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Introduction. According to the World Health Organization (WHO), the incidence of preterm birth is 10-15%, or about 15 million newborns worldwide, and this number is increasing. The highest incidence of morbidity and mortality is observed in infants born before 32 weeks of gestation. Among other things, preterm infants have an immature digestive system, which leads to food intolerance. The formation of cumulative nutrient deficiencies in the digestive system from birth puts children at risk of delayed psychophysical development and contributes to the development of negative long-term neurological consequences. Many of these complications have lifelong consequences for health, growth and development, both in infancy and later in life. Aim of the study. To improve the diagnosis of intestinal dysfunction in perinatal pathology in premature infants based on the study of risk factors and clinical and laboratory parameters. Materials and methods of the study. A comprehensive clinical and paraclinical examination of 91 premature infants with clinical manifestations of moderate and severe perinatal pathology with signs of disturbances of the functional state of the digestive system (group I, gestational age 29 (0/7) - 36 (6/7) weeks) and 57 conditionally healthy newborns (group II, gestational age 35 (0/7) - 36 (6/7) weeks) was performed. The total number of children studied was 148. Exclusion criteria were children with congenital malformations and septic conditions. The list of laboratory parameters used included: levels of α-1-antitrypsin (A1AT), PMN-elastase, albumin, fecal calprotectin (FC) and fecal elastase-1 (FE-1) in children's stool using enzyme-linked immunosorbent assay (ELISA), reagents from Immundiagnostic AG (Germany) on the basis of the German-Ukrainian laboratory "BUKINMED" (Chernivtsi, Ukraine). The scientific work was carried out on the basis of neonatology departments of the Chernivtsi City Clinical Maternity Hospital in 2014-2018. Informed consent of the parents of the child was obtained with adequate explanation of the purpose, objectives, methods and scope of laboratory and instrumental research methods. The study protocol was approved by the Biomedical Ethics Commission of the Bukovinian State Medical University, 2015. The studies were conducted in accordance with the basic provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (April 4, 1997), the World Medical Association Declaration of Helsinki on Ethical Principles for Research Involving Human Subjects (1964-2008), Order of the Ministry of Health of Ukraine ¹ 690 dated September 23, 2009 (as amended by Order of the Ministry of Health of Ukraine ¹ 523 dated July 12, 2012). Statistical processing of data was performed using the software "STATISTICA" (StatSoft Inc., USA, version 10), program MedCalc (https://www.medcalc. org/index.php). Comparison of quantitative indicators with normal distribution was performed using Student's t-test. The difference in parameters was considered statistically significant at p<0.05. The thesis was carried out within the framework of the scientific topics of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University: Research work on "Improvement of directions of prognosis, diagnosis and treatment of perinatal pathology in newborns and infants, optimization of schemes of catamnestic observation and rehabilitation" (State registration number 0115U002768, term of execution 01. 2015-12. 2019); Research work on "Chronobiological and adaptive aspects and features of autonomic regulation in pathological conditions in children of different age groups" (State registration number 0122U002245, term of execution 01.2020-12.2024). Results and discussion. The studied laboratory parameters of stool in premature infants with signs of food intolerance in perinatal pathology revealed certain pathophysiological mechanisms of its development, including acute inflammation, increased permeability of the intestinal mucosa, and exocrine insufficiency. Dysfunction of the digestive system is a consequence of complex autonomic and visceral dysfunction of the child's body against the background of hypoxia and morphological and functional immaturity at birth. An increase in the level of A1AT, PMN-elastase, albumin and a decrease in the concentration of FE-1 in feces are interdependent criteria of digestive system dysfunction. Increased permeability of the intestinal mucosa in conditions of local inflammation leads to translocation of pathogenic and opportunistic microorganisms into the bloodstream, which probably exacerbates the clinical manifestations of endotoxemia in perinatal pathology of premature infants. The above justifies the need to continue scientific research to develop a refinement of comprehensive diagnosis and correction of digestive function in preterm infants. Conclusions. 1. Premature birth of children causes a high risk of adaptation disorders in newborns, which is due to the morphological and functional immaturity of the body and the realization of perinatal risk factors. 2. In the complex of vegetative-visceral dysfunction in conditions of perinatal pathology in newborns, there are signs of combined dysfunction of the digestive system, which is characterized by weakening or absence of sucking reflex, regurgitation, intestinal stasis and paresis, delayed passage of meconium and transitional stools, flatulence; in the most severe cases, persistent and prolonged decrease in tolerance to enteral nutrition is one of the characteristic manifestations of SIDS. 3. Increased levels of A1AT, PMN-elastase, albumin and decreased concentration of FE-1 in feces of children with nutritional dysfunction in the complex of signs of perinatal pathology are laboratory confirmation of digestive system disorders in premature birth. 4. The pathophysiological mechanisms of transient disorders of the functional state of the digestive system, which cause clinical signs of food intolerance, are: acute inflammation, increased permeability of the intestinal mucosa and exocrine insufficiency. Increased permeability of the intestinal mucosal barrier leads to increased translocation of pathogenic and opportunistic microorganisms into the bloodstream, which contributes to the growth of endotoxemia in perinatal pathology of premature infants. 5. Harmonization of clinical and paraclinical criteria for disorders of the functional state of the digestive tract in the complex of perinatal pathology will increase the effectiveness of diagnostic measures in the neonatal period, especially in premature infants, and improve approaches to medical care by improving the range of diagnostic and therapeutic measures. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the clinical characteristics of acute pancreatitis (AP) patients between those who developed pancreatic exocrine insufficiency (PEI) and those who did not, and to investigate the predictive factors of PEI. Patients and Methods: From October 1st 2019 to July 30th 2021, AP patients admitted at our center were included. The fecal elastase-1 assay was adopted for PEI diagnosis. The clinical characteristics, treatments, and outcomes between the patients with and without PEI were analyzed. Results: In total, 63 males and 42 females were included. There were 27 patients with mild AP, 54 with moderately severe AP, and 24 with severe AP. The median modified computed tomography severity index (MCTSI) was 6.000(4.000, 8.000). During the follow-up, 38 patients developed PEI after AP. The univariate analysis showed that higher ASA grade (P = 0.006), more severe AP (P = 0.000), the presence of multiple organ dysfunction syndrome (P = 0.030), higher MCTSI (P = 0.000), the development of infected pancreatic necrosis (P = 0.002) and local complications (P = 0.000), higher levels of triacylglycerol (P = 0.022), video-assisted retroperitoneal debridement intervention (P = 0.015), and longer intensive care unit stay (P = 0.044) were correlated with PEI development. Furthermore, the logistic regression analyses showed that MCTSI during hospitalization is an independent risk factor for PEI development during the AP recovery period. Conclusion: ASA grade, severity of AP, multiple organ dysfunction syndrome, MCTSI, infected pancreatic necrosis, local complications, higher levels of triacylglycerol, video-assisted retroperitoneal debridement intervention, and longer intensive care unit stay were potentially associated with PEI development during the AP recovery period. High MCTSI was independently associated with the development of PEI during the AP recovery period, which may help alert to the possibility of PEI to help with its early detection and treatment. [ABSTRACT FROM AUTHOR]

