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ABSTRACT Background: The treatment of chronic pancreatitis does not consistently solve intestinal abnormalities, and despite the implementation of various therapeutic measures, patients often continue to experience persistent diarrhea. Therefore, it is imperative to recognize that diarrhea may stem from factors beyond pancreatic insufficiency, and intestinal inflammation emerges as a potential contributing factor. Objective: The aim of this study was to assess fecal lactoferrin and calprotectin levels as indicators of intestinal inflammation in patients with chronic pancreatitis experiencing persistent diarrhea. Methods: In this study, 23 male patients with chronic pancreatitis primarily attributed to alcohol consumption and presenting with diarrhea (classified as Bristol stool scale type 6 or 7), underwent a comprehensive evaluation of their clinical and nutritional status. Fecal lactoferrin and calprotectin levels were measured utilizing immunoassay techniques. Results: The average age of the participants was 54.8 years, 43.5% had diabetes, and 73.9% were smokers. Despite receiving enzyme replacement therapy and refraining from alcohol for over 4 years, all participants exhibited persistent diarrhea, accompanied by elevated calprotectin and lactoferrin levels indicative of ongoing intestinal inflammation. Conclusion: The findings of this study underscore that intestinal inflammation, as evidenced by elevated fecal biomarkers calprotectin and lactoferrin, may contribute to explaining the persistence of diarrhea in patients with chronic pancreatitis.
RESUMO Contexto: O tratamento da pancreatite crônica não resolve de forma consistente as anomalias intestinais e, apesar da implementação de várias medidas terapêuticas, os pacientes muitas vezes continuam a apresentar diarreia persistente. Portanto, é imperativo reconhecer que a diarreia pode resultar de fatores além da insuficiência pancreática, e a inflamação intestinal surge como um potencial fator contribuinte. Objetivo: O objetivo deste estudo foi avaliar os níveis fecais de lactoferrina e calprotectina como indicadores de inflamação intestinal em pacientes com pancreatite crônica com diarreia persistente. Métodos: Neste estudo, 23 pacientes do sexo masculino com pancreatite crônica atribuída principalmente ao consumo de álcool e apresentando diarreia (classificada na escala de fezes de Bristol tipo 6 ou 7), foram submetidos a uma avaliação abrangente de seu estado clínico e nutricional. Os níveis fecais de lactoferrina e calprotectina foram medidos utilizando técnicas de imunoensaio. Resultados: A idade média dos participantes foi de 54,8 anos, 43,5% tinham diabetes e 73,9% eram fumantes. Apesar de receber terapia de reposição enzimática e abster-se de álcool por mais de 4 anos, todos os participantes apresentaram diarreia persistente, acompanhada por níveis elevados de calprotectina e lactoferrina, indicativos de inflamação intestinal contínua. Conclusão: Os achados deste estudo ressaltam que a inflamação intestinal, evidenciada pelos biomarcadores fecais elevados calprotectina e lactoferrina, pode contribuir para explicar a persistência da diarreia em pacientes com pancreatite crônica.
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Pancreatic exocrine insufficiency (PEI) refers to insufficient or non-synchronous secretion of trypsin caused by various reasons, resulting in dyspepsia and other symptoms. Intestinal microbiota is a large number of microbiota on the surface of intestinal mucosa. Its main functions include intestinal immune function, forming intestinal biological barrier and participating in the regulation of nutrition and metabolism. Due to aging, some elderly people often have unexplained chronic pancreatic insufficiency, which is often characterized by unexplained weight loss and malnutrition. Several studies have shown that the composition of intestinal microbiota changes significantly with age. This article focuses on aging and its related PEI and then reviews its possible effects on intestinal microbiota, in order to provide a reference basis for individualized prevention and treatment strategies according to the changes of pancreatic exocrine function and microbiota in the elderly.
