scholarly journals A brief review of clinical guidelines for the diagnosis and treatment of exocrine pancreatic insufficiency

2022 ◽  
pp. 5-14
Author(s):  
Yu. A. Kucheryavyy ◽  
D. S. Bordin
Keyword(s):  
Clinical Practice ◽  
Chronic Pancreatitis ◽  
Clinical Guidelines ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Review Article ◽  
Minimal Change ◽  
Diagnosis And Treatment ◽  
International Consensus

In recent years, several consensus and guidelines for the diagnosis and treatment of chronic pancreatitis have been published. In 2017, the Russian and Pan-European (HaPanEU) consensus was published, in 2018 — the international consensus on minimal change pancreatitis, in 2020 — the clinical guidelines of the American College of Gastroenterology, in 2021 — the British clinical guidelines. Many of their provisions overlap. This review article analyzed the main provisions of the latest recommendations, taking into account the possibility of their adaptation to Russian clinical practice.

scholarly journals Early chronic pancreatitis: is a clinical diagnosis possible?

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.

scholarly journals Evidence-based pancreatology 2017/2018 (review of the results of studies on chronic pancreatitis and exocrine pancreatic insufficiency

2018 ◽  
Vol 40 (2) ◽  
pp. 12-20
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevish ◽  
E. V. Berezhnaya
Keyword(s):  
Pancreatic Cancer ◽  
Cystic Fibrosis ◽  
Chronic Pancreatitis ◽  
Imaging Techniques ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Diagnosis And Treatment ◽  
Evidence Based

The article provides an overview of the European recommendations on the diagnosis and treatment of chronic pancreatitis. The results of evidence-based research related to the epidemiology, course of chronic pancreatitis, assessment of the informative value of various imaging techniques, reatment of pancreatic insufficiency upon chronic pancreatitis, cystic fibrosis, pancreatic cancer are analyzed. A conclusion is drawn about the need for further carrying out of evidence-based studies.

scholarly journals Diagnosis and treatment of diabetes mellitus in chronic pancreatitis

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.

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

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.

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

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

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

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
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.

scholarly journals A Case of Chronic Pancreatic Insufficiency Due to Valproic Acid in a Child

2001 ◽  
Vol 15 (2) ◽  
pp. 127-130 ◽  
Author(s):  
Mary Anne Cooper ◽  
Aubrey Groll
Keyword(s):  
Valproic Acid ◽  
Weight Loss ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Exocrine Pancreatic Insufficiency ◽  
Radiological Evaluation ◽  
Enzyme Replacement

A 14-year-old child treated with valproic acid over several years for a seizure disorder developed abdominal pain with radiological evidence of acute pancreatitis. The association with valproic acid was not recognized, and the child continued to take the drug. The patient eventually developed steatorrhea and weight loss that improved with pancreatic enzyme replacement. Radiological evaluation showed an atrophic pancreas. Without evidence of other etiological factors, valproic acid by itself appeared to be the cause of chronic pancreatitis with exocrine pancreatic insufficiency in this patient.

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