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

1995 ◽  
Vol 268 (6) ◽  
pp. G925-G932 ◽  
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.

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

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
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.

scholarly journals COMPARISON OF FECAL ELASTASE 1 FOR EXOCRINE PANCREATIC INSUFFICIENCY EVALUATION BETWEEN EX-ALCOHOLICS AND CHRONIC PANCREATITIS PATIENTS

2014 ◽  
Vol 51 (4) ◽  
pp. 297-301 ◽  
Author(s):  
Rejane MATTAR ◽  
Gustavo André Silva LIMA ◽  
Marianges Zadrozny Gouvêa da COSTA ◽  
Joyce M Kinoshita SILVA-ETTO ◽  
Dulce GUARITA ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Predictive Value ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Exocrine Insufficiency ◽  
Exocrine Insufficiency ◽  
Noninvasive Test ◽  
Fecal Elastase ◽  
Elastase 1 ◽  
Pancreatic Exocrine

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.

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

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
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.

BESTIMMUNG DER INSULINAKTIVITÄT IM MENSCHLICHEM SERUM NACH GLUKOSEBELASTUNG ALS PRÜFUNG DER FUNKTIONSFÄHIGKEIT DES PANKREAS

1963 ◽  
Vol 42 (3) ◽  
pp. 437-452 ◽  
Author(s):  
H. Daweke
Keyword(s):  
Blood Sugar ◽  
Pancreatic Insufficiency ◽  
Normal Subjects ◽  
Insulin Binding ◽  
Epididymal Adipose Tissue ◽  
Moderate Increase ◽  
Glucose Loading ◽  
Before And After ◽  
Oral Hypoglycaemic Drugs ◽  
Severity Of The Disease

Using the method of glucose-1-14C oxydation to 14CO2 on the rat epididymal adipose tissue, the insulin-like activities (ILA) in the serum have been compared before and after oral loading with glucose in normal subjects, in maturity-onset diabetics and in insulin-requiring diabetics. In maturity-onset diabetics mean fasting values were found to be 30% below normal while in insulin-requiring diabetics they were 85% above normal. In normal subjects there was observed, 30 minutes after glucose loading, a moderate increase in blood sugar together with an increase of ILA of 222% above the starting value; in maturity-onset diabetics the increase in ILA was only 106% while the blood sugar was markedly increased. After glucose loading in maturity-onset diabetics, the total amount of insulin detected during the period of the experiment was, on the average, only 45% of that found in normal subjects. In insulin requiring diabetics there was no increase but, on the contrary, a steady decrease of the ILA values, while the blood sugar excessively increased. In general ILA values were higher than those in maturity-onset diabetics. No difference in response was found between maturity-onset diabetics treated with diet alone and those treated with diet and oral hypoglycaemic drugs. In contrast to the absolute ILA values, the index of insulin reserve, is of value in assessing the functional capacity of the pancreas. This index decreases progressively with the severity of the disease and reaches a maximum of 54% of the normal in maturity-onset diabetics, which can satisfactorily be explained by pancreas insufficiency. Only in some cases of insulin-requiring diabetics was an insulin reserve still detectable. The biological inactivity of the insulin circulating in the blood can be deduced from the increased ILA-values, as compared with those found in maturity-onset diabetics. Obviously some of this insulin can be released by the addition of glucose. It is likely that, in addition to pancreatic insufficiency, insulin-binding or insulin-inactivating antibodies play a part in the pathogenesis of insulin-requiring diabetes.

scholarly journals Antibiotic therapy and fat digestion and absorption in cystic fibrosis.

2011 ◽  
Vol 58 (3) ◽  
Author(s):  
Aleksandra Lisowska ◽  
Andrzej Pogorzelski ◽  
Grzegorz Oracz ◽  
Wojciech Skorupa ◽  
Szczepan Cofta ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Antibiotic Therapy ◽  
Pancreatic Insufficiency ◽  
Bacterial Load ◽  
Mass Gain ◽  
Exocrine Pancreatic Insufficiency ◽  
Oral Drug ◽  
Lipid Digestion ◽  
Fat Digestion ◽  
Before And After

Antibiotic therapy in the cystic fibrosis (CF) mouse model has been shown to result in reduced bacterial load of the intestine and significant body mass gain. The effect was suggested to be linked to the improvement of intestinal digestion and absorption. Therefore, we aimed to assess the influence of routinely applied antibiotic therapy in CF patients on fat assimilation. Twenty-four CF patients aged 6 to 30 years entered the study. Inclusion criteria comprised confirmed exocrine pancreatic insufficiency and bronchopulmonary exacerbation demanding antibiotic therapy. Exclusion criteria comprised: antibiotic therapy six weeks prior to the test, liver cirrhosis, diabetes mellitus, oxygen dependency, the use of systemic corticosteroids. In all enrolled CF subjects, (13)C-labelled mixed triglyceride breath test ((13)C MTG-BT) was performed to assess lipid digestion and absorption, before and after antibiotic therapy. Sixteen subjects were treated intravenously with ceftazidime and amikacin, eight patients orally with ciprofloxacin. Cumulative percentage dose recovery (CPDR) was considered to reflect digestion and absorption of lipids. The values are expressed as means (medians). The values of CPDR before and after antibiotic therapy did not differ in the whole studied group [4.6(3.3) % vs. 5.7(5.3) %, p = 0.100] as well as in the subgroup receiving them intravenously [4.6(3.2) % vs. 5.7(5.3) %, p = 0.327] or in that with oral drug administration [4.6(3.4) % vs. 5.7(5.4) %, p = 0.167]. In conclusion, antibiotic therapy applied routinely in the course of pulmonary exacerbation in CF patients does not seem to result in an improvement of fat digestion and absorption.

scholarly journals Chronic pancreatitis: review and update of etiology, risk factors, and management

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 607 ◽  
Author(s):  
Angela Pham ◽  
Christopher Forsmark
Keyword(s):  
Chronic Pancreatitis ◽  
Islet Cells ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Exocrine Insufficiency ◽  
Disease Etiology ◽  
Enzyme Replacement ◽  
Endocrine Insufficiency ◽  
Pancreatic Enzyme Replacement Therapy ◽  
Pancreatic Exocrine

Chronic pancreatitis is a syndrome involving inflammation, fibrosis, and loss of acinar and islet cells which can manifest in unrelenting abdominal pain, malnutrition, and exocrine and endocrine insufficiency. The Toxic-Metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and Severe Acute Pancreatitis, Obstructive (TIGAR-O) classification system categorizes known causes and factors that contribute to chronic pancreatitis. Although determining disease etiology provides a framework for focused and specific treatments, chronic pancreatitis remains a challenging condition to treat owing to the often refractory, centrally mediated pain and the lack of consensus regarding when endoscopic therapy and surgery are indicated. Further complications incurred include both exocrine and endocrine pancreatic insufficiency, pseudocyst formation, bile duct obstruction, and pancreatic cancer. Medical treatment of chronic pancreatitis involves controlling pain, addressing malnutrition via the treatment of vitamin and mineral deficiencies and recognizing the risk of osteoporosis, and administering appropriate pancreatic enzyme supplementation and diabetic agents. Cornerstones in treatment include the recognition of pancreatic exocrine insufficiency and administration of pancreatic enzyme replacement therapy, support to cease smoking and alcohol consumption, consultation with a dietitian, and a systematic follow-up to assure optimal treatment effect.

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 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.

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

2016 ◽  
Vol 25 (3) ◽  
pp. 303-309 ◽  
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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