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Background: Chronic pancreatitis, a debilitating disease which affects the patient to an extent to render him bedridden sometimes and often make him/her unable to perform daily work, leading to poor quality of life, severe emotional stress and financial burden. Frey’s procedure one of the most commonly performed surgery in patient of chronic pancreatitis with stones in pancreatic duct and small inflammatory head mass. This procedure had shown promising results in terms of pain control with unclear outcome with respect to exocrine and endocrine status.Methods: Study was conducted in Government Kilpauk Medical College, Chennai during March 2016 to December 2019. Total 21 patients were followed up for 18 months and Post-operative pain was analysed using pain scoring system used by Bloechle et al. Exocrine status in terms of diarrhea, bloating sensation and Fecal Elastase level(preoperative and postoperative) were analysed. Patient glycaemic status were also analysed and compared. Patient Nutritional status was analysed in terms of weight gain.Results: In this study there was significant improvement in pain after surgery in terms of VAS pain Score (Preop Mean-82.14, Post-op Mean- 9.76, p<0.001) , frequency of pain (Preop Mean-78.57, Post-op Mean- 14.29, p<0.001), analgesia required (Preop Mean-15, Post-op Mean- 3.10, p<0.001), and inability to work due to pain (Preop Mean-80.95, Post-op Mean- 11.90, p<0.001). Overall total Pain score was significantly improved after surgery (Preop Mean-256.67, Post-op Mean- 39.05, p<0.001). There was significant weight gain and significant improvement in Fecal Elastase level in patients following surgery, however there was no significant difference in pancreatic exocrine status on the basis of symptoms.Conclusions: Frey’s procedure is very effective in pain control in properly selected patients of chronic calcific pancreatitis, and it also improves nutritional status of patient. Frey’s procedure might improve patient exocrine and endocrine status but further multicentre studies are needed to come to a conclusion.
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Objective To determine the fecal elastase-1 (FE-1) in critically ill children in order to investigate the relationships between FE-1 and trypsin,sepsis as well as the severity of the disease.Methods Totally 402 critically ill children admitted in pediatric intensive care unit (PICU) of Hunan Children' s Hospital from July 2013 to March 2014 were studied.The formed stool of patients was collected during the first 24 h after admission.Subjects were divided to 3 groups according to FE-1 concentration:＞ 200 μg/g for normal pancreatic exocrine function (group A,n =300),100-200 μg/g for mild to moderate exocrine pancreatic insufficiency (group B,n =52),＜ 100 μg/g for severe pancreatic exocrine insufficiency (group C,n =50).The analyses of the relationships between FE-1 and pancreatic enzymes,sepsis severity,shock,the number of organ dysfunction,PCIS (pediatric critically ill score),SOFA score,and APACHE Ⅱ score were carried out.Chi-squared test was used for data statistics.The median and four percentile interval were used for the measurement data of abnormal distribution or non-neat variance,the rank sum test of each two of multiple samples compared each other was used for non-parametric test,only when it was statistically significant,and the Spearman method of correlation analysis was used for correlation analysis.Results (1) There was significant difference in serum lipase between group A and group B (P ＜ 0.01).(2) There was statistical difference in FE-1 level between sepsis group and non-sepsis group (P ＜ 0.05).Children with sepsis were divided into three groups according to the severity of sepsis:mild sepsis group,severe sepsis group and septic shock group.There were significant difference in FE-1 level among different severities of sepsis groups and as well as non-sepsis group (P ＜ 0.01).(3) The proportions of FE-1 in septic children of A,B and C groups in comparison with those in non-septic children of three groups were 65.79％ vs.78.13％,15.79％ vs.11.80％,18.42％ vs.10.07％,respectively.The proportions of FE-1 in septic children of B and C groups escalated were higher than those in children without sepsis.(4) The general trend in FE-1 concentrations varied along with the severity of sepsis.There were no significant differences in FE-1 concentration between non-sepsis group and mild sepsis group,and between severe sepsis group and septic shock group,but other paired comparisons between the four groups had statistical significant (P ＜0.01).(5) Along with FE-1 level decreased,the number of organ dysfunction,SOFA score,APS score (This is a part of APACHE Ⅱ score and other part,CPS,is excluded) increased and PCIS score decreased (rs1 =-0.194,P =0.000; rs2 =-0.348,P =0.000; rs3 =-0.176,P =0.000; rs4 =0.185,P =0.000).Conclusions Pancreatic exocrine function damage is associated with sepsis,the pancreatic dysfunction in patients with mild sepsis may not be significant,but its incidence increases gradually with the development of sepsis or with the deterioration of the disease.
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Aim Undernutrition is considered to be a cause of tropical pancreatitis (TP) since this disease is commonly seen in the underprivileged populations of the world. This study was done to compare the nutritional status in patients with TP and alcoholic chronic pancreatitis (ACP) using anthropometric measurements. Methods Anthropometric measurements were done in patients with TP and ACP aged >18 years and matched healthy controls. Presence of pain, recent dietary restriction, diabetes mellitus (DM), calcification, serum prealbumin (PAB), and quantitative fecal elastase (FE) was assessed. Premorbid body mass index (BMI) was determined from weight before the onset of illness as reported by the patients. Results Of 54 patients (47 male), 39 (72.2%) had TP and the rest had ACP. Patients with TP were younger than those with ACP; the frequency of pain, DM, calcification, and exocrine insufficiency was similar in the two groups. Compared to control subjects, patients had lower BMI, triceps skin fold thickness (TSFT) and mid-arm circumference (MAC) (p<0.01), but waist-to-hip ratio (W/H) was similar. Undernutrition was equally common in TP and ACP (15 [38.5%] vs. 6 [40%]). The BMI, TSFT, MAC, and W/H were similar in TP and ACP. The premorbid BMI was higher than that at presentation (20.2 [3.8] kg/m² vs. 19.1 [3.3] kg/m², p<0.01). There was no association between BMI and features contributing to undernutrition (DM, pain, recent dietary restriction, FE level, and calcification) on univariate analysis. Conclusions Energy undernutrition occurs equally commonly in TP and ACP and this appears to develop after the onset of illness.
