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 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.

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 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 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.

Simultaneous assessments of exocrine pancreatic function by cholesteryl-[14C]octanoate breath test and measurement of plasma p-aminobenzoic acid

1995 ◽  
Vol 41 (4) ◽  
pp. 599-604 ◽  
Author(s):  
M J Bruno ◽  
F J Hoek ◽  
B Delzenne ◽  
D J van Leeuwen ◽  
C D Schteingart ◽  
...  
Keyword(s):  
Breath Test ◽  
Test Sample ◽  
Exocrine Pancreatic Function ◽  
Pancreatic Function ◽  
Single Sample ◽  
Exocrine Function ◽  
Aminobenzoic Acid ◽  
Aminosalicylic Acid ◽  
Exocrine Insufficiency ◽  
Pancreatic Exocrine

Abstract Two noninvasive tests for assessing pancreatic exocrine function, the cholesteryl-[14C]octanoate breath test and the HPLCN-benzoyl-tyrosyl-p-aminobenzoic acid/p-aminosalicylic acid (NBT-PABA/PAS) test, were simultaneously performed in nine patients with pancreatic exocrine insufficiency due to chronic pancreatitis and in nine healthy volunteers. 14CO2 output in breath and plasma PABA concentration rose slowly in patients but increased rapidly in healthy subjects. The measurement time giving the best discrimination between both groups was 120 min for the cholesteryl-[14C]octanoate breath test and 90 min for the plasma PABA test. At these points, both single-sample tests had essentially identical diagnostic sensitivity. The diagnostic sensitivities of the two single-sample tests were equal to that of the cumulative 6-h urinary PABA recovery and the cumulative 6-h urinary PABA/PAS ratio. We conclude that, for both the cholesteryl-[14C]octanoate breath test and the plasma PABA test, a single test sample is sufficient for rapid detection of impaired exocrine pancreatic function.

scholarly journals Exocrine pancreatic insufficiency in type 1 and type 2 diabetesmellitus: do we need to treat it? A systematic review

2019 ◽  
Vol 42 (1) ◽  
pp. 18-29
Author(s):  
G. Zsóri ◽  
D. Illés ◽  
V. Terzin ◽  
L. Czakó
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Diabetic Patients ◽  
Enzyme Replacement ◽  
Advantages And Disadvantages ◽  
Patients With Diabetes

The exocrine and endocrine pancreata are very closely linked both anatomically and physiologically. Abdominal symptoms such as nausea, bloating, diarrhea, steatorrhea, and weight loss can often occur in diabetic patients. Impairments of the exocrine pancreatic function seem to be a frequent complication of diabetes mellitus; however, they are largely overlooked. The aim of this paper is to provide an overview of the current concepts of exocrine pancreatic insufficiency (PEI) in diabetes mellitus. This systematic review provides information on the high prevalence of chronic pancreatic diseases in patients with diabetes; statements that reveal the multifactorial mechanism of PEI development upon violation of glucose uptake are summarized. The main PEI clinical manifestations in diabetes are described, the difficulties of timely detection of EPN are considered, the advantages and disadvantages of the “gold standards” of laboratory diagnostics (determination of the level of fecal elastase 1 and the coefficient of fat absorption, respiratory test using mixed triglycerides, 13C labeled, and secretin-pancreozymin test) in this cohort of patients. The data of randomized researches that studied the effectiveness of enzyme replacement therapy of PEI in patients with diabetes are analyzed. The ability of enzyme replacement therapy to normalize digestion has been confirmed, and its possible effect on glycemia and vitamin D levels in patients with diabetes and EPN has been considered. The reasons for the continuation of taking enzyme preparations are listed.

scholarly journals Magnitude of pancreatic exocrine insufficiency and associated factors among adult diabetic patients attending Madda Walabu University Goba referral hospital, south east Ethiopia, 2019

2020 ◽  
Author(s):  
Tadele Regasa Gemechu ◽  
Minale Fekadie Baye ◽  
Gesese Bogale Awgichew ◽  
Behonegn Birhan Chekole ◽  
Zegeye Regassa Gemechu ◽  
...  
Keyword(s):  
Referral Hospital ◽  
Diabetic Patients ◽  
Pancreatic Exocrine Insufficiency ◽  
Type 2 Diabetic Patients ◽  
Exocrine Insufficiency ◽  
Pancreatic Exocrine ◽  
Study Participants ◽  
Type 2 Diabetic

Abstract Background: Diabetes mellitus is a group of metabolic disorders which is characterized by increased blood glucose level. It causes a lot of systemic complications including pancreatic atrophy that leads to pancreatic exocrine insufficiency. It is more common among type 1 diabetic than type 2 diabetic patients. The aim of this study was to assess magnitude of pancreatic exocrine insufficiency and associated factors among diabetic patients attending Madda Walabu University Goba referral hospital, 2019.Materials and method: An institution based cross sectional study was conducted on 286 diabetic patients during study period. The study participants were selected by systematic random sampling technique among diabetic patients attending Madda Walabu University Goba referral hospital internal medicine department. The demographic data of the study participants were collected by face to face interview. Serum and urine samples were collected from each patient and analyzed to check pancreatic exocrine insufficiency and factors associated with it. The raw data were entered in to Epi Data V 3.0.2 and exported in to SPSS V 25 for analysis. Descriptive analysis and multiple logistic regression was done and variables with 95% confidence interval and p-value less than 0.05 were used to declare statistical significance. Results: The study participants were 250 (87.4%) type 2 diabetic and 36 (12.6%) type 1 diabetic patients. Among them 21.3% suffered from pancreatic exocrine insufficiency. Amylase insufficiency found in 44.4% of type 1 and 16.0% in type 2 diabetics. But, lipase insufficiency was seen in 41.7% of type 1 and 16.0% in type 2 diabetics. The pancreatic exocrine insufficiency was higher among type 1 (44.44%) than type 2 (18.0%). Smoking habit, alcohol consumption, duration of disease, usage of hypoglycemic agents, ketosuria and type of diabetics were significantly associated with pancreatic exocrine insufficiency. Conclusion: There was an alteration of pancreatic exocrine enzyme secretion among both type 1 and type 2 diabetic patients. The habit of alcohol consumption, smoking and increase in the duration of the disease intensify the pancreatic insufficiency.

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