Search

Pancreatic exocrine insufficiency (PEI) is a common complication in patients with chronic pancreatitis (CP), leading to increased morbidity and mortality if not treated adequately. Pancreatic enzyme replacement therapy|pancreas enzyme replacement therapy (PERT) is the cornerstone in treatment of patients with PEI. In the present study, we use data from the Scandinavian Baltic Pancreatic Club database to examine adherence of PERT according to United European Gastroenterology evidence‐based guidelines treatment of CP. Patients with definitive or probable CP according to M‐ANNHEIM diagnostic criteria were included. We collected information on exposures, exocrine function, intake of pancreatic enzymes, and markers of nutrition. Fecal elastase <200 μg/g was defined as a marker for PEI. Enzyme replacement therapy of 100,000 lipase units or more was defined as adequate treatment. We included 1006 patients from 8 centers in five countries. Sixty‐four percent of the patients were correctly treated. Twenty‐five per cent of PEI patients were not taking enzymes at all, and 20% of PEI patients were undertreated with insufficient PERT doses according to the guidelines. Fourteen percent of patients with sufficient pancreatic function were receiving enzymes despite normal exocrine pancreatic function. There were center differences. Current smoking was associated with lack of treatment and alcohol abuse was associated with under‐treatment. There were no associations between “no treatment” or “under‐treatment” for underweight or vitamin Ddeficiency. In our CP expert centers, the adherence to guidelines for enzyme treatment is insufficient. Both patient factors and center differences have influence on treatment adherence.

Background Diabetes mellitus is a common complication of chronic pancreatitis. It is traditionally considered to develop as a consequence of beta cell loss, but there might be additional factors. Recent studies have highlighted the importance of type 2 diabetes-related risk factors in this context and population-based studies show increased risk of diabetes following acute pancreatitis. The aim of this study was to explore multiple risk factors for diabetes in patients with chronic pancreatitis.Methods We conducted a multicentre, cross-sectional study of patients with definitive chronic pancreatitis according to the M-ANNHEIM criteria. We used multivariable logistic regression models to determine risk factors independently associated with diabetes.Results The study included 1117 patients of whom 457 (40.9 %) had diabetes. The mean age was 52.8 ± 14.2 years and 67% were men. On multivariate analysis, parameters indicative of beta cell loss (pancreatic calcification, exocrine insufficiency, pancreatic resection) were confirmed as independent risk factors for diabetes (allp≤ 0.02). In addition, type 2 diabetes-related risk factors (dyslipidaemia and overweight/obesity) were associated with the presence of diabetes (all p≤ 0.002). Patients with a history of pancreatic fluid collections (indicative of previous attacks of acute pancreatitis) had a marginally increased risk of diabetes (p= 0.07).Conclusion In patients with chronic pancreatitis the presence of diabetes is associated with multiple risk factors including type 2 diabetes-related factors. Our observations attest to the understanding of this entity and may have implications for treatment.

Diabetes mellitus is a common complication of chronic pancreatitis. It is traditionally considered to develop as a consequence of beta cell loss, but there might be additional factors. Recent studies have highlighted the importance of type 2 diabetes-related risk factors in this context and population-based studies show increased risk of diabetes following acute pancreatitis. The aim of this study was to explore multiple risk factors for diabetes in patients with chronic pancreatitis. We conducted a multicentre, cross-sectional study of patients with definitive chronic pancreatitis according to the M-ANNHEIM criteria. We used multivariable logistic regression models to determine risk factors independently associated with diabetes. The study included 1117 patients of whom 457 (40.9 %) had diabetes. The mean age was 52.8?±?14.2 years and 67% were men. On multivariate analysis, parameters indicative of beta cell loss (pancreatic calcification, exocrine insufficiency, pancreatic resection) were confirmed as independent risk factors for diabetes (allp?=?0.02). In addition, type 2 diabetes-related risk factors (dyslipidaemia and overweight/obesity) were associated with the presence of diabetes (all p?=?0.002). Patients with a history of pancreatic fluid collections (indicative of previous attacks of acute pancreatitis) had a marginally increased risk of diabetes (p?=?0.07). In patients with chronic pancreatitis the presence of diabetes is associated with multiple risk factors including type 2 diabetes-related factors. Our observations attest to the understanding of this entity and may have implications for treatment.

