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 Evidence-based pancreatology 2018 (review of research results on diseases and exocrine pancreatic insufficiency)

2019 ◽  
Vol 43 (2) ◽  
pp. 4-14
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
A. Ye. Klochkov ◽  
G. M. Lukashevich ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Bacterial Overgrowth ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Tumors ◽  
Research Results ◽  
Enzyme Replacement ◽  
Pancreatic Pathology

The article presents a detailed review of the research results in the field of pancreatology published in 2018. Certain parts of the review are devoted to the pathogenesis, diagnostics, course of pancreatitis, its treatment, as well as autoimmune, hereditary pancreatitis, pancreatic pathology in children, as well as treatment. In studying the pathogenesis of pancreatitis, attention is paid to genetic markers of pancreatitis along with a role of bacterial overgrowth syndrome in the small intestine, both in terms of worsening of the course of pancreatitis and the lack of effectiveness of enzyme replacement therapy. The study of the role of alcohol abuse and smoking in the pathogenesis of pancreatic pathology is still in progress. Diagnostics is going on. Endosonography remains the most informative method. A number of studies have been devoted to the studying of exocrine and endocrine pancreatic insufficiency both upon pancreatitis, pancreatic tumors, and in functional dyspepsia and HIV infection. Autoimmune pancreatitis is increasingly being diagnosed, a number of studies are devoted to its diagnostics and treatment. Pancreatic diseases in children develop mainly on the background of genetic predisposition, while functional pancreatic insufficiency occurs in adult patients. The study of the peculiarities of the effect of enzyme replacement therapy continues. The immediate and remote results of the surgical treatment of pancreatic pathology are assessed.

scholarly journals Enzyme replacement therapy, life quality and expectancy of patients with chronic pancreatitis and exocrine pancreatic insufficiency

2018 ◽  
Vol 41 (3) ◽  
pp. 10-16
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
А. Y. Klochkov ◽  
G. М. Lukashevich ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Life Quality ◽  
Exocrine Pancreatic Insufficiency ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
Enteric Coated ◽  
Adequate Dosage

The article reviews the evidence-based studies devoted to the evaluation of the efficacy and safety of enzyme replacement therapy in patients with chronic pancreatitis with exocrine pancreatic insufficiency. Particular attention is paid to the effect of replacement therapy on the life quality and expectancy of patients. It has been proven that the correct prescription of enzyme preparations (minimicrosphere enteric-coated preparation, adequate dosage) improves the quality and prolongs the life of patients.

Chronic giardiasis: a rare cause of exocrine pancreatic insufficiency

2021 ◽  
Vol 14 (5) ◽  
pp. e242129
Author(s):  
Prateek Pophali ◽  
Maedeh Veyseh ◽  
Omar Fraij ◽  
Sahan Hapangama
Keyword(s):  
Clinical Practice ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Exocrine Pancreatic Insufficiency ◽  
Common Condition ◽  
Enzyme Replacement ◽  
Malabsorption Syndromes ◽  
Pancreatic Enzyme Replacement Therapy

Exocrine pancreatic insufficiency (EPI) is a major cause of maldigestion/malabsorption syndromes. It is routinely diagnosed in clinical practice with the use of faecal elastase 1 levels, and pancreatic enzyme replacement therapy continues to be the mainstay of treatment. Numerous primary pancreatic and extrapancreatic causes for EPI have been established. Chronic giardiasis is a common condition with symptoms similar to EPI; however, it has also been described as an infrequent cause of EPI. Much remains to be understood about the pathobiology of this association. Here, we present our experience of an intriguing case of severe pancreatic insufficiency in the setting of chronic giardiasis. The patient showed improvement in symptoms over weeks after completion of treatment for chronic giardiasis.

scholarly journals COMPARING THE ENZYME REPLACEMENT THERAPY COST IN POST PANCREATECTOMY PATIENTS DUE TO PANCREATIC TUMOR AND CHRONIC PANCREATITIS

2016 ◽  
Vol 53 (2) ◽  
pp. 94-97 ◽  
Author(s):  
Anna Victoria FRAGOSO ◽  
Martha Regina PEDROSO ◽  
Paulo HERMAN ◽  
André Luis MONTAGNINI
Keyword(s):  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Gastrointestinal Surgery ◽  
Exocrine Pancreatic Insufficiency ◽  
Intractable Pain ◽  
Enzyme Replacement ◽  
Significant Difference

