WS17.5 Is there need for a multienzyme product substitution when using high calorie liquid diets in patients with exocrine pancreatic insufficiency? Studies on praecaecal digestibility in pigs with experimentally induced pancreatic exocrine insufficiency

Context Fecal elastase is a noninvasive test for pancreatic insufficiency diagnosis. Objectives Evaluate the usefulness of fecal elastase 1 for the indication of exocrine pancreatic insufficiency among former alcohol addicts and patients with chronic pancreatitis. Methods Forty-three patients with chronic pancreatitis and thirty-three asymptomatic former alcohol addicts entered the study. The levels of fecal elastase 1 were measured using a commercial kit. Pancreatic imaging findings were used to categorize the groups. Results The levels of fecal elastase 1 were significantly lower in the patients than in the former alcohol addicts and in the group with tissue calcifications, duct alterations, or atrophy. With a cutoff level of 100 μg/g, the sensitivity of fecal elastase 1 in chronic pancreatitis was 46.51% and its specificity was 87.88% with a positive predictive value of 83.33% and a negative predictive value of 55.77%. When patients were stratified according to the severity of their pancreatitis, the sensitivity was 6.25% for mild pancreatitis and 70.37% for marked pancreatitis. Conclusion Low level of fecal elastase 1 was associated with marked rather than mild chronic pancreatitis; however, it may be useful to indicate pancreatic exocrine insufficiency in asymptomatic former alcohol addicts.

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Gastric emptying of oil and aqueous meal components in pancreatic insufficiency: effects of posture and on appetite

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1995.268.6.g925 ◽

1995 ◽

Vol 268 (6) ◽

pp. G925-G932 ◽

Cited By ~ 9

Author(s):

B. I. Carney ◽

K. L. Jones ◽

M. Horowitz ◽

W. M. Sun ◽

R. Penagini ◽

...

Keyword(s):

Gastric Emptying ◽

Aqueous Phase ◽

Pancreatic Insufficiency ◽

Normal Subjects ◽

Exocrine Pancreatic Insufficiency ◽

Exocrine Insufficiency ◽

Left Lateral Decubitus Position ◽

Before And After ◽

Pancreatic Exocrine ◽

Lateral Decubitus

The aims of this study were to evaluate the effects of posture on gastric emptying, intragastric distribution, and satiation after a meal containing oil and aqueous phases in patients with exocrine pancreatic insufficiency. Five patients with cystic fibrosis (CF) consumed 60 ml 99mTc-labeled (V)-thiocyanate olive oil and 290 ml 113mIn-labeled diethylenetriaminepentaacetic acid soup while sitting and while lying in the left lateral decubitus position. Hunger and fullness before and after the meal were recorded. Results were compared with those obtained in 11 normal volunteers. In both postures emptying of oil was faster (P < 0.01) in CF patients. Emptying of the aqueous phase was faster (P < 0.01) in CF patients in the decubitus position. In normal subjects there was no overall difference in emptying of oil between the two postures, whereas emptying of the aqueous phase was delayed (P < 0.01) in the decubitus position. In CF patients emptying of oil was faster (P < 0.01) in the decubitus position, and emptying of the aqueous phase was only slightly faster (P < 0.05) in the sitting position. For both postures there was greater retention (P < 0.05) of oil in the proximal stomach in normal subjects than CF patients. Hunger decreased (P < 0.05) after the meal in the control subjects, but there was no change in CF patients. These results indicate that in CF patients with pancreatic exocrine insufficiency 1) gastric emptying of nonhomogenized fat is faster than normal, 2) gravity affects gastric emptying of oil, and 3) effects of a fatty meal on hunger are reduced.

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Exocrine Pancreatic Insufficiency in Diabetic Patients: Prevalence, Mechanisms, and Treatment

International Journal of Endocrinology ◽

10.1155/2015/595649 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 32

Author(s):

Matteo Piciucchi ◽

Gabriele Capurso ◽

Livia Archibugi ◽

Martina Maria Delle Fave ◽

Marina Capasso ◽

...