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Objective:To examine the expression of core clock genes in the peripheral blood mononuclear cells (PBMCs) and the level of circadian disturbance-related proteins in the serum of chronic pancreatitis (CP) patients with pancreatic exocrine insufficiency (PEI), and explore their potential diagnostic value in clinical practice.Methods:The peripheral blood samples and related clinical data from 68 patients diagnosed with CP in Shanghai General Hospital from Jan 2015 to Jan 2022 were collected. Peripheral blood samples from 30 healthy individuals were used for control. The M-ANNHEIM classification system was used to stratify the clinical stages of patients with CP. The mRNA expression of the core clock genes, including Clock, Bmal1, Per1/2/3 and Cry1/2 in PBMCs was analyzed using realtime qPCR, and the expression of circadian disturbance-related proteins like TrkB, CD 36 and Rbp in serum was measured with ELISA. The receiver operating characteristic curve(ROC) and the area under curve (AUC) was used to test the efficiency for diagnozing PEI. Results:The mRNA expression of Per1 in CP patients was significantly decreased (0.76 vs 1, P<0.05), and the AUC for diagnozing PEI was 0.744 (95% CI 0.628-0.860), with a cut-off value of 0.72; and the sensitivity and specificity was 84.8% and 57.1%, respectively. The protein abundance of serum CD 36 was significantly increased in CP patients (33.85±19.74ng/ml vs 24.71±11.53 ng/ml, P<0.05); the AUC for diagnozing PEI was 0.834 (95% CI 0.735-0.932), with a cut-off value of 29.75 pg/ml; and the sensitivity and specificity was 74.3% and 84.8%, respectively. The expression of CD 36 was increased with the increase of CP clinical stage, and there were statistically significant differences between either two stages (all P value <0.05). The mRNA expression of Per1 in patients with CP in Stage Ⅰ was significantly higher than that in patients with CP in Stage Ⅱ or Ⅲ, and the differences were statistically significant ( P<0.05), but no statistical difference was found between Stage Ⅱ and Stage Ⅲ. Conclusions:The decreased expression of Per1 mRNA in PBMCs and increased level of CD 36 in serum are significantly related to the occurrence of PEI in CP, suggesting that they may have potential value for diagnozing PEI and guiding the clinical practice.
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Dyspepsia is the one of the most common clinical manifestations of digestive system diseases and has various and complex causes， among which pancreatic tumor is a relatively uncommon cause and is easily neglected in clinical practice. The dual factors of tumor and dyspepsia may cause a significant reduction in the quality of life of patients. At present， there is still a lack of standardized diagnosis and treatment strategies for dyspepsia associated with pancreatic tumors， and this article reviews the diagnosis and treatment of this disease.
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Dyspepsia due to pancreatic exocrine insufficiency is a common complication after pancreatectomy； however， due to the lack of simple， efficient， and unified diagnostic methods， standardized treatment standards， and awareness of this disease among surgeons， it is difficult to get adequate diagnosis and treatment. Therefore， this article summarizes the research advances in the definition and pathogenesis of pancreatic exocrine insufficiency， the incidence rate of pancreatic exocrine insufficiency after different surgical procedures， and current diagnostic methods and treatment strategies， in order to provide a reference for further improving the diagnosis and treatment of pancreatic exocrine insufficiency after pancreatectomy.
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Dyspepsia is a common group of clinical symptoms and can be classified into organic and functional dyspepsia. Patients with chronic pancreatitis （CP） often have the symptoms of dyspepsia such as fatty diarrhea， abdominal distention， and abdominal pain， and most patients have pancreatic exocrine insufficiency （PEI）， which belongs to organic dyspepsia. In clinical practice， the diagnosis of PEI and dyspepsia requires a comprehensive assessment of clinical manifestations， nutritional status， and pancreatic exocrine function， and an individualized treatment regimen should be developed based on such factors. However， some patients with normal exocrine function may have the symptoms of dyspepsia， and the diagnosis and treatment of such patients are still difficulties in clinical practice. This article reviews the advances in the diagnosis and treatment of dyspepsia in CP patients.