We aimed to show whether insufficiency develops in pancreatic exocrine functions since the insulin resistance period or not. We measured the anthropometric parameters, blood glucose profile parameters and fecal elastase-1 (FE-1) levels of a total of 65 obese patients with 35 insulin resistance and 30 without insulin resistance. Body mass indexes (BMI) and homeostasis of model assessment insulin resistance indexes (HOMA-IR) were calculated. Exocrine pancreatic insufficiency (EPI) was diagnosed with a FE-1of less than 200 mg/g (ELISA). A statistically significant difference was not observed between the mean FE-1 levels between the groups (p> 0.05). No statistically significant difference was observed between the distribution of mild and severe low FE-1 levels of the insulin resistant (IR) and Non-IR groups (p> 0.05). Our study revealed that the presence of insulin resistance does not cause any change in FE-1 levels in obese patients. [Med-Science 2021; 10(3.000): 998-1001]

The article describes and analyzes the results of bioelectrical impedance analysis in patients with chronic pancreatitis and chronic obstructive pulmonary disease considering the level of fecal elastase-1.The aim of our study was to investigate the features of Bioelectrical impedance analysis in patients with chronic pancreatitis (CP) and chronic obstructive pulmonary disease (COPD) considering the level of fecal elastase-1.Materials and methods. We examined 84 patients: 30 patients with CP and 54 patients with comorbid pathology - CP and COPD aged 30-65 years (52.36 ± 1.83 years). Patients were hospitalized in the gastroenterology department of theRegionalClinicalHospital,Chernivtsy,Ukraine with exacerbation of CP. COPD was in stable or unstable remission. Fecal elastase-1 level was determined by using the Pancreatic Elastase ELISA (BIOSERV Diagnostics). Biometric measurements were performed with a body composition analyzer BC-601 (TANITA,Japan). All examined patients were divided into groups depending on the exocrine pancreatic insufficiency (EPI): severe (n=9), moderate (n=34), mild (n=23) and normal (n=18).Results. The group of patients with severe EPI was characterized by weight loss. It can be explained by the appearance of absorption disorders of nutrients (malabsorption and maldigestion syndromes). In the groups of moderate and mild EPI fat and cell mass were significantly lower than normal rate in control group. There is a positive correlation between fecal elastase-1 and the level of patients’ metabolism (pConclusions. Bioelectrical impedance analysis (percentage of fat mass, visceral fat level and muscle mass) correlates with the level of fecal elastase-1, which can be used as an additional criteria for the severity of CP and for the control of the effectiveness of substitution therapy.

• It is the first study about the prevalence of pancreatic exocrine insufficiency (PEI) in Chinese patients with T2DM. Our research showed the frequent occurrence of PEI in Chinese patients with T2DM. • We provided the direct evidence of close connection between the exocrine and endocrine pancreases. Fasting C-peptide is positively correlated with FE-1 and has independent predictive value for PEI with good sensitivity and specificity. • The pancreatic islet function and exocrine impairment of patients with T2DM in clinical practice should be paid attention.. Recently, numerous studies validated frequent pancreatic exocrine dysfunction in patients with diabetes. However, the prevalence of pancreatic exocrine insufficiency (PEI) in diabetes mellitus (DM) varies widely among studies. This study aims to determine the prevalence of PEI in Chinese people with type 2 DM (T2DM) by measuring the fecal elastase-1 (FE-1) levels and further identify potential factors that influence pancreatic exocrine function in patients with T2DM. A total of 85 patients with T2DM without known exocrine pancreatic disorders or digestive system diseases were recruited. Fecal samples were submitted to measure FE-1 levels, and blood samples were collected to investigate pancreatic endocrine function and metabolic biomarkers in all participants. The multiple logistic regression analysis was established to evaluate the influencing factors of PEI in patients with T2DM. The potential predictors of PEI were examined using receiver operating characteristic (ROC) curves. The prevalence of PEI measured by low FE-1 in T2DM was 18.8%. The Spearman correlation demonstrated that the FE-1 level was inversely correlated with DM duration (r = − 0.360, P = 0.001) and glycated hemoglobin (HbA1c) level (r = − 0.228, P = 0.036). A highly significant positive association was observed between FE-1 and fasting C-peptide (FCP) levels (r = 0.451, P < 0.001). Furthermore, the multiple logistic regression analysis showed that FCP was an independent influencing factor of PEI (OR = 0.204, P = 0.024, 95% CI: 0.051–0.813). The ROC analysis indicated that the FCP level had a predictive value for low FE-1 (AUC = 0.793, P < 0.001) with an optimal cutoff value of 1.20 ng/ml. Chinese patients with T2DM show high PEI prevalence. FCP may be a potential predictor of pathological exocrine function in T2DM. The exocrine and endocrine functions of patients with T2DM in clinical practice should be evaluated. Further studies are needed to clarify the internal association between exocrine and endocrine pancreases. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is among the predictors of unfavorable outcome of chronic pancreatitis (CP). Our previous study has shown that the malnutrition prevalence in CP patients was 92%; body mass index (BMI) ≤ 19 kg/m2 was found only in 15.5%.Aim: To identify clinical variants of nutrition status in CP patients. Materials and methods: We have analyzed the data from the first step of an open-label randomized prospective study on 148 patients (80 male) with CP of various etiologies, aged from 22 to 82 years (mean age, 51.8 ± 13.2 years). According to TIGAR-O, the patients were allocated into two groups: the first group with chronic alcoholic pancreatitis (CAP) included 71 patients (57 male and 14 female, mean age 46.3 ± 11.2 years), the second one with chronic obstructive pancreatitis (COP) consisted of 77 patients (29 male and 48 female; mean age 56.81 ± 3 years). Exocrine pancreatic function was assessed by fecal elastase 1 levels. Nutritional status was determined by V.M. Luft classification based on comparison of various anthropometrical parameters, as well as on some laboratory parameters (hemoglobin, total protein, albumin levels, lymphocyte counts, etc.). The anthropometrical and laboratory parameters, as well as smoking and alcohol overconsumption were included into the correlational analysis.Results: In the CAP group, the number of smoking patients was 2.5-fold higher than that in the COP group (р < 0.001). The smokers had a lower BMI (р = 0.002) and lower pre-albumin levels (р = 0.04), compared to the non-smokers. There were associations between: the number of cigarettes per day and the daily amount of alcohol (r = 0.55), the smoking index and thickness of the skin/fat fold over the triceps muscle of the arm (r = -0.4), severity of chronic alcohol abuse and malnutrition grade (r = -0.5), duration of excess alcohol consumption and thickness of the skin/fat fold over the triceps (r = -0.4), hemoglobin levels and malnutrition grade (r = 0.5), hemoglobin level and shoulder circumference (r = 0.47), blood cholesterol level and shoulder circumference (r = 0.37), low density lipoprotein level and shoulder circumference (r = 0.41). Four basic clinical types of nutrition status could be identified: malnutrition of various grades (66%), overweight/obesity without malnutrition (3%), sarcopenic obesity with some malnutrition (26%), euthrophic type (5%). In the patients with malnutrition without sarcopenia, the etiology of CP had no effect on the prevalence of malnutrition. Low albumin levels were found in 54% (80/98) of the patients with pancreatic exocrine insufficiency and malnutrition, indicating a risk of sarcopenia. Sarcopenic obesity with malnutrition was most prevalent in COP (24 vs. 14 patients with CAP) and at higher age (56.8 vs. 46.3 years, respectively, р < 0.001).Conclusion: Smoking, chronic alcohol abuse, low hemoglobin levels are associated (negative correlation) with the development of malnutrition in CP patients. The most prevalent clinical types of nutrition status in CP patients are characterized by various degrees of malnutrition, as well as by malnutrition with sarcopenic obesity.