Keyword(s):

Islet Cells ◽

Pancreatic Insufficiency ◽

Endocrine System ◽

Exocrine Pancreatic Insufficiency ◽

Exocrine Function ◽

Diabetic Patients ◽

Type I ◽

Exocrine Insufficiency ◽

Pancreatic Exocrine ◽

The Impact

Pancreas is a doubled-entity organ, with both an exocrine and an endocrine component, reciprocally interacting in a composed system whose function is relevant for digestion, absorption, and homeostasis of nutrients. Thus, it is not surprising that disorders of the exocrine pancreas also affect the endocrine system and vice versa. It is well-known that patients with chronic pancreatitis develop a peculiar form of diabetes (type III), caused by destruction and fibrotic injury of islet cells. However, less is known on the influence of diabetes on pancreatic exocrine function. Pancreatic exocrine insufficiency (PEI) has been reported to be common in diabetics, with a prevalence widely ranging, in different studies, in both type I (25–74%) and type II (28–54%) diabetes. A long disease duration, high insulin requirement, and poor glycemic control seem to be risk factors for PEI occurrence. The impact of pancreatic exocrine replacement therapy on glycemic, insulin, and incretins profiles has not been fully elucidated. The present paper is aimed at reviewing published studies investigating the prevalence of PEI in diabetic patients and factors associated with its occurrence.

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242 Effects of experimentally induced pancreatic exocrine insufficiency on digestibility of electrolytes (praecaecal/total tract), urinary electrolyte content and acid-base status in young pigs – used as a model for children

Journal of Cystic Fibrosis ◽

10.1016/s1569-1993(15)30417-3 ◽

2015 ◽

Vol 14 ◽

pp. S120

Author(s):

A. Mößeler ◽

M. Höltershinken ◽

J. Kamphues

Keyword(s):

Pancreatic Exocrine Insufficiency ◽

Acid Base ◽

Exocrine Insufficiency ◽

Electrolyte Content ◽

Young Pigs ◽

Acid Base Status ◽

Pancreatic Exocrine ◽

Experimentally Induced

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Should we Investigate Gastroenterology Patients for Pancreatic Exocrine Insufficiency? A Dual Centre UK Study

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.253.uks ◽

2016 ◽

Vol 25 (3) ◽

pp. 303-309 ◽

Cited By ~ 11

Author(s):

Jennifer A. Campbell ◽

David S. Sanders ◽

Katherine A. Francis ◽

Matthew Kurien ◽

Sai Lee ◽

...

Keyword(s):

Secondary Care ◽

Pancreatic Insufficiency ◽

Pancreatic Enzyme ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Enzyme Replacement ◽

Co Morbidity ◽

Immunodeficiency Virus ◽

Pancreatic Enzyme Replacement Therapy ◽

Pancreatic Exocrine

Background & Aims: Pancreatic exocrine insufficiency may be under recognised in gastroenterological practice. We aimed to identify the prevalence of pancreatic insufficiency in secondary care gastroenterology clinics and determine if co-morbidity or presenting symptoms could predict diagnosis. A secondary aim was to assess response to treatment. Methods: A dual centre retrospective analysis was conducted in secondary care gastroenterology clinics. Patients tested for pancreatic exocrine insufficiency with faecal elastase-1 (FEL-1) between 2009 and 2013 were identified in two centres. Demographics, indication and co-morbidities were recorded in addition to dose and response to pancreatic enzyme replacement therapy. Binary logistic regression was used to assess if symptoms or co-morbidities could predict pancreatic insufficiency. Results: 1821 patients were tested, 13.1% had low FEL-1 (<200μg/g). This prevalence was sub-analysed with 5.4% having FEL-1 100-200μg/g (mild insufficiency) and 7.6% having faecal elastase readings <100μg/g. Low FEL-1 was most significantly associated with weight loss or steatorrhoea. Co-morbidity analysis showed that low levels were significantly associated with excess alcohol intake, diabetes mellitus or human immunodeficiency virus; 80.0% treated with enzyme supplements reported symptomatic benefit with no difference in response between high and low dose supplementation (p=0.761). Conclusion: Targeting the use of FEL-1 in individuals with specific symptoms and associated conditions can lead to improved recognition of pancreatic exocrine insufficiency in a significant proportion of secondary care patients. Intervening with lifestyle advice such as smoking cessation and minimising alcohol intake could improve outcomes. In addition, up to 80% of patients with low faecal elastase respond to supplementation. Abbreviations: CFA: coefficient of fat absorption; CP: chronic pancreatitis; ELISA: enzyme-linked immune-absorbent assay; PEI: pancreatic exocrine insufficiency; FEL-1: faecal elastase-1; HIV: human immunodeficiency virus; IBD: inflammatory bowel disease; IBS: irritable bowel syndrome; PERT: pancreatic enzyme replacement therapy.