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Various pancreatic diseases can cause dyspepsia due to pancreatic exocrine insufficiency （PEI） caused by pancreatic parenchymal injury and/or pancreatic duct obstruction， which further leads to impaired digestive function and a series of severe clinical outcomes such as malnutrition， weight loss， and shortened survival time. Therefore， pancreatic disease-related dyspepsia should be taken seriously in clinical practice to improve its diagnosis and treatment rates， so as to improve the quality of life of patients with pancreatic diseases and prolong overall survival time.
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La fibrosis quística (FQ) es un trastorno hereditario, de las glándulas de secreción exocrina, considerada la causa más frecuente de insuficiencia pancreática exocrina (IPE) en la infancia. Esta revisión resume el panorama del tratamiento de reposición enzimática en la IPE asociada a la FQ, las formulaciones disponibles, su dosificación y modo de administración, así como las limitaciones y desafíos actuales y las posibles áreas del desarrollo futuro
Cystic fibrosis (CF) is an inherited disorder of the exocrine secretion glands, considered the most frequent cause of exocrine pancreatic insufficiency (EPI) in childhood. This review summarizes the landscape of enzyme replacement therapy in PEI associated with CF, the available formulations, their dosage and mode of administration, as well as the current limitations and challenges and potential areas for future development.
Subject(s)
Cystic Fibrosis , Exocrine Pancreatic Insufficiency , Enzyme Replacement TherapyABSTRACT
Background : Exocrine pancreatic insufficiency (EPI), characterized by reduced secretion or activity of pancreatic enzymes, causes improper absorption of food, excessive fat excretion in the stool, and malnourishment. Methods : In this observational, real-world evidence study, patients with one or more of the following condition were enrolled: abdominal pain, acidity, diarrhea, nausea, or dyspepsia (as per ROME III criteria). Patients had either been diagnosed with gallstones, hypertriglyceridemia, alcohol consumption or undergone abdominal surgery. Patients were prescribed capsule EnzigestTM10000 (pancreatin minimicrospheres) for one month.The severity and frequency of various gastric symptoms was measured at day 0 and day 30. Results : 540 patients were enrolled with a mean age of 51.6 years. Enzigest significantly reduced the severity of functional dyspepsia by 88.67% (p<0.001) as per Rome III Criteria. There is significant improvement in frequency of symptoms (83.80%), abdominal pain severit(81.58%), epigastric pain (83.09%), nausea (84.35%) and vomiting by 89.62% (all P<0.001). The overall improvement in symptoms was significant (p<0.001). Enzigest was well tolerated.Conclusion : Enzigest improved abdominal pain, dyspepsia, and acidity in patients with exocrine pancreatic insufficiency due to alcohol consumption, gallstones, hypertriglyceridemia, diuretic (Furosemide or Thiazide) or abdominal surgery. Enzigest containing pancreatin minimicrospheres can be an easy therapeutic option to counteract EPI.
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Chronic pancreatitis (CP) during pregnancy is rare but complicated in clinic, and its pathophysiology, clinical manifestations, diagnosis and treatment are special, which may seriously harm the health of mother and fetus if not properly treated. During pregnancy, physiological changes such as insulin resistance, mechanical pressure caused by the enlarged uterus and increased secretion of estrogen and progesterone will affect patients with CP. CP may increase the risk of pregnancy⁃related complications and adverse perinatal outcomes. The management of pregnant patients with CP mainly includes the improvement of lifestyle, symptomatic treatment and obstetric management. This article mainly reviewed the pancreatic physiology, clinical manifestations and management of pregnant patients with CP.
