Serum-Derived Bovine Immunoglobulin/Protein Isolate for the Management of Diarrhea Associated with Chronic Pancreatitis and Pancreatic Insufficiency: A Novel Approach

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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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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Percutaneous transhepatic islet cell autotransplantation after pancreatectomy for chronic pancreatitis: a novel approach

HPB ◽

10.1111/j.1477-2574.2011.00332.x ◽

2011 ◽

Vol 13 (7) ◽

pp. 511-516 ◽

Cited By ~ 19

Author(s):

Katherine A. Morgan ◽

Michael Nishimura ◽

Renan Uflacker ◽

David B. Adams

Keyword(s):

Chronic Pancreatitis ◽

Islet Cell ◽

Novel Approach

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

Surgical Practice ◽

10.1111/1744-1633.12029 ◽

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

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Differential Treatment of Exocrine Pancreatic Insufficiency in Chronic Pancreatitis

Pancreatic Enzymes in Health and Disease ◽

10.1007/978-3-642-76097-6_21 ◽

1991 ◽

pp. 191-208 ◽

Cited By ~ 6

Author(s):

P. G. Lankisch

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Insufficiency ◽

Exocrine Pancreatic Insufficiency ◽

Differential Treatment

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Autoimmune Pancreatitis

10.2310/gastro.5467 ◽

2018 ◽

Author(s):

Allison L Yang ◽

Julia McNabb-Baltar

Keyword(s):

Chronic Pancreatitis ◽

Obstructive Jaundice ◽

Autoimmune Pancreatitis ◽

Pancreatic Insufficiency ◽

Imaging Findings ◽

Laboratory Findings ◽

Related Disease

Autoimmune pancreatitis (AIP) is a subcategory of chronic pancreatitis that is highly responsive to steroids. The term was first proposed in 1995 by Yoshida and colleagues, and since its discovery, the diagnosis of AIP has dramatically increased. AIP is a chronic fibroinflammatory disease characterized by lymphoplasmacytic infiltrates and fibrosis on histology. There are two distinct subtypes: type 1 AIP is the pancreatic manifestation of a systemic serum immunoglobulin G subtype 4–related disease (IgG4-RD) and type 2 AIP is described clinically as idiopathic duct-centric pancreatitis and has no association with IgG4. Clinically, AIP presents most commonly as obstructive jaundice in type 1 AIP and can present as acute pancreatitis in type 2 AIP. The diagnostic criteria include histology, imaging findings, and responsiveness to steroids as well as laboratory findings and other organ involvement. The mainstay of treatment is steroid therapy, with immunomodulators such as rituximab used for maintenance or relapsing disease. Long-term complications of AIP include pancreatic insufficiency and are often associated with relapsing disease. This review contains 45 references, 1 figure, and 2 tables. Key Words: autoimmune pancreatitis, chronic pancreatitis, EUS-guided biopsy, IgG4, immunomodulatory, obstructive jaundice, pancreas mass, steroid

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Endoscopic Ultrasound Findings in Patients Diagnosed with Exocrine Pancreatic Insufficiency by Low Fecal Elastase-1

Gastroenterology Research and Practice ◽

10.1155/2019/5290642 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Mazen Shobassy ◽

Nedaa Husainat ◽

Abdalaziz Tabash ◽

Kalpesh Patel ◽

Hashem B. El-Serag ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Endoscopic Ultrasound ◽

Pancreatic Insufficiency ◽

Cross Sectional Study ◽

Lifestyle Factors ◽

Exocrine Pancreatic Insufficiency ◽

Cross Sectional ◽

Fecal Elastase ◽

Elastase 1 ◽

Pancreatic Neoplasia

Background and Aims. Fecal elastase-1 (FE-1) as a screening test for exocrine pancreatic insufficiency (EPI) is gaining popularity in clinical practice. The role of imaging in patients with FE-1-related suspicion of EPI remains unclear. The aim of this study was to characterize endoscopic ultrasound (EUS) findings for patients with low FE-1. Methods. A retrospective cross-sectional study was performed in 40 patients who had low FE-1 and underwent EUS to evaluate the pancreas. We obtained data on demographic and lifestyle factors, EUS findings, and histopathology results. We compared these variables between patients with FE‐1<100 mcg/g vs. 100-200 mcg/g. Results. Most patients (82.5%) established one or more new diagnoses from EUS. Diagnoses included: definitive chronic pancreatitis (n=29, 72.5%), fatty pancreas (n=9, 22.5%), and pancreatic solid mass or cyst (n=9, 22.5%). Half (n=4) of the solid or cystic lesions were neoplastic. All patients with a solid pancreatic mass also had concurrent chronic pancreatitis. There were no significant differences in EUS findings or demographic or lifestyle factors between groups with FE‐1<100 mcg/g vs. 100-200 mcg/g. Conclusion. Chronic pancreatitis is the most common EUS finding in patients with low FE-1 levels. EUS appears helpful in determining the cause of EPI in most patients with low FE-1 and may detect unsuspected pancreatic neoplasia.

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