scholarly journals Staging chronic pancreatitis with exocrine function tests: are we better?

2018 ◽  
Vol 42 (4) ◽  
pp. 16-19
Author(s):  
C. Sperti ◽  
L. Moletta
Keyword(s):  
Chronic Pancreatitis ◽  
Early Stage ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Function ◽  
Clinical Severity ◽  
Exocrine Function

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas evolving in progressive fibrotic disruption of the gland with exocrine and endocrine pancreatic insufficiency. Although imaging features of CP are well known, their correlation with exocrine pancreatic function tests are not obvious, particularly in the early stage of the disease. There are many clinical classification of CP, all suggested for better distinguish and manage different forms based on etiological and clinical factors, and severity of the disease. Recently, a new classification of CP has been suggested: the M-ANNHEIM multiple risk factor classification that includes etiology, stage classification and degree of clinical severity. However, more accurate determination of clinical severity of CP requires a correct determination of exocrine function of the pancreas and fecal fat excretion. Recently, Kamath et al. (2017) demonstrated that the evaluation of exocrine pancreatic function by acid steatocrit and fecal elastase-1 (EF-1) was helpful, but EF-1 was able to detect exocrine pancreatic insufficiency in more patients, upgrading some patients in higher stage of disease according to M-ANNHEIM classification. So, EF-1 is a more accurate test to determine exocrine pancreatic insufficiency and to stage chronic pancreatitis in the M-ANNHEIM classification. On the contrary, EF-1 determination shows low sensitivity in detecting exocrine pancreatic insufficiency in early stage of the disease.

Exocrine pancreatic insufficiency after esophagectomy: a systematic review of literature

2021 ◽  
Author(s):  
L Blonk ◽  
N J Wierdsma ◽  
E P Jansma ◽  
G Kazemier ◽  
D L van der Peet ◽  
...  
Keyword(s):  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Enzymes ◽  
Pancreatic Function ◽  
Study Quality ◽  
Fecal Elastase ◽  
Elastase 1 ◽  
Fecal Fat ◽  
Effect Of Treatment

Summary Complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are often attributed to an impaired exocrine pancreatic function. This review systematically summarizes all literature reporting on the presence of exocrine pancreatic insufficiency (EPI) after esophagectomy and the effect of treatment with pancreatic enzymes on gastrointestinal complaints, body weight, and quality of life. Databases of PubMed, Embase, and Wiley/Cochrane Library were searched systematically until July 2020. Studies reporting on EPI and pancreatic enzyme replacement therapy after esophagectomy were included. The Newcastle–Ottawa scale was used to assess study quality. Four studies, including 158 patients, were selected. The maximum score for study quality was six (range 4–6). Exocrine pancreatic function was investigated in three studies, measured by fecal elastase-1 and 72-hour fecal fat excretion. Fecal elastase-1 levels <200 μg/g were reported in 16% of patients at 4 months, 18% at 6 months, and 31% at 18–24 months postoperatively. A decreased fecal fat absorption was noticed in 57% 1 month postoperatively. Treatment with pancreatic enzymes was reported in two studies. In patients with fecal elastase-1 levels <200 μg/g, 90% of patients reported improvement in symptoms and 70% reported improvement in weight. In patients with complaints of steatorrhea, 87% noticed settlement of symptoms. Based on current literature, complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are common and can be related to an impaired exocrine pancreatic function. High-quality studies evaluating the presence of EPI and the effect of treatment with pancreatic enzymes after esophagectomy are needed to verify this conclusion.

727 EXOCRINE PANCREATIC INSUFFICIENCY AFTER ESOPHAGECTOMY: A SYSTEMATIC REVIEW OF LITERATURE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Lotte Blonk ◽  
N J Wierdsma ◽  
E P Jansma ◽  
G Kazemier ◽  
D L Peet ◽  
...  
Keyword(s):  
Weight Loss ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Enzymes ◽  
Pancreatic Function ◽  
Fecal Elastase ◽  
Elastase 1 ◽  
Fecal Fat ◽  
Effect Of Treatment

