Fecal Elastase 1 Determination in Chronic Pancreatitis

This study assessed the diagnostic accuracy offecal elastase 1 in chronic pancreatitis. Fifty-threehealthy subjects, 44 patients with chronic pancreatitis(22 severe, 13 moderate, and 9 mild), and 43 patients with nonpancreatic digestive diseasewere studied. Elastase 1 concentration was determined ona small sample of feces using a commercially availablekit. Fecal chymotrypsin was also measured. With a cutoff level of 190 g/g, all healthycontrols except one (98.1%), and the majority ofpatients with nonpancreatic digestive diseases (40 of43; 93.0%) had elastase values above this limit. Amongthe 44 patients with chronic pancreatitis, 34(77.3%) had pathological values: all 22 (100%) withsevere disease, 10 of 13 (76.9%) with moderate diseaseand 2 of 9 (22.2%) with mild disease. Chymotrypsinvalues were pathological in 25 of 44 (56.8%) patientswith chronic pancreatitis: 17 of 22 (77.2%) with severepancreatitis, 7 of 13 (53.8%) with moderatepancreatitis, and 1 of 9 (11.1%) with mild disease. The specificity was 95.8% for elastase 1 and 85.4%for chymotrypsin. The difference both in sensitivity andspecificity of the two enzymes was statisticallysignificant (P < 0.05). Fecal elastase 1 has a high sensitivity, superior to that of fecalchymotrypsin, in the diagnosis of chronic pancreatitis.For its simplicity and rapidity, it could represent thetubeless test of choice in chronicpancreatitis.     

Postprandial Cholecystokinin Response in Patients with Chronic Pancreatitis in Treatment with Oral Substitutive Pancreatic Enzymes

Cholecystokinin (CCK) response to a test mealshould be increased in patients with pancreaticinsufficiency, as trypsin is absent from the duodenum.If pancreatic enzymes are added, a restoration of the inhibitory feedback should result in lowerlevels of CCK. Ten patients with chronic pancreatitisand steatorrhea were studied. CCK basal and postprandiallevels were evaluated the day before and 45 and 90 days after treatment with oral pancreatin.Twelve healthy volunteers were included as referencegroup. CCK basal levels did not vary. CCK response to atest meal was increased in patients before treatment and diminished when oral enzymes weremaintained for months even after three days of therapywithdrawal. We conclude that long-term therapy with oralenzymes induces changes in CCK response that do not regress after three days of treatmentsuspension.     

Gastric Transit and Pharmacodynamics of a Two-Millimeter Enteric-Coated Pancreatin Microsphere Preparation in Patients with Chronic Pancreatitis

It has been suggested that enteric-coatedpancreatin microsphere (ECPM) preparations with spheresizes larger than 1.7 mm pass through the stomach at aslower rate than a meal and therefore may be less efficacious in restoring pancreatic enzymeactivity than preparations with smaller sphere sizes.The aim of this study was to investigate the gastrictransit profile of a 2-mm ECPM preparation in relation to that of a solid meal and to simultaneouslymeasure enzyme activities in eight patients withpancreatic exocrine insufficiency due to chronicpancreatitis. Gastric transit was assessed bydouble-isotope scintigraphy. A pancake was labeled with^99mTc. A 2-mm ECPM preparation was labeledwith ¹⁷¹Er. Intraluminal pancreatic enzymeactivities were assessed during a 6-hr period with thecholesteryl-[¹⁴C]octanoate breath test (for carboxyl ester lipaseactivity) and the N -benzoyl-L-tyrosyl-p aminobenzoicacid/p-aminosalicylic acid (NBT-PABA/PAS) test (forchymotrypsin activity). The ECPM preparation passedthrough the stomach more rapidly (median 24 min) thanthe pancake (median 52 min, P < 0.05). During ECPMtherapy, mean cumulative ¹⁴CO₂outputs rose significantly from 30% to 70% (P <0.05), but remained below outcomes in healthy volunteers. Mean cumulative plasmaPABA concentrations rose significantly from 46% to 87%(P < 0.05) and were not significantly different fromoutcomes in healthy volunteers. In chronic pancreatitis, a 2-mm ECPM preparation does not pass throughthe stomach more slowly than a solid meal, but in factfaster. Digestion of ester lipids and proteins showed animprovement to subnormal and normal levels,respectively.     

Effect of Tramadol and Morphine on Pain and Gastrointestinal Motor Function in Patients with Chronic Pancreatitis

Tramadol and morphine were compared fortreatment of severe chronic pancreatitis pain and theirinteraction with gut motor function. Oral tramadol ormorphine doses were titrated double-blinded andrandomized for five days in 25 patients and pain, sideeffects, bowel function, orocecal and colonic transit,anal resting pressure, and rectal distension thresholdswere measured. Pain intensities (mean ± SD, 0 = none, 100 = unbearable) before treatment andon day 4 were 75 ± 19 and 8 ± 13 withtramadol (P < 0.001), and 65 ± 21 and 5± 6 with morphine (P < 0.001). On day 4, 67%of patients with tramadol and 20% with morphine rated their analgesia asexcellent (P < 0.001) with mean respective doses of840 mg (range: 80-1920) and 238 mg (20-1125). Orocecaltransit was unchanged after five days of tramadol, but increased with morphine (P < 0.05). Morepatients had prolonged colonic transit times withmorphine by day 5 (P < 0.05). Rectal distensionthreshold pressures increased only with tramadol (P < 0.01). It is concluded tramadol and morphineare potent analgesics in severe chronic pancreatitispain when individually titrated. Tramadol interferedsignificantly less with gastrointestinal function and was more often rated as an excellent analgesicthan morphine.     