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BACKGROUND/AIMS: The quantitative analysis of fecal elastase-1 has been proposed as a noninvasive test for the examination of pancreatic exocrine function. Therefore, we evaluated the diagnostic value of fecal elastase-1 by comparing with endoscopic intraductal secretin test (IDST) which is used as a direct exocrine function test for the diagnosis of chronic pancreatitis. METHODS: Fecal elastase-1 concentrations were measured by ELISA in spot stool samples of 40 healthy control subjects, 21 patients with liver disease, and 12 patients with chronic pancreatitis diagnosed with endoscopic retrograde cholangiopancreatography (ERCP) and IDST. Chronic pancreatitis were then sub-classified into mild (I), moderate (II) and severe form (III), using the Cambridge classification according to ERCP finding. The linear regression analysis to evaluate the correlation between the concentration of fecal elastase-1 and IDST was performed during ERCP. The cut-off value of fecal elastase-1 to discriminate chronic pancreatitis was calculated based on receiver operating characteristic curve, and the clinical usefulness of fecal elastase-1 in the diagnosis of chronic pancreatitis was evaluated. RESULTS: There were several significant correlations between fecal elastase-1 and various parameters of IDST: pancreatic juice secretory volume (r=0.797, p<0.002), bicarbonate concentration (r=0.846, p<0.001), elastase-1 concentration in pancreatic juice (r=0.671, p<0.017), and amylase output (r=0.783, p<0.003). The mean value of fecal elastase-1 concentration in the patients with chronic pancreatitis (197+/-77microgram/g stool) was significantly lower than those in the healthy control subjects (815+/-133microgram/g stool) and patients with liver disease (594+/-206microgram/g stool) (p<0.05). The cutoff value of fecal elastase-1 to discriminate between the healthy control and chronic pancreatitis patients was 201microgram/g stool. With this cutoff value, the accuracy, sensitivity, and specificity of fecal elastase-1 to diagnose chronic pancreatitis were 78.8%, 67.7%, and 82.5%, respectively, compared to the morphological severity (the sensitivity of mild, moderate, and severe chronic pancreatitis was 33.3%, 66.7%, 83.3%, respectively). CONCLUSIONS: Measurement of fecal elastase-1 is a reliable and sensitive non-invasive test for the diagnosis of moderate to severe forms of chronic pancreatitis.
Subject(s)
Humans , Amylases , Cholangiopancreatography, Endoscopic Retrograde , Classification , Diagnosis , Enzyme-Linked Immunosorbent Assay , Linear Models , Liver Diseases , Pancreatic Function Tests , Pancreatic Juice , Pancreatitis, Chronic , ROC Curve , Secretin , Sensitivity and SpecificityABSTRACT
Fecal elastase-1 concentration reflects exocrine pancreatic function. There have been some reports from Europe, but so far there has not been a report of fecal elastase-1 concentration in Indonesia, especially concerning infants. The aim of this study is to know the concentration of elastase-1 in feces of infants aged 1-120 days as a preliminary report of the study of the ontogeny of pancreatic elastase-1 in term and preterm infants. Fecal elastase-1 were measured from feces of 28 healthy preterm and 34 healthy term infants up to 120 days (4 month) of age. Elastase-1 concentration in infants less than 14 days of age fluctuated below 200 μg/gram feces. At the first day of life 80% preterm and 60% term infants had elastase-1 concentration less than 200 μg/gram feces, and by the age of 7 days 50% preterm and 33% term infants had elastase-1 concentration less than 200 μg/gram feces. After 14 days of age its concentration was more than 200 μg/gram feces, regardless of gestational age. This preliminary study corroborates supported the previous studies that the level of fecal elastase-1 reached normal level after 14 days. Future longitudinal study is needed to know elastase-1 concentration in infants less than 14 days.
Subject(s)
Infant , Pancreatic ElastaseABSTRACT
The aim of this study was to evaluate the clinical application of fecal elastase test in exocrine insufficiency of chronic pancreatitic patieats. The fecal elastase 1 was detected by ELISA method in 55 cases with chronic pancreatitis(CP) and 25 cases with nonpancreatic digestive disease, and the urine BT PABA was measured by DACA method simultaniously.The results showed that the fecal elastase 1 and urine BT PABA excretion in patients with CP were much lower than those in patients with nonpancreatic disease ( P
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Objective To evaluate the clinical application of fecal elastase test in exocrine insufficiency of pancreatic disease. Methods The fecal elastase 1 was detected by ELISA method in 55 patients with chronic pancreatitis, 21 with pancreatic cancer and 25 with nonpancreatic digestive disease, and the urine BT PABA was measured by DACA method simultaneously. Results The fecal elastase 1 and urine BT PABA excretion in patients with chronic pancreatitis and pancreatic cancer were much lower than those in patients with nonpancreatic disease ( P