Abstract   Complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are often attributed to an impaired exocrine pancreatic function. This review systematically summarizes all literature reporting on the presence of exocrine pancreatic insufficiency (EPI) after esophagectomy and the effect of treatment with pancreatic enzymes on gastrointestinal complaints, body weight, and quality of life. Methods Databases of PubMed, Embase, and Wiley/Cochrane Library were searched systematically until July 2020. Studies reporting on EPI and pancreatic enzyme replacement therapy after esophagectomy were included. Results Four studies, including 158 patients, were selected. Exocrine pancreatic function was investigated in three studies, measured by fecal elastase-1 and 72-hour fecal fat excretion. Fecal elastase-1 levels <200 μg/g were reported in 16% of patients at 4 months, 18% at 6 months, and 31% at 18-24 months postoperatively. A decreased fecal fat absorption was noticed in 57% 1 month postoperatively. Treatment with pancreatic enzymes was reported in two studies. In patients with fecal elastase-1 levels <200 μg/g, 90% of patients reported improvement in symptoms and 70% reported improvement in weight. In patients with complaints of steatorrhea, 87% noticed settlement of symptoms. Conclusion Based on current literature, complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are common and can be related to an impaired exocrine pancreatic function. High-quality studies evaluating the presence of EPI and the effect of treatment with pancreatic enzymes after esophagectomy are needed to verify this conclusion.

scholarly journals Method Performance of Bicarbonate and Electrolytes by Use of Duodenal Fluid for Assessment of Exocrine Pancreatic Function

2018 ◽  
Vol 3 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Amy Pyle-Eilola ◽  
Jill Pagan ◽  
Adam Kayatin ◽  
Patrick N Povse ◽  
Jacqua A Rietschlin ◽  
...  
Keyword(s):  
Limit Of Detection ◽  
Pancreatic Insufficiency ◽  
Method Comparison ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Function ◽  
Stability Studies ◽  
Method Performance ◽  
Sodium Potassium ◽  
Duodenal Fluid

Abstract Background Evaluation of exocrine pancreatic insufficiency is challenging for both clinicians and laboratories. Indirect pancreatic function tests such as serum trypsinogen, fecal elastase, and fecal fat measurements are moderately sensitive for diagnosis of advanced chronic pancreatitis but show reduced sensitivity and specificity for diagnosis of early disease. An alternative is the endoscopic pancreatic function test, which uses duodenal secretions after administration of IV secretin. Samples are collected at various times via the endoscopic tube and then analyzed for bicarbonate, sodium, potassium, and chloride. Methods Precision, linearity, method comparison, and stability studies were performed on the Beckman Coulter AU5822 chemistry analyzer with duodenal fluid. Comparison with the Vitros 4600 dry slide chemistry instrument was used to interrogate differences between methods. Results All assays produced a CV <2% without any measurable effects from the endoscopy fluid matrix and showed acceptable imprecision near the limit of detection (CV < 5%). All analytes showed linear dilution across the analytical measuring range. All the calculated error biases from dilutions were within 50% of the CLIA-allowable error for serum for each of the respective analytes. The calculated slopes ranged from 0.841 to 1.274 when compared to the Vitros 4600. Stability studies demonstrated that sodium, potassium, chloride, and bicarbonate remained stable after storage at −20 °C and after multiple freeze–thaw cycles. The percent change for all analytes was <5% mmol/L. Conclusions The AU5800 series demonstrated adequate performance for the analysis of bicarbonate in duodenal fluid and therefore can be used for assessment of exocrine pancreatic function. However, notable discrepancies were observed for sodium, potassium, and chloride between the AU5800 series and the Vitros 4600.

scholarly journals 13C labelled cholesteryl octanoate breath test for assessing pancreatic exocrine insufficiency

Gut ◽  
1998 ◽  
Vol 42 (1) ◽  
pp. 81-87 ◽  
Author(s):  
M Ventrucci ◽  
A Cipolla ◽  
G M Ubalducci ◽  
A Roda ◽  
E Roda
Keyword(s):  
Breath Test ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Pancreatic Disease ◽  
Exocrine Pancreatic Function ◽  
Significant Rise ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Function ◽  
Healthy Controls ◽  
Exocrine Insufficiency