We aimed to show whether insufficiency develops in pancreatic exocrine functions since the insulin resistance period or not. We measured the anthropometric parameters, blood glucose profile parameters and fecal elastase-1 (FE-1) levels of a total of 65 obese patients with 35 insulin resistance and 30 without insulin resistance. Body mass indexes (BMI) and homeostasis of model assessment insulin resistance indexes (HOMA-IR) were calculated. Exocrine pancreatic insufficiency (EPI) was diagnosed with a FE-1of less than 200 mg/g (ELISA). A statistically significant difference was not observed between the mean FE-1 levels between the groups (p> 0.05). No statistically significant difference was observed between the distribution of mild and severe low FE-1 levels of the insulin resistant (IR) and Non-IR groups (p> 0.05). Our study revealed that the presence of insulin resistance does not cause any change in FE-1 levels in obese patients. [ABSTRACT FROM AUTHOR]

Exocrine pancreatic insufficiency (EPI) can be a problem following gastrectomies. This study aimed to reveal the EPI prevalence and its possible causes in gastric cancer patients that underwent subtotal or total gastrectomy, with completed oncological treatments, and with long-term disease-free survival success. Additionally, we also sought to determine whether there were any relations between EPI and blood biomarkers, weight change, malnutrition parameters, and quality of life after gastrectomy. A total of 69 gastric cancer patients whose oncological treatments had already been completed, with a minimum follow-up period of 16 months, were included in the study. Fecal samples were taken from all patients for the Fecal Elastase-1 Test, and patients were stratified into three groups based on the results: low (<100 μg/g), moderate (100–200 μg/g), and normal (>200 μg/g). These results were compared with patients' clinical characteristics, blood nutrition biomarkers, Maastricht indexes (MI), Bristol stool scale, and Gastrointestinal Quality of Life Index (GIQLI) scores. FE-1 levels were low in 33 (47.8%) of the patients, moderate in 11 (15.9%), and normal in 25 (36.2%). The rate of patients receiving chemoradiotherapy (CRT) in the low FE-1 group was higher than the normal FE-1 and moderate FE-1 groups (P < 0.001 and P = 0.012, respectively). The serum total protein and lipase levels were lower in the low FE-1 group than in the normal FE-1 group (P = 0.023 and P < 0.001, respectively). When compared to the normal FE-1 group, the MI score of the low FE-1 group was higher (P = 0.018). The low FE-1 group had lower GIQLI gastrointestinal symptom scores than the normal FE-1 group (P = 0.046). During long-term follow-up, EPI can be seen in more than half of patients with gastric cancer after curative gastrectomy. Radiotherapy as an adjunct to adjuvant treatment in the postoperative period is considered a serious risk factor for EPI development. EPI contributes to malnutrition development after gastrectomy and negatively affects the patients' quality of life, especially in terms of gastrointestinal symptoms. [ABSTRACT FROM AUTHOR]

Aim: To estimate the frequency of occurrence malnutrition and efficacy its correction in chronic pancreatitis (CP).Materials and methods: 148 patients were examined. Group I included 71 people with chronic alcoholic pancreatitis (CAP); group II — 77 patients with chronic obstructive pancreatitis (COP). Trophological status (TS) was investigated by criteria of V.M. Luft. Lymphocytes, pancreatic amylase, lipase, total protein, albumin, urine diastase and faecal elastase-1 were investigated before and after treatment. Two treatment options were used: combination therapy (CT, (Mezym-forte 10500 USP/day and pharmaconutrient Ensure 2 200 ml/day)) and high-dose pancreatic enzyme replacement therapy ((HD PERT), Kreon 120000 USP/day) for 10 weeks. 62 patients received HD PERT: 24 patients with CAP and 38 patients with COP; CT — 86 patients: 47 and 39, respectively.Results: The prevalence of malnutrition in patients with CP was 92% (n=136). Lymphopenia was determined in 44%, hypoproteinemia-in 11,5%, hypoalbuminemia-in 54%. 12 (8%) patients did not have malnutrition. In the group CAP: mild malnutrion was established in44, moderate — in 20, severe — 2, eutrophia — 6; in the group COP: mild malnutrion — in 33, moderate — in 37, severe — 0, eutrophia — 6. Aftertreatment in the group CAP: malnutrion moderate — in 7, mild — 58, eutrophia — 7, in the COP: malnutrion moderate — 37, mind — 31, eutrophy — 8.Conclusions: Malnutrition is frequent symptom complex in patients with CP. The severity of malnutrition is more severy in CAP. The most effective treatment malnutrition was CT in patients with CAP. HD PERT is indicated to correct exocrine pancreatic insufficiency.