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Resumen Introducción: la pancreatitis crónica (PC) es una inflamación progresiva del páncreas que puede llevar a su destrucción e insuficiencia irreversibles. Es una patología desafiante para el médico, debido a que establecer su diagnóstico puede tomar meses e incluso años, el seguimiento de pacientes suele ser problemático y el conocimiento sobre la clínica y epidemiología en Colombia es incompleto. Este estudio pretende hacer una descripción de pacientes con PC en un centro de referencia en gastroenterología de Cali, Colombia. Metodología: estudio de corte transversal de pacientes adultos con PC confirmada por criterios clínicos y radiológicos entre 2011 y 2017. Resultados: se incluyeron 36 pacientes con PC. La mayoría fueron hombres (72,2%) y la media de edad fue 56 (+ 15,1) años. El dolor abdominal crónico fue la presentación clínica más común (83,3%). Cerca de un cuarto de pacientes presentaba diabetes mellitus (22,2%). Se consideró etiología idiopática en 58,3%, alcohólica en el 11,0% y biliar en el 11,0%. La tomografía axial computarizada (TAC), resonancia magnética (RMN) y colangiopancreatografía por RMN fueron los métodos diagnósticos más usados (60,5%), con los que en su mayoría se visualizó atrofia (53,1%), dilatación de conductos (49,0%) y calcificaciones del páncreas (34,7%). Conclusión: los síntomas inespecíficos de la PC en fases iniciales y su largo curso clínico favorecen al subdiagnóstico de esta patología. Los resultados presentados pueden contribuir a la futura creación de escalas clínicas locales que orienten estudios radiológicos y genéticos tempranos, con el fin de lograr un diagnóstico oportuno y mejorar la calidad de vida de estos pacientes.
Abstract Introduction: Chronic pancreatitis (CP) is a progressive inflammation of the pancreas that can lead to irreversible damage and failure. This condition poses great challenges to physicians since its diagnosis can take months or even years. Patient follow-up is often problematic and knowledge about its clinical presentation and epidemiology in Colombia is scarce. This study aims to describe patients with CP treated at a gastroenterology reference center in Cali, Colombia. Methodology: Cross-sectional study in adult patients with CP confirmed based on clinical and radiological criteria between 2011 and 2017. Results: 36 patients with CP were included. The majority were men (72.2%), and the mean age was 56 (+15.1) years. Chronic abdominal pain was the most common clinical presentation (83.3%). About a quarter of patients had diabetes mellitus (22.2%). Etiology was idiopathic in 58.3%, alcoholic in 11.0%, and biliary in 11.0%. Computed tomography (CT), magnetic resonance imaging (MRI), and MRI cholangiopancreatography were the most commonly used diagnostic methods (60.5%), showing mostly atrophy (53.1%), duct dilation (49.0%), and pancreatic calcifications (34.7%). Conclusion: Nonspecific symptoms of CP in early stages and its long clinical course favor the underdiagnosis of this condition. The results presented may contribute to the future creation of local clinical scales that guide early radiological and genetic studies to achieve a timely diagnosis and improve the quality of life of these patients.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Abdominal Pain , Epidemiology , Pancreatitis, Chronic , Patients , Magnetic Resonance Spectroscopy , Tomography , Diagnosis , Forecasting , HospitalsABSTRACT
At present, there is still a lack of comprehensive diagnosis and treatment criteria for pancreatic exocrine insufficiency around the world. Pancreatic surgeons often ignore or misjudge pancreatic exocrine insufficiency secondary to pancreatic cancer, and as a result, pancreatic exocrine insufficiency is not adequately treated, which greatly affects the quality of life of patients with pancreatic cancer. This article summarizes the latest research advances in the pathogenesis, typical symptoms, and diagnostic methods of pancreatic exocrine insufficiency, as well as pancreatic enzyme replacement therapy in different stages of pancreatic cancer. It is pointed out that pancreatic enzyme replacement therapy can significantly improve the quality of life of patients with different stages of pancreatic cancer.