Background—A non-invasive test for assessment of fat digestion has been developed based on the intraluminal hydrolysis of cholesteryl-[1-13C]octanoate by pancreatic esterase.Aims—To determine the diagnostic performance of this breath test in the assessment of exocrine pancreatic function.Methods—The test was performed in 20 healthy controls, 22 patients with chronic pancreatic disease (CPD), four with biliopancreatic diversion (BPD), and 32 with non-pancreatic digestive diseases (NPD); results were compared with those of other tubeless tests (faecal chymotrypsin and fluorescein dilaurate test).Results—Hourly recoveries of13CO2 were significantly lower in CPD when compared with healthy controls or NPD. In patients with CPD with mild to moderate insufficiency, the curve of 13CO2recovery was similar to that of healthy controls, while in those with severe insufficiency it was flat. In three patients with CPD with severe steatorrhoea, a repeat test after pancreatic enzyme supplementation showed a significant rise in13CO2 recovery. The four BPD patients had low and delayed 13CO2 recovery. Only eight of the 32 patients with NPD had abnormal breath test results. There was a significant correlation between the results of the breath test and those of faecal chymotrypsin, the fluorescein dilaurate test, and faecal fat measurements. For the diagnosis of pancreatic disease using the three hour cumulative 13CO2 recovery test, the sensitivity was 68.2% and specificity 75.0%; values were similar to those of the other two tubeless pancreatic function tests. In seven healthy controls, nine patients with CPD, and nine with NPD a second breath test was performed using Na-[1-13C]octanoate and a pancreatic function index was calculated as the ratio of13C recovery obtained in the two tests: at three hours this index was abnormal in eight patients with CPD and in three with NPD.Conclusion—The cholesteryl-[1-13C]octanoate breath test can be useful for the diagnosis of fat malabsorption and exocrine pancreatic insufficiency.

scholarly journals Causes of Exocrine Pancreatic Insufficiency Other Than Chronic Pancreatitis

2021 ◽  
Vol 10 (24) ◽  
pp. 5779
Author(s):  
Lumír Kunovský ◽  
Petr Dítě ◽  
Petr Jabandžiev ◽  
Michal Eid ◽  
Karolina Poredská ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Pancreatic Disease ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Tumors ◽  
Enzyme Replacement ◽  
Pancreatic Enzyme Replacement Therapy ◽  
Exact Etiology

Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist. These include pancreatic tumors, pancreatic resection procedures, and cystic fibrosis. Other diseases and conditions, such as diabetes mellitus, celiac disease, inflammatory bowel disease, and advanced patient age, have also been shown to be associated with EPI, but the exact etiology of EPI has not been clearly elucidated in these cases. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Pancreatic enzyme replacement therapy (PERT) is indicated for the conditions described above presenting with clinically clear steatorrhea, weight loss, or symptoms related to maldigestion and malabsorption. This review summarizes the current literature concerning those etiologies of EPI less common than chronic pancreatitis, the pathophysiology of the mechanisms of EPI associated with each diagnosis, and treatment recommendations.

scholarly journals Determination of the level of pancreatic elastase as the “gold standard” for assessing the state of the pancreas in pediatric practice

2020 ◽  
pp. 63-67
Author(s):  
N. V. Rylova ◽  
A. V. Zholinsky
Keyword(s):  
Chronic Pancreatitis ◽  
Quantitative Determination ◽  
Gold Standard ◽  
Structural Changes ◽  
Pancreatic Insufficiency ◽  
The State ◽  
Exocrine Function ◽  
Pancreatic Elastase ◽  
Elastase 1

The purpose of the study was to assess the state of the pancreas in children, taking into account the indicators of pancreatic elastase of blood serum and feces.Materials and methods. A study of pancreatic elastase was carried out in 115 children aged 7-15 years with combined gastroduodenal and biliary pathology.Results. In a comprehensive assessment of the structural and functional state of the pancreas, it was found that in 26.5% of cases there were functional and 45.2% structural changes: chronic pancreatitis - 9.6% of patients, recurrent pancreatitis - 9.9%, reactive pancreatitis - 25.7% of children, dysfunctional disorders - 26.5% of patients. Findings. The studied method has 100% sensitivity and 98% specificity in the differential diagnosis of functional and structural changes in the pancreas. The coprological test allows a quantitative determination of the elastase-1 level, reflecting the degree of pancreatic insufficiency.Conclusion. Using this test for quantitative determination in serum provides an opportunity to assess the level of enzymemia in reactive pancreatitis. In accordance with modern concepts, pancreatic elastase can be considered as the “gold standard” for diagnosing chronic pancreatitis, a marker for the exocrine function of the pancreatic gland (scatological test) and as an indicator of reactive pancreatitis (definition of serum elastase-1).