Introduction: After bariatric surgery (BS), patients might suffer from nutrient maldigestion, malabsorption, and vitamin deficiencies. In this study, our aim was to assess pancreatic functions after BS using fecal elastase-1 assay (FE-1). Material and Methods: Sixty patients (21M) undergoing BS and 20 (6M) healthy controls were included into the study. Stool samples were collected 1 year after surgery. Ten patients from one anastomosis gastric bypass (OAGB) and single anastomosis duodenal switch (SADS) groups with the lowest value of FE-1 and GIQLI scores were given pancreatic enzyme replacement therapy (PERT). After PERT, FE-1, excess weight loss (EWL), BMI, GIQLI scores, and vitamin D levels were measured. Results: Vitamin D levels were detected as 19.04 (9–46.5) pg/ml, 15.1 (8.4–23.6) pg/ml, 17.8 (5–30) pg/ml, and 21.79 (11–40.3) pg/ml after sleeve gastrectomy (SG), OAGB, SADS, and control groups, respectively (p = 0.04). GIQLI scores in the first year were found to have increased in all patients (p = 0.02). FE-1 levels were found as 642.35 (566.3–711.4) μg/g, 378.52 (183.5–561.1) μg/g, 458.88 (252.5–593, 5) μg/g, and 518.2 (351.6–691) μg/g for the SG, OAGB, SADS, and control groups, respectively. There was a strong inverse correlation between EWL and FE-1 levels at the end of the first year (Spearman's rho = − 0.688, p = 0.003). After having performed PERT for patients with the lowest FE-1 levels, the levels increased to 683.39 (615.5–720) μg/g in the OAGB and 691.5 (643.1–720) μg/g in the SADS groups (p = 0.011). Conclusion: FE-1 measurements demonstrated that many patients suffer from malabsorption after OAGB or SADS, whereas functions remain normal after SG. PERT corrects pancreatic functions without affecting weight loss and also contributes to the normal serum level of vitamin D. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a chronic abnormal metabolic condition, which manifests elevated blood sugar level over a prolonged period. The pancreatic endocrine system generally gets affected during diabetes, but often abnormal exocrine functions are also manifested due to its proximity to the endocrine system. Fecal elastase-1 (FE-1) is found to be an ideal biomarker to reflect the exocrine insufficiency of the pancreas. Aim: The aim of this study was conducted to assess exocrine dysfunction of the pancreas in patients with type-2 DM (T2DM) by measuring FE levels and to associate the level of hyperglycemia with exocrine pancreatic dysfunction. Methodology: A prospective, cross-sectional comparative study was conducted on both T2DM patients and healthy nondiabetic volunteers. FE-1 levels were measured using a commercial kit (Human Pancreatic Elastase ELISA BS 86-01 from Bioserv Diagnostics). Data analysis was performed based on the important statistical parameters such as mean, standard deviation, standard error, t-test-independent samples, and Chi-square test/cross tabulation using SPSS for Windows version 20.0. Results: Statistically nonsignificant (P = 0.5051) relationship between FE-1 deficiency and age was obtained, which implied age as a noncontributing factor toward exocrine pancreatic insufficiency among diabetic patients. Statistically significant correlation (P = 0.003) between glycated hemoglobin and FE-1 levels was also noted. The association between retinopathy (P = 0.001) and peripheral pulses (P = 0.001) with FE-1 levels were found to be statistically significant. Conclusion: This study validates the benefit of FE-1 estimation, as a surrogate marker of exocrine pancreatic insufficiency, which remains unmanifest and subclinical.

Post‐prandial gastrointestinal symptoms such as diarrhea, abdominal distension, flatulence, bloating and a feeling of fullness are common complaints of often unknown etiology and pathogenesis. There is a long history of trials reporting the successful use of products containing a variety of combinations of digestive enzymes including a number of randomized placebo‐controlled trials. We provide a narrative review of studies describing the use of multi‐digestive enzymes for symptoms consistent with irritable bowel syndrome. We describe clinical trials reported over the past 60 years including double‐blinded randomized, placebo‐controlled studies and recent trials that focused on post‐prandial diarrhea consistent with diarrhea‐predominant irritable bowel syndrome. Disaccharidase deficiencies or deficiencies of other carbohydrate digesting enzymes were excluded. Worldwide studies have generally reported success with multi‐enzyme preparations although none used a factorial design to identify subgroups or attempted to link specific symptom responses to specific components of therapy. Although there is a long history of the successful use of multi‐enzyme preparations for post‐prandial symptoms consistent with irritable bowel syndrome, long‐term studies using validated scoring systems and factorial designs are needed to confirm the results for specific symptoms and the components of the combination drugs received. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a chronic abnormal metabolic condition, which manifests elevated blood sugar level over a prolonged period. The pancreatic endocrine system generally gets affected during diabetes, but often abnormal exocrine functions are also manifested due to its proximity to the endocrine system. Fecal elastase-1 (FE-1) is found to be an ideal biomarker to reflect the exocrine insufficiency of the pancreas. Aim: The aim of this study was conducted to assess exocrine dysfunction of the pancreas in patients with type-2 DM (T2DM) by measuring FE levels and to associate the level of hyperglycemia with exocrine pancreatic dysfunction. Methodology: A prospective, cross-sectional comparative study was conducted on both T2DM patients and healthy nondiabetic volunteers. FE-1 levels were measured using a commercial kit (Human Pancreatic Elastase ELISA BS 86-01 from Bioserv Diagnostics). Data analysis was performed based on the important statistical parameters such as mean, standard deviation, standard error, t-test-independent samples, and Chi-square test/cross tabulation using SPSS for Windows version 20.0. Results: Statistically nonsignificant (P = 0.5051) relationship between FE-1 deficiency and age was obtained, which implied age as a noncontributing factor toward exocrine pancreatic insufficiency among diabetic patients. Statistically significant correlation (P = 0.003) between glycated hemoglobin and FE-1 levels was also noted. The association between retinopathy (P = 0.001) and peripheral pulses (P = 0.001) with FE-1 levels were found to be statistically significant. Conclusion: This study validates the benefit of FE-1 estimation, as a surrogate marker of exocrine pancreatic insufficiency, which remains unmanifest and subclinical. [ABSTRACT FROM AUTHOR]