Background/Aims:The diagnosis of chronic pancreatitis is often difficult in the early stages of the disease. Morphological tests may be normal, and reliable methods for the evaluation of the exocrine pancreatic function are time-consuming and troublesome. A new test for exocrine pancreatic function, using endoscopic aspiration of secretin-stimulated pancreatic juice, has been developed. We evaluated the test using the Lundh meal test as reference. Methods:The endoscopie secretin stimulation test (ESST) was performed in a consecutive row of 24 patients referred for pancreatic function testing because of clinical suspicion of chronic pancreatitis and in 23 healthy volunteers. The participants fasted overnight and secretin was given intravenously (1 CU/kg) as a bolus the following morning. Thirty minutes after administration of secretin, the tip of the duodenoscope was placed close to the ampulla of Vater and duodenal aspirate was drawn for 10 min. Intraduodenal concentrations of lipase, bicarbonate, elastase and zinc were measured. The concentration of lipase during the Lundh test (4 × 20 min aspiration) was used as reference test in the patients. Results:Judged from the Lundh test, the exocrine pancreatic function was nearly abolished in 5 patients (<10% of lower normal limit), reduced in 6 patients and normal in 13 patients. ESST failed in 1 patient (no aspirate). Lipase concentrations (KU/I) were significantly lower in the patients with nearly abolished function compared to patients with reduced or normal exocrine pancreatic function (NEPF; Mann-Whitney U test: p < 0.01), but an overlap was found between patients with reduced exocrine pancreatic function [100.1 (median); 60.0–225.0 (range)] patients with NEPF (145.7; 44.6–268.0) and healthy controls (175.0; 84.8–381.0). Bicarbonate concentrations (mEq/l) were significantly lower in patients with reduced exocrine pancreatic fuction (51.2; 32.5–69.6) compared to patients with NEPF (80.0; 48.1–101.8; Mann-Whitney U test: p < 0.05). Pancreatic elastase concentration was significantly lower in the group with nearly abolished exocrine function compared to patients with NEPF (Mann-Whitney U test: p < 0.05), but there was no difference between elastase concentrations among the other groups. We found significant correlation between lipase and bicarbonate concentrations during ESST and lipase concentrations during the Lundh test in all 23 patients (Spearman's Ranktest: p = 0.597 and 0.683, respectively, p < 0.01). By using receiver operating characteristic curves, best cut-off point for bicarbonate was estimated. Lipase and bicarbonate results in the healthy volunteers were not statistically different from results in patients with NEPF. No side effects were observed except for worsening of nausea and abdominal pain in 2 of the patients. Conclusion:The ESST is safe, and by combining the estimation of lipase and bicarbonate concentrations this test is a rapid, easy and useful diagnostic test for exocrine pancreatic function.

Background/Aims: The diagnosis of chronic pancreatitis is often difficult in the early stages of the disease. Morphological tests may be normal, and reliable methods for the evaluation of the exocrine pancreatic function are time-consuming and troublesome. A new test for exocrine pancreatic function, using endoscopic aspiration of secretin-stimulated pancreatic juice, has been developed. We evaluated the test using the Lundh meal test as reference. Methods: The endoscopic secretin stimulation test (ESST) was performed in a consecutive row of 24 patients referred for pancreatic function testing because of clinical suspicion of chronic pancreatitis and in 23 healthy volunteers. The participants fasted overnight and secretin was given intravenously (1 CU/kg) as a bolus the following morning. Thirty minutes after administration of secretin, the tip of the duodenoscope was placed close to the ampulla of Vater and duodenal aspirate was drawn for 10 min. Intraduodenal concentrations of lipase, bicarbonate, elastase and zinc were measured. The concentration of lipase during the Lundh test (4 × 20 min aspiration) was used as reference test in the patients. Results: Judged from the Lundh test, the exocrine pancreatic function was nearly abolished in 5 patients (<10 of lower normal limit), reduced in 6 patients and normal in 13 patients. ESST failed in 1 patient (no aspirate). Lipase concentrations (KU/l) were significantly lower in the patients with nearly abolished function compared to patients with reduced or normal exocrine pancreatic function (NEPF; Mann-Whitney U test: p < 0.01), but an overlap was found between patients with reduced exocrine pancreatic function [100.1 (median); 60.0–225.0 (range)] patients with NEPF (145.7; 44.6–268.0) and healthy controls (175.0; 84.8–381.0). Bicarbonate concentrations (mEq/l) were significantly lower in patients with reduced exocrine pancreatic function (51.2; 32.5–69.6) compared to patients with NEPF (80.0; 48.1–101.8; Mann-Whitney U test: p < 0.05). Pancreatic elastase concentration was significantly lower in the group with nearly abolished exocrine function compared to patients with NEPF (Mann-Whitney U test: p < 0.05), but there was no difference between elastase concentrations among the other groups. We found significant correlation between lipase and bicarbonate concentrations during ESST and lipase concentrations during the Lundh test in all 23 patients (Spearman’s Rank test: ρ = 0.597 and 0.683, respectively, p < 0.01). By using receiver operating characteristic curves, best cut-off point for bicarbonate was estimated. Lipase and bicarbonate results in the healthy volunteers were not statistically different from results in patients with NEPF. No side effects were observed except for worsening of nausea and abdominal pain in 2 of the patients. Conclusion: The ESST is safe, and by combining the estimation of lipase and bicarbonate concentrations this test is a rapid, easy and useful diagnostic test for exocrine pancreatic function. and IAP