scholarly journals Combined Single Day 14C-Triolein Breath Test and Paba Test in the Diagnosis of Malabsorption

1990 ◽  
Vol 27 (1) ◽  
pp. 50-55 ◽  
Author(s):  
S C Fleming ◽  
M S Kapembwa ◽  
G E Griffin
Keyword(s):  
Breath Test ◽  
Gastrointestinal Disease ◽  
Pancreatic Insufficiency ◽  
Pancreatic Disease ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Function ◽  
Fat Absorption ◽  
Aminosalicylic Acid ◽  
Function Combination

The 14C-triolein breath test, a recognised index of fat absorption, and the p-aminobenzoic acid (PABA) test, a ‘tubeless’ test of exocrine pancreatic function, have both been widely used in the diagnosis of malabsorption and exocrine pancreatic insufficiency. This study evaluates the potential of a combination of both tests in the investigation of fat absorption and exocrine pancreatic function. Combination of the tests has become technically feasible because of the introduction of high pressure liquid chromatography as the preferred method of analysis for PABA, and use of p-aminosalicylic acid (PAS) as the marker for PABA absorption and metabolism We studied 25 healthy subjects, 11 patients with exocrine pancreatic disease and 12 patients with gastrointestinal disease. The combined test identified subjects with reduced fat absorption and distinguished subjects with exocrine pancreatic insufficiency from those with an intestinal cause of fat malabsorption. The test could be completed in 7 h and had high patient acceptibility. These findings suggest that the combined 14C-triolein breath test and PABA test can be used as a non-invasive, 1-day investigation of fat absorption and exocrine pancreatic function.

scholarly journals Digestive enzyme replacement relieves growth failure in preterm infants with poor exocrine pancreatic function: a retrospective case series

2021 ◽  
Author(s):  
Annette Münch ◽  
Christoph Bührer ◽  
Ann Carolin Longardt
Keyword(s):  
Weight Gain ◽  
Preterm Infants ◽  
Digestive Enzyme ◽  
Pancreatic Insufficiency ◽  
Growth Failure ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Very Preterm Infants ◽  
Enzyme Replacement ◽  
Fecal Pancreatic Elastase

AbstractIn orally fed preterm infants, poor weight gain may be linked to low fecal pancreatic elastase-1 (FPE-1) activity, indicative of exocrine pancreatic insufficiency. The objective of this study was the retrospective assessment of the effect of exogenous digestive enzyme replacement by gavage in preterm infants with growth failure and low FPE-1 (<200 μg/g). We analyzed weight gain relative to baseline and caloric intake during 14-day periods before and after institution of digestive enzyme replacement containing 6000 U lipase and 240 U protease kg−1 d−1. Among 46 of 132 preterm infants < 1250g birth weight surviving to at least 14 days in whom FPE-1 was determined, 38 infants had low FPE-1 (< 200 μg/g), and 33 infants received exogenous digestive enzyme replacement. Average daily weight gain significantly increased from 14.4 [range 2.6–22.4] g kg−1 d−1 to 17.4 [8.4–29.0] g kg−1 d−1 (P = 0.001), as did weight gain per kcal, from 0.08 [0.02–0.13] g kcal−1 d−1 to 0.11 [0.05–0.18] g kcal−1 d−1.Conclusion: In preterm infants with signs and symptoms of exocrine pancreatic insufficiency, exogenous digestive enzyme replacement is associated with improved growth. What is Known:• Very preterm infants on full enteral nutrition may display growth failure linked to transient poor exocrine pancreatic function.• Porcine pancreatic enzymes covered with an acid-resistant coating are too large to pass the internal diameter of most gavage tubes used in very preterm infants.What is New:• Administration of a liquid formulation of acid-resistant microbial digestive enzymes in preterm infants with growth failure and low fecal pancreatic elastase-1 values was associated with improved weight gain.• Response to exogenous digestive enzyme replacement was associated with the prior extent of growth failure.

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