In both types of diabetes mellitus (DM), type 1 and type 2 (T1DM and T2DM), there are both endocrine and exocrine dysfunctions of the pancreas (PED), as well as disturbances in serum magnesium levels. The aim of this study was to examine the frequency of PED according to the level of fecal elastase-1 (FE-1) in patients with T1DM and T2DM, determining the correlation of the level of FE-1 with certain anthropometric parameters, certain indicators of metabolic regulation of diabetes, and certain nutritive markers of PED. Materials and methods: In the examinees, (56 with T1DM (F = 35 and M= 21), 62 with T2DM (F = 30 and M= 32), and 40 in the control group (F = 19 and M= 21)), we examined anthropometric parameters, and using standard biochemical methods, we measured the level of FE-1, magnesium concentration in blood and erythrocytes, and selected blood parameters. Results: FE-1 concentration<200 µ/g was present in 14.2% of the examinees with T1DM, 20.9% with T2DM, and 2.5% in the control group. In all examinees with DM, there was a statistically significant correlation (P<0.05) between the level of FE-1 and Mg concentration in the erythrocytes (R= 0.40). Conclusions: Prevalence of pancreatic exocrine insufficiency (PEI), according to the level of FE-1, is significantly higher in patients with DM than in the control group, while it is a bit higher in patients with T2DM than the ones with T1DM. In both types of DM, Mg concentration in erythrocytes is in a significant correlation with the level of FE-1. [ABSTRACT FROM AUTHOR]

Superior mesenteric artery (SMA) syndrome is an uncommon cause of upper bowel obstruction. SMA syndrome is linked to unspecific upper digestive symptomps. The main point of this research is the presence of exocrine pancreatic insufficiency (EPI) linked to SMA syndrome assessed by fecal elastase-1. EPI was proposed as the underlying pathogenesis, thus this group of children necessitates routine screening for pancreatic dysfunction. There are several types of appropriate therapeutic options and the patophysiological aspects of the changes on EPI after surgical approaches were discussed. We suggest that SMA syndrome must be considerd as a new cause of exocrine pancreatic dysfunction. [ABSTRACT FROM AUTHOR]

The early diagnosis of pancreatic exocrine insufficiency (PEI) is hindered because many of the functional diagnostic techniques used are expensive and require specialized facilities, which prevent their widespread availability. We have reviewed current evidence in order to compare the utility of these functional diagnostic techniques with the fecal elastase-1 (FE-1) test in the following three scenarios: screening for PEI in patients presenting with symptoms suggestive of pancreatic disease, such as abdominal pain or diarrhea; determining the presence of PEI in patients with an established diagnosis of pancreatic disease, such as chronic pancreatitis or cystic fibrosis; determining exocrine status in disorders not commonly tested for PEI, but which have a known association with this disorder. Evidence suggests the FE-1 test is reliable for the evaluation of pancreatic function in many pancreatic and non-pancreatic disorders. It is non-invasive, is less time-consuming, and is unaffected by pancreatic enzyme replacement therapy. Although it cannot be considered the gold-standard method for the functional diagnosis of PEI, the advantages of the FE-1 test make it a very appropriate test for screening patients who may be at risk of this disorder. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether pancreatic function is impaired in children with severe acute malnutrition, is different between edematous vs nonedematous malnutrition, and improves by nutritional rehabilitation.Study Design: We followed 89 children with severe acute malnutrition admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi. Stool and blood samples were taken on admission and 3 days after initial stabilization to determine exocrine pancreatic function via fecal elastase-1 (FE-1) and serum trypsinogen and amylase levels.Results: A total of 33 children (37.1%) had nonedematous severe acute malnutrition, whereas 56 (62.9%) had edematous severe acute malnutrition. On admission, 92% of patients showed evidence of pancreatic insufficiency as measured by FE-1 <200 μg/g of stool. Patients with edematous severe acute malnutrition were more likely to have low FE-1 (98% vs 82.8%, P = .026). FE-1 levels remained low in these individuals throughout the assessment period. Serum trypsinogen was elevated (>57 ng/mL) in 28% and amylase in 21% (>110 U/L) of children, suggesting pancreatic inflammation.Conclusion: Exocrine pancreatic insufficiency is prevalent in children with severe acute malnutrition and especially in children with edematous severe acute malnutrition. In addition, biochemical signs suggestive of pancreatitis are common in children with severe acute malnutrition. These results have implications for standard rehabilitation treatment of children with severe acute malnutrition who may benefit from pancreatic enzyme replacement therapy.Trial Registration: ISRCTN.com: 13916953. [ABSTRACT FROM AUTHOR]

Objective: The aim: To study the features of the functional state of the liver in patients with chronic hepatitis C (CHC) in the presence of CP, depending on the enzymatic activity of the pancreas., Patients and Methods: Materials and methods: 72 patients were under observation: 52 with CHC and CP with exocrine secretory insufficiency (EI) of the pancreas and 20 - with CHC and CP without EI. In all patients, the degree of liver fibrosis, levels of aminotransferases, total bilirubin, gamma-glutamyltransferase, albumin, stool coproscopy and pancreatic fecal elastase-1 (FE-1) were determined., Results: Results: It was revealed that in patients with CHC combined with CP+EI of the pancreas, higher activity of the necroinflammatory process and deeper stages of liver fibrosis is more often noted than in patients with preserved exocrine function of the pancreas. A statistically significant association was established between the degree of liver fibrosis and the presence of EI of the pancreas (p=0.03), namely, in patients with CHC and CP with EI of the pancreas, the degree of fibrosis F2-4 was 2.8 times more frequent. Also, higher levels of aminotransferases and lower levels of albumin were noted in this group of patients than in patients with CHC and CP with preserved exocrine function of the pancreatic gland., Conclusion: Conclusions: In patients with CHC combined with CP+EI of the pancreas, higher levels of fibrosis and necroinflammatory activity of the liver are more often detected, as well as a tendency to lower albumin levels, than in patients with CHC and CP without EI.

Objective. Progressive familial intrahepatic cholestasis type 1 (PFIC1) is a rare, autosomal, recessive, inherited disease resulting from mutations in the ATP8B1 gene which is expressed at high levels in the small intestine and pancreas and at lower levels in the liver. Given this expression pattern, patients might be expected to have a pancreatic phenotype. Although pancreatitis and steatorrhea have been reported in patients with PFIC1, the available data on pancreatic function are not fully convincing. Therefore, the objective of this study was to assess exocrine pancreatic function in patients with PFIC1. Material and methods. Three subjects with a diagnosis of PFIC1 were included in the study. The diagnosis was confirmed by molecular analysis of ATP8B1. Prior to surgical treatment (biliary diversion), two patients had steatorrhea and in the third patient, a borderline value for fecal fat excretion was documented. In one patient, liver transplantation also was subsequently performed. Exocrine pancreatic secretion was assessed by the use of fecal elastase-1 and chymotrypsin tests. Fecal lipase concentrations were determined in order to exclude isolated lipase deficiency. Other typical diagnostic procedures were performed annually. Results. The results of the fecal tests were within the normal range. None of the three patients experienced any episodes that could be related to acute or chronic pancreatitis. Laboratory tests including serum amylase and lipase tests were always normal. Abdominal ultrasonography findings did not show any pancreatic pathology. Conclusions. Pancreatic secretion in the study patients with progressive familial intrahepatic cholestasis type 1 was normal. The observed steatorrhea was not related to pancreatic insufficiency. [ABSTRACT FROM AUTHOR]