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Treatment of Pancreatic Exocrine Insufficiency with Enteric Coated Pancreatin Formulations: An Overview

International Journal of Pharmaceutical Sciences and Nanotechnology ◽

10.37285/ijpsn.2013.6.3.3 ◽

2013 ◽

Vol 6 (3) ◽

pp. 2125-2130

Author(s):

B K Bhattacharyya ◽

S Chowdhury ◽

S Das ◽

S Mukherjee ◽

D Bhattacharjee

Keyword(s):

Cystic Fibrosis ◽

Digestive Enzymes ◽

Pancreatic Insufficiency ◽

Pancreatic Enzyme ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Enzyme Replacement ◽

Increased Risk ◽

Pancreatic Exocrine ◽

Enteric Coated

Pancreatin is a mixture of several digestive enzymes produced by the exocrine cells of the pancreas. It is composed of amylase, lipase and protease. It is used to treat conditions in which pancreatic secretions are deficient, such as surgical pancreatectomy, pancreatitis and cystic fibrosis. Pancreatin products contain the pancreatic enzymes trypsin, amylase and lipase. The patients with pancreatic diseases often suffer from pancreatic exocrine insufficiency. In such condition pancreas does not secrete required amount of digestive enzymes for proper digestion to occur. Severe pancreatic insufficiency occurs in cystic fibrosis, chronic pancreatitis, tumors or after surgical resection. Thus pancreatic exocrine insufficiency may result in clinical manifestation of malnutrition, weight loss and steatorrhea leading towards the increased risk of morbidity and mortality. For the improvement of clinical symptoms, restriction of fat intake and pancreatic enzyme replacement therapy are recommended. The enzyme substitution therapy is very much challenging because the optimal enzyme dose is highly variable to mimic the physiological pattern of pancreatic exocrine secretion. Regulatory authorities have approved several pancreatic enzyme formulations in the form of enteric coated minimicrosphere which are now available commercially. This review focuses on the physiological considerations of pancreatic exocrine insufficiency and its treatment with enteric coated pancreatin formulations.

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Case report of oxalate nephropathy in a patient with pancreatic metastases from renal carcinoma

BMC Cancer ◽

10.1186/s12885-019-6215-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Karin Purshouse ◽

Sarah Chamberlain ◽

Maria Soares ◽

Mark Tuthill ◽

Andrew Protheroe ◽

...

Keyword(s):

Renal Failure ◽

Renal Carcinoma ◽

Kinase Inhibitor ◽

Pancreatic Insufficiency ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Case Presentation ◽

Pancreatic Metastases ◽

Pancreatic Exocrine ◽

Oxalate Nephropathy

Abstract Background Patients with metastatic renal carcinoma frequently have pre-existing renal impairment and not infrequently develop worsening renal function as a complication of their treatment. The presence of pancreatic metastases in patients with metastatic renal carcinoma, often confers a more favourable prognosis and as a consequence this patient group may be exposed to such treatments for more prolonged periods of time. However, the development of renal failure may also be a consequence of the cancer itself rather than its treatment. Case presentation We present an 84-year-old patient receiving the tyrosine kinase inhibitor (TKI) pazopanib for metastatic renal carcinoma who developed oxalate nephropathy as a consequence of pancreatic exocrine insufficiency resulting from pancreatic metastases. Conclusions This case demonstrates the importance of investigating unexpected toxicities and highlights the potential consequences of pancreatic insufficiency and its sequelae in patients with pancreatic metastases.

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Exocrine Pancreatic Insufficiency in Diabetes Mellitus: A Complication of Diabetic Neuropathy or a Different Type of Diabetes?

Experimental Diabetes Research ◽

10.1155/2011/761950 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 54

Author(s):

Philip D. Hardt ◽

Nils Ewald

Keyword(s):

Diabetes Mellitus ◽

Diabetic Neuropathy ◽

Pancreatic Insufficiency ◽

Exocrine Pancreatic Insufficiency ◽

Diabetic Patients ◽

Exocrine Insufficiency ◽

Morphological Alterations ◽

Tissue Changes ◽

Pancreatic Exocrine

Pancreatic exocrine insufficiency is a frequently observed phenomenon in type 1 and type 2 diabetes mellitus. Alterations of exocrine pancreatic morphology can also be found frequently in diabetic patients. Several hypotheses try to explain these findings, including lack of insulin as a trophic factor for exocrine tissue, changes in secretion and/or action of other islet hormones, and autoimmunity against common endocrine and exocrine antigens. Another explanation might be that diabetes mellitus could also be a consequence of underlying pancreatic diseases (e.g., chronic pancreatitis). Another pathophysiological concept proposes the functional and morphological alterations as a consequence of diabetic neuropathy. This paper discusses the currently available studies on this subject and tries to provide an overview of the current concepts of exocrine pancreatic insufficiency in diabetes mellitus.

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