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PURPOSE: The objective of this study was to describe the clinical phenotypes of children and adolescents with cystic fibrosis (CF); and to assess the role of pancreatic insufficiency and neonatal screening in diagnosis. METHODS: A cross-sectional study was conducted, which included 77 patients attending a reference center of CF between 2014 and 2016. Epidemiological data, anthropometric measurements, and the presence of pulmonary, pancreatic, gastrointestinal and hepatobiliary manifestations were evaluated based on clinical data and complementary examinations. RESULTS: Of the 77 patients, 51.9% were male, with a median age of 147 months (7.0-297.0 months), and the majority showed adequate nutritional status. The most common phenotype was pulmonary (92.2%), followed by pancreatic (87.0%), with pancreatic insufficiency in most cases. Gastrointestinal manifestation occurred in 46.8%, with constipation being the more common factor. Hepatobiliary disease occurred in 62.3% of patients. The group with pancreatic insufficiency was diagnosed earlier (5.0 months) when compared to the group with sufficiency (84.0 months) (p=0.01). The age of diagnosis was reduced following implementation of neonatal screening protocols for CF (6.0 months before vs. 3.0 months after, p=0.02). CONCLUSION: The pulmonary phenotype was the most common, although extrapulmonary manifestations were frequent and clinically relevant, and should mandate early detection and treatment. Neonatal screening for CF led to earlier diagnosis in patients with pancreatic failure, and therefore, should be adopted universally.
Subject(s)
Adolescent , Child , Humans , Infant, Newborn , Male , Constipation , Cross-Sectional Studies , Cystic Fibrosis , Diagnosis , Exocrine Pancreatic Insufficiency , Gastrointestinal Diseases , Liver Diseases , Neonatal Screening , Nutritional Status , PhenotypeABSTRACT
Gastric resection can cause a multifactorial clinical manifestations of dyspepsia,such as flatulence,diarrhea,weight loss,and fat diarrhea.Exocrine pancreatic insufficiency (EPI) is one of the possible mechanisms of fat maldigestion following gastric surgery,the main causes may be related to rapid gastric emptying;asynchrony between gastric emptying and bilio-pancreatic secretion due to new tracts of various reconstructions;bacterial overgrowth after gastrectomy and so on.Oral pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment for EPI,due to lack of available evidence so far,the efficacy and safety of pancreatic enzyme substitution in patients following gastric resection remains unclear and cannot be generally recommended.This review will sum up the revelant studies addressing EPI and PERT after gastric resection in recent years,and summarizes the mechanisms,clinical diagnostic methods and PERT treatment perscription of EPI after gastrectomy to improve the cognition of clinicans.
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Exocrine pancreatic insufficiency is a commom complication after pancreatic operation with high morbidity.At present,surgeons have insufficient understanding of it,and there is no internationally normalized standard for the diagnosis and treatment of exocrine pancreatic insufficiency.Through systematic reviewing of the relevant literature,this review summarizes the research progress of exocrine pancreatic insufficiency after pancreatic operation,including the definition of exocrine pancreatic insufficiency,aetiological agent,diagnosis,treatment,prevention,and morbidity of pancreatic exocrine insufficiency in different surgical procedures,in order to provide a reference for the improvement of diagnosis and treatment of exocrine pancreatic insufficiency in the future.
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ABSTRACT Objective: To determine the prevalence of malnutrition in patients attending an adult cystic fibrosis (CF) program and to investigate the associations of malnutrition with the clinical characteristics of those patients. Methods: This was a cross-sectional study involving patients with clinically stable CF patients (16 years of age or older). The patients underwent clinical assessment, nutritional assessments, pulmonary function tests, and pancreatic function assessment. They also completed a questionnaire regarding diet compliance. On the basis of their nutritional status, the patients were classified divided into three groups: adequate nutrition; at nutritional risk; and malnutrition. Results: The study has included 73 patients (mean age, 25.6 ± 7.3 years), 40 of whom (54.8%) were female. The mean body mass index was 21.0 ± 3.0 kg/m2 and the mean FEV1 was 59.7 ± 30.6% of predicted. In this sample of patients, 32 (43.8%), 23 (31.5%), and 18 (24.7%) of the patients were allocated to the adequate nutrition, nutritional risk, and malnutrition groups, respectively. The logistic regression analysis identified three independent factors associated with the risk of malnutrition: Shwachman-Kulczycki score, percent predicted FEV1; and age. Conclusions: Malnutrition remains a common complication in adolescents and adults with CF, despite dietary advice. Malnutrition is associated with age, clinical severity, and lung function impairment.