Abstract Background The existence of a feedback mechanism for exocrine pancreatic secretion in humans is controversial. Exclusion of proteases from the duodenum stimulates exocrine pancreatic secretion. Conversely, addition of exogenous enzymes could reduce the enzyme secretion. Further investigation of the feedback mechanism should be performed under the most physiological conditions. In the present study we investigated exocrine pancreatic function by measuring fecal enzyme output in healthy volunteers consuming a normal diet, before and during a time course of exogenous pancreatic enzyme supplementation. Material and methods Twenty-five healthy subjects (HS) were given two different doses (30 and 60 FIP proteases kg-1 d-1 ) divided by the number of meals. In all subjects, fecal elastase-1 (E1) concentrations and chymotrypsin (ChT) activities were measured without and with enzyme supplements after 7 days of treatment. In eight subjects, E1 concentrations and ChT activities were measured daily for 10 consecutive days. The subjects were given a dose regimen of 100 FIP proteases kg-1 d-1 (divided by the number of meals) for the first 7 days. Results Oral pancreatic treatment dose-dependently inhibited endogenous pancreatic secretion measured with the use of E1 concentrations. In both regimen groups, the differences were statistically significant. The exogenous enzymes, which interfere with colorimetric method for ChT, dose-dependently increased ChT output. However, only the higher dose resulted in a statistically significant difference. In the subgroup of eight HS, time-dependent changes of fecal enzyme output occurred with a decrease of E1 concentrations and an increase of ChT activity from the second up to eighth or ninth day of the experiment. Conclusion Exogenous applied pancreatic enzymes, dose- and time-dependently inhibited endogenous pancreatic secretion. The obtained results strongly support the existence of a... [ABSTRACT FROM AUTHOR]

Background: Fecal elastase-1 (E1) test is a sensitive and specific indirect test. However, there are few data on the best cut-off level in the assessment of exocrine pancreatic function in cystic fibrosis (CF). Material and methods: In 725 CF patients and 243 healthy subjects (HS) from Greece, Russia, Poland and the United Kingdom, E1 concentrations were measured. The best cut-off levels for the discrimination between CF and HS (for whole group as well as for individual countries) were calculated. Results: The best cut-off level for the differentiation between CF pancreatic insufficiency and normal pancreatic function in HS was found to be 184 μg/g of feces. However, some inter-country differences were stated. E1 concentrations in the UK subgroup were significantly lower than those found in Polish and Russian CF patients. E1 concentrations in Greek patients were significantly higher than in the other countries. However, E1 concentrations in ΔF508 homozygotes were very similar in all studied subgroups. In conclusion: In clinical practice, instead of a single best cut-off level for the E1 test, we suggest using a range of values (160–200 μg/g). The presence of different best cut-off levels within countries is a practical consequence of the different distribution of pancreatic function. [Copyright &y& Elsevier]

Background: Tubeless pancreatic function tests measuring the content of elastase-1 and the activity of chymotrypsin in stool are used with different cut-off levels and with varying success in diagnosing functional impairment of the pancreas. The aim of our study was to re-evaluate the sensitivity and specificity of elastase-1 and chymotrypsin in stool in the assessment of exocrine pancreatic insufficiency. Methods: In 127 patients displaying clinical signs of malassimilation, the secretin-caerulein test ('gold standard'), fecal fat analysis, fecal chymotrypsin activity and fecal elastase-1 concentration were performed. Exocrine pancreatic insufficiency was graded, according to the results of the secretincaerulein test, into mild, moderate and severe. Chymotrypsin and elastase-1 in stool were estimated using two commercially available test kits. Fecal elastase-1 concentration of 200 and 100 µg/g stool and chymotrypsin activity of 6 and 3 U/g stool were used separately as cut-off levels for calculation. Results: 1) In 65 patients, a normal pancreatic function was found using the secretin-caerulein test. In 62 patients, an exocrine pancreatic insufficiency was found and classified into severe (n = 25), moderate (n = 14) and mild (n = 23). 2) The correlation between fecal elastase-1 and chymotrypsin with duodenal enzyme outputs of amylase, lipase, trypsin, chymotrypsin and elastase-1 ranged between 33% and 55% and 25% and 38%, respectively. 3) Using a cut-off of 200 µg elastase-1/g, stool sensitivities of fecal elastase-1 and fecal chymotrypsin (cut-off: 6 U/g) were 100% and 76%, respectively (P < 0.0001 and P < 0.001 respectively) in severe exocrine pancreatic insufficiency, 89% and 47% respectively (P < 0.001; P = 0.34, respectively) in moderate and 65% for both in mild pancreatic insufficiency. Specificities of elastase-1 and chymotrypsin in stool were 55% and 47%, respectively. 4) Elastase-1 based diagnostic provided a positive predictive value of 50% using a 'cut-off' 200 µg/g stool in a representative group of consecutively recruited patients with gastroenterological disorders. Conclusion: Determination of fecal elastase-1 is highly sensitive in the diagnosis of severe and moderate exocrine pancreatic insufficiency and is of significantly higher sensitivity than fecal chymotrypsin estimation. Specificity for both stool tests is low. Correlation between elastase-1 and chymotrypsin in stool and duodenal enzyme outputs is moderate. Neither test is suitable for screening, as they provide a pathologic result in roughly half of 'non-pancreas' patients. [ABSTRACT FROM AUTHOR]

BackgroundCystic fibrosis (CF) is the most common cause of exocrine pancreatic insufficiency in childhood. The aim of the present study is to evaluate the correlation between genotype and exocrine pancreatic insufficiency in CF patients. The special emphasis was put on the analysis of mild CFTR mutations. DesignThe study comprised 394 CF patients and 105 healthy subjects (HS). Elastase-1 concentrations were measured in all subjects. ResultsSevere pancreatic insufficiency was associated with the presence of two CFTR gene mutations (ΔF508, N1303K, CFTR dele 2,3 (21kb), G542X, 1717–1G-A, R533X, W1282X, 621GT, 2183AAG, R560T, 2184insA and ΔI507, G551D, 895T) and mild insufficiency with the presence of at least one mutation (R117H, 3171insC, A155P2, 138insL, 296 + 1G-A, E92GK, E217G, 2789 + 5G-A. 3849 + 1kbC-T/3849 + 1kbC-T) genotype resulted in high elastase-1-values. However, in case of patients with genotype ΔF508/3849 + 10kbC-T, 1717–1GA/3849 + 10kbC-T as well as with ΔF508/R334W, both high and low elastase-1 concentrations were found. Low E1 values were found in a patient with ΔF508/R347P genotype. ConclusionPatients who carry two ‘severe’ mutations develop pancreatic insufficiency, whereas those who carry at least one ‘mild’ usually remain pancreatic sufficient. However, the presence of one mild mutation does not exclude pancreatic insufficiency. [ABSTRACT FROM AUTHOR]

