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

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.

Exocrine pancreatic insufficiency after esophagectomy: a systematic review of literature

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.

Impaired exocrine pancreatic function in different stages of type 1 diabetes

IntroductionAim of this study was to investigate the pancreatic exocrine function in patients with type 1 diabetes (T1D) by multiple non-invasive tests.Research design and methodsThe study is a single-center, cross-sectional study of pancreatic exocrine function in adult patients with new-onset or long-standing T1D and healthy controls.ResultsHealthy controls, new-onset T1D, and long-standing T1D were similar for age at the time of the study, gender and body mass index (BMI) categories. Age of onset of T1D patients with long-standing disease was younger than that of patients with new-onset T1D (p<0.001). As expected, the three groups differed for C-peptide and hemoglobin A1c (HbA1c) levels. Lipase activity measured by 13C-mixed triglyceride breath test was reduced progressively, although not significantly, from controls to recent-onset T1D and long-standing T1D participants. Fecal elastase-1 was significantly lower in participants with T1D, either new onset or long standing. Pancreatic amylase, lipase, retinol binding protein and prealbumin were significantly different across the groups, with a significant trend toward lower values in long-standing T1D and intermediate values in new-onset T1D, while no differences were observed for total amylase. The markers of impaired exocrine function tests (fecal elastase-1, serum pancreatic amylase and lipase) and of nutritional status (retinol binding protein and prealbumin levels) correlated with the reduction of fasting and urinary C-peptide.ConclusionsOur results confirm that exocrine pancreatic impairment is a feature of T1D, with low fecal elastase-1, serum pancreatic amylase and lipase as specific markers, associated with reduced levels of nutritional indexes. Moreover, the evidence of more advanced insufficiency in long-standing disease reflects the chronic nature of this process, and its correlation with the residual β-cell function suggests parallel pathways for the impairment of the endocrine and exocrine pancreatic function.

POSSIBILITIES OF COMPLEX CORRECTION OF MORPHOLOGICAL GASTRODUODENAL CHANGES WITH COMORBIDITY OF CHRONIC PANCREATITIS AND CHRONIC H. PYLORI – GASTRITIS

The aim: To investigate the efficacy of Doctovit, a combination of dexpanthenol (provitamin B5) and methylmethionine (vitamin U), in the treatment of patients with chronić pancreatitis in combination with chronic erosive gastritis associated with H. pylori by studying the dynamics of stomach lining morphological changes. Materials and methods: Forty-five outpatients with CP and H.pylori CG were examined. The degree of excretory insufficiency of the pancreas was determined by the level of fecal α-elastase-1. At the beginning of the study and two months after the treatment has started, esophagogastroduodenoscopy + urease test for H. pylori + biopsy from 5 sites with histological examination has been performed. Results: It was found that a significant decrease in lymphohistiocytic infiltration of stomach lining, restoration of the structure of glands which have not undergone atrophy, increased focal hyperplasia (proliferation) of the glandular epithelium as signs of morphological restoration of the epithelium, reduction of epithelial dysplasia signs against the complete absence of positive dynamics of epithelial dysplasia in the group of patients receiving standard treatment of CP and CG, are clear and reliable signs of the effectiveness of vitamin Doctovit in complex therapy of CG associated with H.pylori, which indicate the feasibility of using the medicine to restore SL, which is the basis for effective carcinoprevention. Conclusions: The effectiveness of both treatment complexes in the correction of exocrine insufficiency of the pancreas by the dynamics of fecal α-elastase-1 was proved and which was statistically significantly higher when using the program with the inclusion of Doctovit: respectively 28.12% vs. 20.74% (p< 0.05). The total dynamics of morphological state improvement of stomach lining in the 1st group of patients was 0.9 points against 1.6 points in the 2nd group of patients, which was 17% and 32%, respectively (p <0.05), which activates clinical data on the effectiveness and feasibility of using a combination of dexpanthenol and methylmethionine according to the suggested scheme in the treatment of patients with chronic pancreatitis in comorbidity with H. pylori erosive CG.