ABSTRACT Background - Among late postoperative complications of pancreatectomy are the exocrine and endocrine pancreatic insufficiencies. The presence of exocrine pancreatic insufficiency imposes, as standard treatment, pancreatic enzyme replacement. Patients with chronic pancreatitis, with intractable pain or any complications with surgical treatment, are likely to present exocrine pancreatic insufficiency or have this condition worsened requiring adequate dose of pancreatic enzymes. Objective - The aim of this study is to compare the required dose of pancreatic enzyme and the enzyme replacement cost in post pancreatectomy patients with and without chronic pancreatitis. Methods - Observational cross-sectional study. In the first half of 2015 patients treated at the clinic of the Department of Gastrointestinal Surgery at Hospital das Clínicas, Universidade de São Paulo, Brazil, who underwent pancreatectomy for at least 6 months and in use of enzyme replacement therapy were included in this series. The study was approved by the Research Ethics Committee. The patients were divided into two groups according to the presence or absence of chronic pancreatitis prior to pancreatic surgery. For this study, P<0.05 was considered statistically significant. Results - The annual cost of the treatment was R$ 2150.5 ± 729.39; R$ 2118.18 ± 731.02 in patients without pancreatitis and R$ 2217.74 ± 736.30 in patients with pancreatitis. Conclusion - There was no statistically significant difference in the cost of treatment of enzyme replacement post pancreatectomy in patients with or without chronic pancreatitis prior to surgical indication.

scholarly journals News of European Pancreatology (based on the materials of the 52nd meeting of the European Pancreatic Club)

2020 ◽  
Vol 49 (4) ◽  
pp. 6-20
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevich ◽  
L. A. Yaroshenko ◽  
A. Ye. Klochkov ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Exocrine Function ◽  
Anatomical Variants ◽  
Enzyme Replacement ◽  
Pancreatic Pathology ◽  
Pancreatic Steatosis

The 52nd meeting of the European Pancreatic Club was organized and conducted online in Paris on July 2–3, 2020. It is the first time the Congress took place online, with about a thousand of pancreatologists having participated in it. The high scientific, organizational and technical level of the congress should be noted. This review presents the most interesting research results in the following sections: anatomy of the pancreas, acute early chronic, autoimmune pancreatitis, cancer and other malignant pancreatic diseases, functional pancreatic insufficiency, enzyme replacement therapy, pancreatic steatosis, microbiota in pancreatic pathology. Dugic et al. (Sweden) conducted a systematic review “The effect of anatomical variants of the Wirsung’s duct on exocrine function and risk of pancreatic pathology”. Studies of the MEDLINE database from 1960 to 2019 were analyzed; data of 3234 patients were included. A classification of anatomical variants of the pancreatic duct system was compiled. A lecture by T. B. Gardner (Great Britain) on pancreatic steatosis drew great attention. The problem of pancreatic steatosis is surrounded by a number of unresolved issues; the terminology of pancreatic steatosis itself is unclear. Under conditions of oxidative stress, cytokines released from adipocytes trigger the local inflammation and dysfunction of the affected pancreatic cells. The pathogenesis of pancreatic steatosis requires further studies. The symposium on exocrine pancreatic insufficiency in pancreatic cancer played the central role in the congress. Professor E. Dominguez-Munoz (Spain) gave a lecture within the framework of the symposium. 80% of patients with pancreatic cancer have sarcopenia and/or cachexia. Sarcopenia and cachexia in pancreatic adenocarcinoma are the most obviousamong all tumor localizations. The pathogenesis of cachexia and sarcopenia in pancreatic cancer was analyzed in detail; the necessity of enzyme replacement therapy with Creon was substantiated. Particular attention was paid to the pathogenesis of pancreatic insufficiency after surgical treatment (pancreatic resections, pancreatectomy); the features of replacement therapy were highlighted. The meeting of the European Pancreatic Club, as usual, was informative and interesting

Sign in / Sign up

Export Citation Format

Share Document