Pancreatitis crónica autoinmune / No disponible

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[Early carbohydrate metabolism dysfunction in chronic pancreatitis. Relation with the exocrine pancreatic function]. / Disfunción temprana del metabolismo hidrocarbonado en la pancreatitis crónica. Relación con la función exocrina pancreática.

BACKGROUND: The relationship between endocrine and exocrine dysfunction in chronic pancreatitis (CP) is controversial. Our goals were to evaluate the disturbances of carbohydrate metabolism in relation to the degree of exocrine insufficiency, to compare the usefulness of oral glucose tolerance test (OGTT) versus fasting blood glucose and to investigate the degree of exocrine and endocrine dysfunction according to the duration of CP. PATIENTS AND METHOD: 73 patients with CP were studied. Pancreas exocrine and endocrine status was evaluated by secretin-CCK test (SCT), fecal fat analysis and OGTT. RESULTS: Out of 8 patients with normal SCT, 4 had an abnormal glucose metabolism with diabetes in 2 of them. Out of 50 patients with moderate exocrine insufficiency, there was an abnormal fecal fat excretion in 20%, an endocrine dysfunction in 54% and diabetes in 40%. All patients with severe dysfunction of the exocrine pancreas were diabetics. The OGTT test demonstrated that 42% of patients with normal fasting blood glucose had an abnormal glucose metabolism. Mean evolution time of CP was shorter in patients with endocrine dysfunction than in those with steatorrhea. CONCLUSIONS: As far as functional exocrine status is concerned, in chronic pancreatitis there is a higher proportion of patients with glucose metabolism dysfunction than with abnormal fecal fat excretion. Carbohydrate metabolism dysfunction can be demonstrated by OGTT in a large proportion of patients with normal fasting blood glucose. In patients with CP, hydrocarbonate dysfunction seems to develop earlier than abnormal fecal fat excretion.

Seguimiento del páncreas endocrino tras una pancreatitis aguda de origen biliar. Estudio prospectivo / Follow-up of endocrine pancreatic function after acute biliary pancreatitis. Prospective study

Objetivo. Valorar si tras la pancreatitis aguda biliar existía una insuficiencia pancreática endocrina y si este posible déficit se relacionaba con la gravedad del episodio. Pacientes y métodos. Sesenta y tres pacientes con pancreatitis aguda biliar fueron estudiados prospectiva y consecutivamente, 46 mujeres (73 por ciento) y 17 varones (27 por ciento); 45 casos eran leves y 18, graves. Todos ellos fueron colecistectomizados, ninguno fue sometido a necrosectomía o pancreatectomía. Durante la fase aguda se valoró la gravedad siguiendo los criterios de Atlanta, la existencia de necrosis y su porcentaje determinado por tomografía computarizada dinámica. Durante el seguimiento se valoró la función pancreática endocrina al mes, a los 6 meses y al año del episodio de la pancreatitis aguda mediante diversos tests de función pancreática. Resultados. Al mes de la pancreatitis aguda biliar se detectaron alteraciones endocrinas en el 50 por ciento de los casos, disminuyendo al sexto mes al 30 por ciento, persistiendo al año de la pancreatitis aguda en el 25 por ciento de los pacientes; sin embargo, éstas no eran secundarias a la pancreatitis, puesto que el test de arginina presentaba valores dentro del rango de la normalidad. El análisis estadístico realizado a fin de valorar la relación existente entre la gravedad de la pancreatitis aguda y los diversos tests de función pancreática endocrina demostró que no existían diferencias significativas (p > 0,05).Conclusión. La función pancreática endocrina retorna a la normalidad después de un episodio de pancreatitis aguda de origen biliar tras haberse eliminado la causa primaria de la enfermedad, no detectándose alteración de la reserva funcional endocrina secundaria a la pancreatitis, y no existiendo relación entre dicha función y la gravedad de la enfermedad (AU)

[Nutritional status assessment in diabetes mellitus secondary to chronic alcoholic pancreatitis]. / Valoración del estado nutricional en la diabetes mellitus secundaria a pancreatitis crónica alcohólica.

BACKGROUND: Diabetes mellitus secondary to alcoholic chronic pancreatitis (DM-ACP) represents 0.5-2% of all cases of diabetes mellitus (DM) and shows predominantly symptoms related to malnutrition instead of cardinal clinical signs of diabetes. The aim of this study was to try to further characterize the features of the malnutrition in patients with pancreatic insufficiency. PATIENTS MATERIAL AND METHODS: We selected 40 patients (39 males and 1 female) meeting clinical, functional and morphological diagnostic criteria of DM-ACP which received a nutritional assessment that included estimation on fat and proteic body compartments being classified as caloric, proteic or mixed malnutrition. RESULTS: 29 patients (72.5%) showed some kind of malnutrition. The most frequent type was mixed (proteic-caloric) malnutrition found in 19 of them (47.5%). Caloric malnutrition was present in 6 (15%) and mainly proteic in 4 (10%). Only 11 patients with DM-ACP in our series showed a normal nourishment state. CONCLUSIONS: Large prevalence of mixed malnutrition in DM-ACP patients may be related to malabsorption of macronutrients (especially proteins and fat) due to exocrine insufficiency and misuse of nutrients as a result of the characteristic hypoinsulinemia showed by these patients.

[Chronic calcifying pancreatitis and chronic renal failure]. / Pancreatitis crónica calcificante e insuficiencia renal crónica.

We report a case of chronic calcifying pancreatitis and exocrine pancreatic deficiency in a patient with chronic renal failure under hemodialysis. We analyze the possible relationship between these two entities with special reference to the role of secondary hyperparathyroidism and extraosseous or metastatic calcification.

[Brown bowel syndrome: diagnostic and therapeutic problems]. / Síndrome del intestino marrón: problemas diagnósticos y terapéuticos.

A new case of a brown bowel syndrome is presented in a 27 year-old man, clinically with severe esteatorrhea of many years of duration, with moderate pancreatic exocrine insufficiency and intestinal motility disorders suggesting a functional change secondary to a deposit of lipofucsin. We comment the pathogenic, diagnostic and therapeutic implications related to this circumstance.