RESUMO Objetivo: Determinar a prevalência de desnutrição em pacientes de um programa para adultos com fibrose cística (FC) e investigar a relação da desnutrição com as características clínicas desses pacientes. Métodos: Trata-se de um estudo transversal com pacientes com FC clinicamente estáveis (com 16 anos de idade ou mais). Os pacientes foram submetidos a avaliação clínica, avaliação nutricional, testes de função pulmonar e avaliação da função pancreática. Eles também preencheram um questionário sobre sua adesão à dieta proposta. Os pacientes foram divididos em três grupos, de acordo com seu estado nutricional: nutrição adequada, risco nutricional e desnutrição. Resultados: O estudo incluiu 73 pacientes (média de idade: 25,6 ± 7,3 anos), dos quais 40 (54,8%) eram do sexo feminino. A média do índice de massa corporal foi de 21,0 ± 3,0 kg/m2, e a média do VEF1 foi de 59,7 ± 30,6% do previsto. Nessa amostra de pacientes, 32 (43,8%) ficaram no grupo com nutrição adequada, 23 (31,5%) ficaram no grupo com risco nutricional e 18 (24,7%) ficaram no grupo com desnutrição. A análise de regressão logística identificou três fatores independentes relacionados com o risco de desnutrição: escore de Shwachman-Kulczycki, VEF1 em % do previsto e idade. Conclusões: A desnutrição ainda é uma complicação comum em adolescentes e adultos com FC, não obstante o aconselhamento dietético. A desnutrição está relacionada com a idade, a gravidade clínica e o comprometimento da função pulmonar.
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Humans , Male , Female , Adolescent , Adult , Cystic Fibrosis/complications , Malnutrition/epidemiology , Body Mass Index , Cross-Sectional Studies , Malnutrition/diagnosis , Malnutrition/etiology , National Health Programs , Nutritional Status , Predictive Value of Tests , Prevalence , Respiratory Function Tests , Sensitivity and Specificity , SpirometryABSTRACT
Pancreatic exocrine function examination is mainly divided into direct examination and indirect examinationmethods. Direct examination methods include secretin test, secretin-caerulein test, endoscopic pancreatic function test, secretin-stimulated magnetic resonance pancreatography, Lundh test, etc. Indirect examination methods are comprised of routine serological testing, fecal fat detection, fecal enzyme detection, breath test, urine analysis of specific substances and so on. Direct examination has higher accuracy than indirect examination, but it is more invasive and cumbersome than noninvasive indirect examination. In this review, we summarized the clinical application and progress of pancreatic exocrine function examination.
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Desde hace más de 70 años se conoce la asociación de diarrea con diabetes mellitus. En pacientes diabéticos su prevalencia es de alrededor del 20%. Sus manifestaciones clínicas son diversas, y representa un reto diagnóstico y terapéutico. Existen ciertos diagnósticos de mayor prevalencia en pacientes diabéticos que en la población general. Las distintas etiologías relacionadas pueden ser diagnosticadas adecuadamente a través de la historia clínica y pruebas diagnósticas complementarias. Los medicamentos utilizados por el paciente diabético para el manejo de su enfermedad, frecuentemente causan diarrea crónica, por lo que se debe profundizar en los antecedentes farmacológicos al momento de estudiar la diarrea. Los pacientes diabéticos pueden presentar otras condiciones patológicas asociadas, como enfermedad celíaca o colitis microscópica, cuya molestia única es la diarrea. La función del páncreas exocrino puede estar disminuida en el paciente diabético, frecuentemente llevando a insuficiencia pancreática exocrina. Factores dietarios, como los edulcorantes libres de azúcar y otros agentes, pueden causar diarrea en el paciente diabético. La presencia de condiciones como la neuropatía autonómica y neuropatía periférica secundarias a la diabetes mellitus, pueden explicar desordenes como la disfunción anorrectal y la incontinencia fecal. Finalmente, la enteropatía diabética per se o con sobrecrecimiento bacteriano asociado, puede causar diarrea. Lograr un control glicémico adecuado constituye el pilar del tratamiento de la diarrea en el diabético, después de esto existen medidas adicionales que se aplican según el contexto especifico del paciente. En el presente artículo se revisan las causas de mayor incidencia diarrea en el paciente diabético y los mecanismos fisiopatológicos implicados
