammation with the presence of biomarkers of CP, which does not meet the diagnostic criteria of proven or late CP, as well as the appearance of signs of exocrine pancreatic insufficiency in the form of reduced functional test results to 70% of normal). Features of the different stages of the pancreatic diseases’ course are presented, substantiatinganeed for a practical identification of the “early CP” diagnosis: "for" - the possibility of timely diagnosis, the identification of patients with an increased risk of prostate cancer; "against": the lack of specific antifibrotic, anti-inflammatory therapy, an increase in financial costs, no impact on the clinical outcome.Advantages and disadvantages of using the “early CP” diagnosis in practice are considered. The authors cite the provisions of the International Consensus on early CP, and list the current diagnostic criteria for this diseaseelaborated by the Japanese Pancreas Society. Advantages and disadvantagesof the instrumental and laboratory diagnostic methods are analyzed, including probable early CP biomarkers (interleukin-8, prostaglandin E2). The most suitable therapeutic tactics for management of patients with early CP are presented, including correction of the exocrine and endocrinepancreatic function, as well as the use of antifibrotic drugs.

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

Herald of Pancreatic Club ◽

10.33149/vkp.2019.02.01 ◽

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.

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Diagnosis and treatment of diabetes mellitus in chronic pancreatitis

Herald of Pancreatic Club ◽

10.33149/vkp.2017.04.02 ◽

2017 ◽

Vol 38 (4) ◽

pp. 15-21

Author(s):

N. Ewald ◽

P. D. Hardt

Keyword(s):

Diabetes Mellitus ◽

Chronic Pancreatitis ◽

Medical Therapy ◽

Pancreatic Insufficiency ◽

Clinical Importance ◽

Underlying Disease ◽

Exocrine Pancreatic Insufficiency ◽

Develop Type ◽

Fat Hydrolysis ◽

Type 3

Diabetes secondary to pancreatic diseases is commonly referred to as pancreatogenic diabetes or type 3c diabetes mellitus. It is a clinically relevant condition with a prevalence of 5-10% among all diabetic subjects in Western populations. In nearly 80% of all type 3c diabetes mellitus cases, chronic pancreatitis seems to be the underlying disease. The prevalence and clinical importance of diabetes secondary to chronic pancreatitis has certainly been underestimated and underappreciated so far. In contrast to the management of type 1 or type 2 diabetes mellitus, the endocrinopathy in type 3c is very complex. The course of the disease is complicated by additional present comorbidities such as maldigestion and concomitant qualitative malnutrition. General awareness that patients with known and/or clinically overt chronic pancreatitis will develop type 3c diabetes mellitus (up to 90% of all cases) is rather good. However, in a patient first presenting with diabetes mellitus, chronic pancreatitis as a potential causative condition is seldom considered. Thus many patients are misdiagnosed. The failure to correctly diagnose type 3 diabetes mellitus leads to a failure to implement an appropriate medical therapy. In patients with type 3c diabetes mellitus treating exocrine pancreatic insufficiency, preventing or treating a lack of fat-soluble vitamins (especially vitamin D) and restoring impaired fat hydrolysis and incretin secretion are key-features of medical therapy.

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

Acta gastroenterológica latinoamericana ◽

10.52787/qwpo5827 ◽

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.

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