Background Fecal elastase-1 (E1) is a sensitive and reliable test in the assessment of exocrine pancreatic function in cystic fibrosis (CF). In patients with celiac disease (CD), different E1 values have been reported. E1 levels in other malabsorption conditions are unknown. Therefore, the aim of the present study was to evaluate E1 concentrations in various malabsorption syndromes. Material and methods The study was carried out in 54 patients, selected from patients referred with suspicion of CF, who had been diagnosed as celiac disease (CD; n = 16), secondary malabsorption syndrome (SMS, giardiasis- or cow milk-related enteropathy; n = 18) and food allergy (FA; n = 20). 70 age-matched healthy children (HC) and 131 cystic fibrosis (CF) patients served as control groups. In CD and SMS patients, a gluten-free diet was introduced. In addition, SMS patients were treated appropriately to underlying disease. In all subjects, E1 concentrations were measured. In CD and SMS patients, E1 concentrations were repeatedly measured after one year of the treatment. Results With a cut-off level of 200 µg g-1, abnormal E1 concentrations were found in 87·2% of the CF group and in 56·2% and 50·0% of the CD and SMS subgroups, respectively. In none of FA patients, were E1 values below the normal range. After mucosal recovery, E1 concentrations in patients with CD and SMS increased, suggesting that villous atrophy can diminish exocrine pancreatic secretion. In 18 out of 19 CD and SMS patients with abnormal E1 concentrations, monitored for at least 12 months of a gluten-free diet, abnormal E1 concentrations increased above the cut-off value to normal range. Two out of the 54 referred patients were finally diagnosed as having CF, one with stable low E1 levels and the second with finally normal values. Conclusions The exocrine pancreatic function is decreased in villous atrophy regardless of underlying disease. The specificity of the fecal elastase-1 test in the differentiation between ‘primary’ exocrine pancreatic insufficiency and intestinal malabsorption with mucosal atrophy is low. After mucosal regeneration, fecal elastase-1 specificity is high. [ABSTRACT FROM AUTHOR]

Background: Exocrine pancreatic insufficiency (EPI) can be a problem following gastrectomies. This study aimed to reveal the EPI prevalence and its possible causes in gastric cancer patients that underwent subtotal or total gastrectomy, with completed oncological treatments, and with long-term disease-free survival success. Additionally, we also sought to determine whether there were any relations between EPI and blood biomarkers, weight change, malnutrition parameters, and quality of life after gastrectomy., Methods: A total of 69 gastric cancer patients whose oncological treatments had already been completed, with a minimum follow-up period of 16 months, were included in the study. Fecal samples were taken from all patients for the Fecal Elastase-1 Test, and patients were stratified into three groups based on the results: low (<100 μg/g), moderate (100-200 μg/g), and normal (>200 μg/g). These results were compared with patients' clinical characteristics, blood nutrition biomarkers, Maastricht indexes (MI), Bristol stool scale, and Gastrointestinal Quality of Life Index (GIQLI) scores., Results: FE-1 levels were low in 33 (47.8%) of the patients, moderate in 11 (15.9%), and normal in 25 (36.2%). The rate of patients receiving chemoradiotherapy (CRT) in the low FE-1 group was higher than the normal FE-1 and moderate FE-1 groups (P < 0.001 and P = 0.012, respectively). The serum total protein and lipase levels were lower in the low FE-1 group than in the normal FE-1 group (P = 0.023 and P < 0.001, respectively). When compared to the normal FE-1 group, the MI score of the low FE-1 group was higher (P = 0.018). The low FE-1 group had lower GIQLI gastrointestinal symptom scores than the normal FE-1 group (P = 0.046)., Conclusions: During long-term follow-up, EPI can be seen in more than half of patients with gastric cancer after curative gastrectomy. Radiotherapy as an adjunct to adjuvant treatment in the postoperative period is considered a serious risk factor for EPI development. EPI contributes to malnutrition development after gastrectomy and negatively affects the patients' quality of life, especially in terms of gastrointestinal symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Aims: To determine the prevalence of low faecal elastase-1 (FE-1) (≤200 μg/g) in type 2 diabetes (T2DM), and to test the hypothesis that pancreatic enzyme replacement therapy (PERT) would reduce postprandial glycaemia after a high-fat, high-carbohydrate meal in T2DM subjects with low FE-1.Methods: Of 109 community-based patients who submitted stool samples, 10 had low FE-1 and 8 were recruited (6 male, 2 female, 67.8 ± 3.0 years). Participants were given a high-fat, high-carbohydrate meal (718 kcal) with either pancrelipase (50,000 units) or placebo in a randomised, double-blind, crossover fashion. The primary outcome was the difference in postprandial glycaemia following PERT vs placebo, as evaluated by the incremental area under the postprandial plasma glucose curve (iAUC). Secondary outcomes included differences in gastric half-emptying time (T50) measured using scintigraphy, and C-peptide iAUC.Results: The prevalence of low FE-1 in T2DM was 9.2% (95% CI 3.8-14.6%). There was no difference in postprandial glycaemia iAUC (P = 0.38), gastric emptying T50 (P = 0.69) or C-peptide iAUC (P = 0.25) after PERT compared to placebo.Conclusions: Decreased FE-1 has a relatively low prevalence in community-based patients with T2DM, and PERT does not reduce postprandial glycaemia in these patients.Clinical Trial Registration Number: ACTRN12617000349347. [ABSTRACT FROM AUTHOR]