The association of diarrhea with diabetes mellitus has been known for more than 70 years. In diabetic patients its prevalence is around 20%.Its clinical manifestations are diverse, and represents a diagnostic and therapeutic challenge.There are certain diagnoses of higher prevalence in diabetic patients than in the general population.The different related etiologies can be adequately diagnosed through the clinical history and complementary diagnostic tests.The medications used by the diabetic patient to manage their disease often cause chronic diarrhea, so the pharmacological background should be studied at the time of the study of diarrhea.Diabetic patients can present other associated pathological conditions, such as celiac disease or microscopic colitis, which only discomfort is diarrhea.Exocrine pancreatic function may be decreased in the diabetic patient, frequently leading to exocrine pancreatic insufficiency. Dietary factors, such as sugar-free sweeteners and other agents, can cause diarrhea in the diabetic patient.The presence of conditions such as autonomic neuropathy and peripheral neuropathy secondary to diabetes mellitus may explain disorders such as anorectal dysfunction and faecal incontinence. Finally, diabetic enteropathy alone or with associated bacterial overgrowth can cause diarrhea.Achieving adequate glycemic control is the pillar of the treatment of diarrhea in the diabetic, after which there are additional measures that are applied according to the specific context of the patient.This article reviews the causes of higher diarrhea incidence in the diabetic patient and the pathophysiological mechanisms involved
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Humans , Diabetes Complications/etiology , Diarrhea/etiology , Chronic Disease , Risk Factors , Diabetes Complications/diagnosis , Diabetes Complications/physiopathology , Diabetes Complications/therapy , Diarrhea/diagnosis , Diarrhea/physiopathology , Diarrhea/therapyABSTRACT
Autoimmune pancreatitis (AIP) is an uncommon disease that represents a diagnostic challenge unless it is considered as a cause of acute pancreatitis, pancreatic exocrine insufficiency and a pancreatic mass. This entity is under diagnosed and successful medical therapy is available. In this paper, we will describe a case of a 59 year-old, Hispanic woman diagnosed with autoimmune pancreatitis, a disease previously believed to affect typically older men. We will review the definition, types, clinical manifestations, radiological features, serology, histopathological findings, treatment strategies and diagnostic criteria of autoimmune pancreatitis
La pancreatitis autoinmune (PAI) es una enfermedad rara que se presenta como un reto diagnóstico a menos que sea considerada como causa de pancreatitis aguda, insuficiencia pancreática exocrina y masa pancreática. Es una enfermedad sub diagnosticada y existe una terapia médica satisfactoria. En este trabajo, describiremos un caso de una mujer hispana de 59 años diagnosticada de pancreatitis autoinmune, una enfermedad que se creía previamente que afectaba típicamente a hombres de avanzada edad. Revisaremos la definición, los tipos, las manifestaciones clínicas, hallazgos radiológicos, serología, hallazgos histopatológicos, estrategias de tratamiento y criterios diagnósticos de la pancreatitis autoinmune
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BACKGROUND:Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy. OBJECTIVE: To systematicaly evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy. METHODS: A computer-based search of Chinese and English databases was performed, and then 15 controled clinical trials were included and systematicaly evaluated using RevMa5.2 software. RESULTS AND CONCLUSION: Totaly 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time (SMD: 59.23, 95%CI: 22.41-96.05, P < 0.01) and hospital stays (SMD: 7.01, 95%CI: 1.94-12.09,P< 0.01) were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinicaly, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.