ABSTRACT
Background and aim: There have been conflicting reports on the role of cassava ingestion in tropical pancreatitis (TCP). In this study we aimed to estimate cyanogens detoxifying enzyme rhodanese, thiocyanate and sulfur containing amino acids in cassava consumer as well as cassava non-consumer TCP patients and healthy controls and compare the same. Methods: Eighty-six TCP patients and 90 healthy controls were recruited. Serum rhodanese, thiocyanate, plasma amino acids, urinary inorganic sulfate/creatinine were measured. Results: There was significant reduction in serum rhodanese activity in both cassava consumer- and non-consumer TCP patients as compared to controls but no significant difference between cassava consumer- and non-consumer TCP patients was observed. Serum thiocyanate was significantly lower in cassava consumer TCP patients as compared to cassava consumer controls but not significantly different from cassava non-consumer TCP patients. Plasma methionine, cysteine and urinary inorganic sulfate / creatinine ratio was significantly lower in both cassava consumer and non-consumer TCP patients as compared to controls but were comparable among cassava consumers and non-consumers. Conclusions: Significant reduction in rhodanese activity with concomitant decrease in sulfur containing amino acids and antioxidants such as glutathione suggests that TCP patients are at higher risk of defective detoxification of cyanogens. However there was no difference between cassava consumers and non-consumers. Low levels of sulfur amino acids may contribute to the development of pancreatitis.
ABSTRACT
Background Oxidative stress-induced free radicals have been implicated in the pathology of chronic pancreatitis (CP). Aim We aimed to estimate oxidative stress and antioxidant status in tropical chronic pancreatitis (TCP) and alcoholic chronic pancreatitis (ACP) and correlate with zinc status. Methods One hundred and seventy-five CP patients (91 TCP, 84 ACP) and 113 healthy subjects were prospectively studied. Disease characteristics and imaging features were recorded. Erythrocyte reduced glutathione, glutathione peroxidase (GPx), superoxide dismutase (SOD), plasma vitamin C, and erythrocyte thiobarbituric acid reactive substance (TBARS) were estimated by spectrophotometry. Erythrocyte zinc was estimated by flame atomic absorption spectrophotometry. Results Enhanced lipid peroxidation with concomitant decrease in antioxidant status was observed in both TCP and ACP patients (p<0.05). The findings were comparable in both diabetic and non-diabetic CP patients. Significantly, lower plasma vitamin C and elevated levels of erythrocyte TBARS was noted in TCP as compared to ACP patients. The erythrocyte zinc significantly correlated with SOD activity (r=0.450, p<0.001). Conclusions Our study corroborates the role of oxidative stress in CP and suggests some differences in oxidative status in TCP and ACP patients. Zinc deficiency appears to affect oxidative status in CP patients.
ABSTRACT
Background and aim: Recent surveys suggest a change in nutritional status of population in Kerala along with a steep rise in alcoholism. We aimed to conduct a comprehensive assessment of anthropometric, biochemical, clinical and dietary parameters and study the association of nutritional status with dietary intake. Methods: We compared the nutrient intake of a cohort of patients with chronic pancreatitis with a recent population survey. We also sought to compare the prevalent nutritional status of patients with previous series. Results: Chronic pancreatitis patients had poor intake of most nutrients. However, severe malnutrition is present only in a small minority (4%) as compared to previous series. Fat intake in patients with tropical chronic pancreatitis was significantly lower in alcoholic chronic pancreatitis patients (27.5g/d vs. 43g/d). Conclusions: Malnutrition remains an important problem in chronic pancreatitis; however severe malnutrition is rare as compared to previous series. Energy (calorie) deprivation and micronutrient deficiency are major nutritional issues. Use of additional anthropometric parameters, especially triceps skin fold thickness, in conjunction with body mass index, is helpful. Subjective global assessment is a useful method for assessment for nutritional status in chronic pancreatitis patients.
ABSTRACT
Background Measurement of pancreatic exocrine function and steatorrhea in chronic pancreatitis in the clinical setting has not received much attention. Aim To assess pancreatic exocrine function and fecal fat excretion in a cohort of patients with chronic pancreatitis. Methods Stool elastase1 levels were measured in 101 patients using polyclonal ELISA and acid steatocrit was measured in 86 chronic pancreatitis patients. Associations with etiology, clinical and radiological features, and diabetic status were examined. Results Low pancreatic stool elastase1 (<200 μg/g stool) was observed in two-thirds of chronic pancreatitis patients and correlated with ductal dilatation, pancreatic atrophy and calcification (p<0.05). Diabetes was more prevalent in chronic pancreatitis patients with low elastase1 (p=0.045). There was no difference in mean acid steatocrit between diabetics and non-diabetics (p=0.069). Elastase1 levels had a negative correlation with acid steatocrit (r=–0.606, p<0.001), and a positive correlation (r=0.412) with body mass index (p=0.013). Fiftythree percent of chronic pancreatitis patients with normal BMI had low elastase1. Conclusions Fecal elastase1 levels correlated with fecal fat excretion and BMI. Fecal elastase1 estimation may be helpful in early detection of malabsorption in chronic pancreatitis.