Objective: To assess the benefits of pancreatic enzyme replacement therapy (PERT) in children with complicated severe acute malnutrition.Study Design: We conducted a randomized, controlled trial in 90 children aged 6-60 months with complicated severe acute malnutrition at the Queen Elizabeth Central Hospital in Malawi. All children received standard care; the intervention group also received PERT for 28 days.Results: Children treated with PERT for 28 days did not gain more weight than controls (13.7 ± 9.0% in controls vs 15.3 ± 11.3% in PERT; P = .56). Exocrine pancreatic insufficiency was present in 83.1% of patients on admission and fecal elastase-1 levels increased during hospitalization mostly seen in children with nonedematous severe acute malnutrition (P <.01). Although the study was not powered to detect differences in mortality, mortality was significantly lower in the intervention group treated with pancreatic enzymes (18.6% vs 37.8%; P < .05). Children who died had low fecal fatty acid split ratios at admission. Exocrine pancreatic insufficiency was not improved by PERT, but children receiving PERT were more likely to be discharged with every passing day (P = .02) compared with controls.Conclusions: PERT does not improve weight gain in severely malnourished children but does increase the rate of hospital discharge. Mortality was lower in patients on PERT, a finding that needs to be investigated in a larger cohort with stratification for edematous and nonedematous malnutrition. Mortality in severe acute malnutrition is associated with markers of poor digestive function.Trial Registration: ISRCTN.com: 57423639. [ABSTRACT FROM AUTHOR]

Background/objectives: Exocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL)., Methods: This was a cross-sectional, multicenter Spanish study. CP patients without follow-up by a gastroenterologist or surgeon in at least 2 years were included. EPI was defined as fecal elastase test <200mcg/g. For nutritional assessment, laboratory and anthropometric data were obtained. QoL was investigated using the EORTC QLQ-C30 questionnaire., Results: 64 patients (mean age 58.8±10.3 years, 85.9% men) from 10 centers were included. Median time since diagnosis of CP was 58.7 months [37.7-95.4]. Forty-one patients (64.1%) had EPI. Regarding nutritional status, the following differences were observed (EPI vs. Non-EPI): BMI (23.9±3.5kg/m 2 vs. 25.7±2.5, p=0.03); glucose (121 [96-189] mg/dL vs. 98 [90-116], p=0.006); HbA1c 6.6% [6.0-8.4] vs. 5.5 [5.3-6.0], p=0.0005); Vitamin A (0.44mg/L [0.35-0.57] vs. 0.53 [0.47-0.63], p=0.048) and Vitamin E (11.2±5.0μg/ml vs. 14.4±4.3, p=0.03). EPI group showed a worse EORTC QLQ-C30 score on physical (93.3 [66.7-100] vs. 100 [93.3-100], p=0.048) and cognitive function (100 [83.3-100] vs. 100 [100-100], p=0.04)., Conclusions: Prevalence of EPI is high in patients with CP without follow-up. EPI group had higher levels of glucose, lower levels of vitamins A and E and worse QoL., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Background: Diabetes mellitus (DM) is a chronic abnormal metabolic condition, which manifests elevated blood sugar level over a prolonged period. The pancreatic endocrine system generally gets affected during diabetes, but often abnormal exocrine functions are also manifested due to its proximity to the endocrine system. Fecal elastase-1 (FE-1) is found to be an ideal biomarker to reflect the exocrine insufficiency of the pancreas., Aim: The aim of this study was conducted to assess exocrine dysfunction of the pancreas in patients with type-2 DM (T2DM) by measuring FE levels and to associate the level of hyperglycemia with exocrine pancreatic dysfunction., Methodology: A prospective, cross-sectional comparative study was conducted on both T2DM patients and healthy nondiabetic volunteers. FE-1 levels were measured using a commercial kit (Human Pancreatic Elastase ELISA BS 86-01 from Bioserv Diagnostics). Data analysis was performed based on the important statistical parameters such as mean, standard deviation, standard error, t -test-independent samples, and Chi-square test/cross tabulation using SPSS for Windows version 20.0., Results: Statistically nonsignificant ( P = 0.5051) relationship between FE-1 deficiency and age was obtained, which implied age as a noncontributing factor toward exocrine pancreatic insufficiency among diabetic patients. Statistically significant correlation ( P = 0.003) between glycated hemoglobin and FE-1 levels was also noted. The association between retinopathy ( P = 0.001) and peripheral pulses ( P = 0.001) with FE-1 levels were found to be statistically significant., Conclusion: This study validates the benefit of FE-1 estimation, as a surrogate marker of exocrine pancreatic insufficiency, which remains unmanifest and subclinical., Competing Interests: There are no conflicts of interest.

Background/objectives: To evaluate the usefulness of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in chronic pancreatitis (CP), we compared the severity of disease determined histopathologically with that indicated by S-MRCP imaging parameters in an induced CP cat model., Materials and Methods: An experimental group of randomly chosen cats (n = 24) underwent ligation of the pancreatic duct to induce CP, and cats in a similarly chosen control group (n = 8) were sham-operated. MRCP was performed prior to secretin stimulation, and 5 and 15 min afterward, noting in particular the pancreatic duct caliber change (PDC) and the increasing degree of fluid volume (IDFV). Histopathological changes were observed in pancreatic samples processed for hematoxylin-eosin and Sirius red staining, and CP was classified as normal, minimal, moderate, or advanced. Correlations were investigated between these groups and the PDC at 5 min and the IDFV at 15 min., Results: Between cats with minimal CP and the controls, the differences in mean IDFV and PDC were not significant although diseased cats showed a downward trend in both parameters. However, compared with the control group both the mean IDFV and PDC were significantly lower in cats with moderate (IDFV, P = 0.001; PDC, P = 0.013) or advanced (IDFV, P = 0.013; PDC, P = 0.001) CP., Conclusion: The S-MRCP parameters IDFV and PDC correlated with the histopathological severity of induced CP. S-MRCP could be used to evaluate the severity of CP, although it is somewhat insensitive for depicting very early disease., (Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Introduction: Exocrine pancreatic insufficiency (EPI) can occur in patients with diabetes mellitus (DM). Incidence of EPI and its clinical significance remain poorly defined. The aim of our study was to determine whether exocrine pancreatic function is impaired in patients with DM., Patients and Methods: One hundred and fifty consecutive patients, mean age 59.0 (± 12.0 years), with DM lasting at least 5 years were included in the study. We included 50 patients with type 1 DM (DM1), 50 insulin-treated patients DM type 2 (DM2-insulin) and 50 non-insulin treated patients with DM type 2 (DM2 no-insulin). Diagnosis of DM was established from health records, lasting 15.0 ± 9.9 years on average. EPI was diagnosed with a fecal elastase-1 concentration (FE1) of less than 200 μg/g (ELISA)., Results: FE1 was reduced in 8 (5.4%) patients: mildly reduced (100-200 μg/g) in 4 patients (2.7%) and markedly reduced (<100 μg/g) in 4 patients (2.7%). Frequency of EPI was 3 in DM1, 5 in DM2(insulin) and none in DM2 (no-insulin) groups., Conclusions: EPI in DM occurred less frequently than in previous studies, probably due to our strict exclusion criteria (age, alcohol intake)., (Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.)