Incidence and Risk of Pancreatic Cancer in Patients with a New Diagnosis of Chronic Pancreatitis

Digestive Diseases and Sciences - Chronic pancreatitis (CP) is a risk factor for pancreatic ductal adenocarcinoma (PDAC); nevertheless, the true incidence of PDAC in CP patients in the United...     

Worldwide Burden of,Risk Factors for,and Trends in Pancreatic Cancer

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Determination of Plasma Trypsin-Like Activity in Healthy Subjects, Patients With Mild to Moderate Alcoholic Chronic Pancreatitis, and Patients With Nonjaundice Pancreatic Cancer

Trypsin-like activity is released after stimulation of the exocrine pancreas. We investigated under basal conditions and after stimulation by a meal whether patients suffering from pancreatic disorders differ with respect to plasma trypsin-like activity (PTLA). In 45 subjects (healthy volunteers: n = 18, mild/moderate alcoholic chronic pancreatitis: n = 16, nonjaundice pancreatic cancer n = 7, and calcifying chronic pancreatitis: n = 4), basal and postprandial levels of PTLA were measured over a period of 2 hours. Basal plasma levels were similar in the first 3 groups. After stimulation, healthy volunteers and patients with pancreatic cancer showed significant decreases in trypsin-like activity; however, plasma levels did not decrease in patients with mild/moderate chronic pancreatitis (P < .001). Healthy individuals demonstrate a consistent decrease in postprandial trypsin-like plasma activity. This response is not altered in patients with pancreatic cancer, and it is not seen in patients with mild/moderate alcoholic chronic pancreatitis.     

Changes in Blood Alcohol Levels as a Function of Alcohol Concentration and Repeated Alcohol Exposure in Adult Female Rats: Potential Risk Factors for Alcohol-Induced Fetal Brain Injury

Fetal alcohol syndrome and alcohol-related birth defects are the result of heavy maternal alcohol consumption during gestation. The magnitude of deficit manifested by the offspring is invariably a consequence of several risk factors that may result in high peak blood alcohol concentrations (BACs), such as the duration, timing, or pattern of alcohol consumption. In addition, the alcohol content of the consumed beverage may play a role in determining offspring developmental consequences. Because higher BACs are positively correlated with risk and severity of brain injury early in postnatal lie, initially it was important to determine how BAC is influenced by alcohol concentration and whether that influence is constant over repeated alcohol treatments. Groups of female Sprague-Dawley rats received daily intragastric intubations of 5 g/kg alcohol in one of several concentrations: 45% (v/v), 30% (v/v), 22.5% (v/v), or 15% (v/v) for a duration of 18 consecutive days. Blood samples were taken at various times postintubation on days 3,8,13, and 18 of treatment, and analyzed by headspace gas chromatography. Multivariate analyses of peak BAC, average BAC, and time to reach peak BAC revealed some noteworthy results. First, peak BAC and average BAC were significantly lower in the 45% group, compared with the other concentration groups, whereas this group also took a longer time to reach peak BAC than the other three groups. Second, peak BAC and averege BAC were higher on the last day of treatment than any of the other treatment days. These results suggest that alcohol concentration and repeated alcohol exposure can influence BAC and, as such, are important risk factors to be considered in the appraisal of alcohol-induced fetal brain injuries.     

International Consensus Guidelines for Risk Factors in Chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology,the American Pancreatic Association,the Japan Pancreas Society,and European Pancreatic Club

BackgroundChronic pancreatitis (CP) is a complex inflammatory disease with remarkably impaired quality of life and permanent damage of the pancreas. This paper is part of the international consensus guidelines on CP and presents the consensus on factors elevating the risk for CP.MethodsAn international working group with 20 experts on CP from the major pancreas societies (IAP, APA, JPS, and EPC) evaluated 14 statements generated from evidence on four questions deemed to be the most clinically relevant in CP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the level of evidence available per statement. To determine the level of agreement, the working group voted on the 14 statements for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach’s alpha reliability coefficient.ResultsStrong consensus and agreement were obtained for the following statements: Alcohol, smoking, and certain genetic alterations are risk factors for CP. Past history, family history, onset of symptoms, and life-style factors including alcohol intake and smoking history should be determined. Alcohol consumption dose-dependently elevates the risk of CP up to 4-fold. Ever smokers, even smoking less than a pack of cigarettes per day, have an increased risk for CP, as compared to never smokers.ConclusionsBoth genetic and environmental factors can markedly elevate the risk for CP. Therefore, health-promoting lifestyle education and in certain cases genetic counselling should be employed to reduce the incidence of CP.