ABSTRACT
BACKGROUND: Little is known about risk factors for complications in chronic pancreatitis (CP). High fat diet (HFD) has been demonstrated to aggravate pancreatic injury in animal models. The aim of this study was to investigate the role of HFD in age at diagnosis of CP and probability of CP related complications. METHODS: A cross-sectional case-case study was performed within a prospectively collected cohort of patients with CP. Diagnosis and morphological severity of CP was established by endoscopic ultrasound. Pancreatic exocrine insufficiency (PEI) was diagnosed by ¹³C mixed triglyceride breath test. Fat intake was assessed by a specific nutritional questionnaire. Odds ratios (OR) for CP related complications were estimated by multivariate logistic regression analysis. RESULTS: 168 patients were included (128 (76.2%) men, mean age 44 years (SD 13.5)). Etiology of CP was alcohol abuse in 89 patients (53.0%), other causes in 30 (17.9%) and idiopathic in the remaining 49 subjects (29.2%). 24 patients (14.3%) had a HFD. 68 patients (40.5%) had continuous abdominal pain, 39 (23.2%) PEI and 43 (25.7%) morphologically severe CP. HFD was associated with an increased probability for continuous abdominal pain (OR = 2.84 (95% CI, 1.06-7.61)), and a younger age at diagnosis (37.0 ± 13.9 versus 45.8 ± 13.0 years, p = 0.03) but not with CP related complications after adjusting for sex, years of follow-up, alcohol and tobacco consumption, etiology and body mass index. CONCLUSIONS: Compared with a normal fat diet, HFD is associated with a younger age at diagnosis of CP and continuous abdominal pain, but not with severity and complications of the disease.
Subject(s)
Abdominal Pain/etiology , Diet, High-Fat/adverse effects , Pancreas, Exocrine/physiopathology , Pancreatitis, Chronic/physiopathology , Abdominal Pain/epidemiology , Abdominal Pain/prevention & control , Adult , Age of Onset , Alcoholism/physiopathology , Case-Control Studies , Cohort Studies , Cross-Sectional Studies , Female , Hospitals, University , Humans , Male , Middle Aged , Pancreas, Exocrine/diagnostic imaging , Pancreatitis, Chronic/diet therapy , Pancreatitis, Chronic/epidemiology , Pancreatitis, Chronic/etiology , Prospective Studies , Risk Factors , Severity of Illness Index , Spain/epidemiology , Surveys and Questionnaires , UltrasonographyABSTRACT
El diagnóstico diferencial del síndrome confusional agudo abarca un gran número de procesos entre los que hay que considerar firmemente las enfermedades metabólicas. El diagnóstico del hiperparatiroidismo como causa del mismo debe apoyarse en parámetros biológicos, y su tratamiento tiene un enfoque inicial destinado a corregir el trastorno neuropsiquiátrico y otro definitivo basado en la cirugía para revertir la desmineralización ósea y la mortalidad ulterior relacionada con la hipercalcemia. El abordaje quirúrgico debe efectuarse por cirujanos experimentados, cuyo objetivo principal conlleva la extirpación de la glándula enferma mediante técnicas lo menos agresivas posibles. Los estudios de imagen preoperatorios pueden contribuir a un abordaje selectivo que evite una exploración cervical bilateral. La determinación intraoperatoria de hormona paratiroidea intacta (PTHi), o el empleo de sonda isotópica, contribuyen a asegurar una solución quirúrgica efectiva
The differential diagnosis of acute confusional state encompasses a large number of processes including metabolic diseases. The diagnosis of hyperparathyroidism as a cause of acute confusional state should rest on biological parameters; treatment should initially be focused on correcting the neuropsychological disorder and then definitive surgical treatment should be undertaken to reverse bone demineralization and ulterior mortality related to hypercalcemia. The surgical approach should be carried out by experienced surgeons with the principal aim of extirpating the diseased gland using the least aggressive techniques possible. Preoperative imaging studies can help to ensure a selective approach that obviates bilateral cervical exploration. Intraoperative determination of intact parathyroid hormone (PTHi) levels or the use of a gamma probe help to ensure an effective surgical solution
