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1.
Pancreatology ; 22(3): 374-380, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35216905

RESUMEN

BACKGROUND/OBJECTIVES: There is scarce information about risk factors for exocrine pancreas insufficiency (EPI) in chronic pancreatitis (CP), and how it associates with other complications. The aim of the present study was to examine risk factors for EPI and associations to procedures and other CP related complications in a large, Northern European cohort. PATIENTS AND METHODS: We retrieved cross-sectional data on demographics, status on EPI, aetiological risk factors for CP, CP related complications as well as surgical and endoscopic treatment from the Scandinavian Baltic Pancreatic Club Database. Associations were assessed by univariate and multivariate logistic regression analyses. Results are presented as odds ratios (OR) with 95% confidence intervals. RESULTS: We included 1869 patients with probable or definitive CP in the study. Exocrine pancreas insufficiency was present in 849 (45.4%) of patients. In multivariate analyses, EPI associated with smoking aetiology (OR 1.47 (1.20-1.79), p < 0.001), and nutritional/metabolic aetiology (OR 0.52 (0.31-0.87), p = 0.01) to CP. Pancreatic or common bile duct stenting procedure and pancreatic resection were both associated with EPI (ORs 1.44 (1.15-1.80), p = 0.002 and 1.54 (1.02-2.33), p = 0.04, respectively). The presence of diabetes mellitus (OR 2.45 (1.92-3.15), p < 0.001), bile duct stenosis (OR 1.48 (1.09-2.00), p = 0.02) and underweight (2.05 (OR 1.40-3.02), p < 0.001) were all associated with presence of EPI. CONCLUSIONS: Smoking, bile duct stenosis, previous stenting and resection procedures are all associated with EPI in patients with CP. Presence of EPI were also associated with malnutrition and diabetes mellitus. Hence, intensive nutritional surveillance is needed in these patients.


Asunto(s)
Insuficiencia Pancreática Exocrina , Páncreas Exocrino , Pancreatitis Crónica , Constricción Patológica/complicaciones , Estudios Transversales , Insuficiencia Pancreática Exocrina/complicaciones , Insuficiencia Pancreática Exocrina/epidemiología , Humanos , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/epidemiología , Factores de Riesgo
2.
Eur J Nutr ; 60(4): 2231-2248, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33108521

RESUMEN

PURPOSE: To explore whether high intake of cod or salmon would affect gut microbiota profile, faecal output and serum concentrations of lipids and bile acids. METHODS: Seventy-six adults with overweight/obesity with no reported gastrointestinal disease were randomly assigned to consume 750 g/week of either cod or salmon, or to avoid fish intake (Control group) for 8 weeks. Fifteen participants from each group were randomly selected for 72 h faeces collection at baseline and end point for gut microbiota profile analyses using 54 bacterial DNA probes. Food intake was registered, and fasting serum and morning urine were collected at baseline and end point. RESULTS: Sixty-five participants were included in serum and urine analyses, and gut microbiota profile was analysed for 33 participants. Principal component analysis of gut microbiota showed an almost complete separation of the Salmon group from the Control group, with lower counts for bacteria in the Bacteroidetes phylum and the Clostridiales order of the Firmicutes phyla, and higher counts for bacteria in the Selenomonadales order of the Firmicutes phylum. The Cod group showed greater similarity to the Salmon group than to the Control group. Intake of fibres, proteins, fats and carbohydrates, faecal daily mass and output of fat, cholesterol and total bile acids, and serum concentrations of cholesterol, triacylglycerols, non-esterified fatty acids and total bile acids were not altered in the experimental groups. CONCLUSION: A high intake of cod or salmon fillet modulated gut microbiota but did not affect faecal output or serum concentrations of lipids and total bile acids. CLINICAL TRIAL REGISTRATION: This trial was registered at clinicaltrials.gov as NCT02350595.


Asunto(s)
Microbioma Gastrointestinal , Adulto , Animales , Ácidos y Sales Biliares , Heces , Humanos , Sobrepeso , Salmón , Triglicéridos
3.
Pancreatology ; 20(5): 844-851, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32507681

RESUMEN

BACKGROUND/OBJECTIVES: Smoking and alcohol abuse are established risk factors for chronic pancreatitis (CP). Few studies have examined how exposure to smoking and alcohol abuse act as risk factors for complications in CP. Our aim was to examine associations between patient reported exposure to smoking and alcohol abuse and complications in CP in a large cohort of patients from the Scandinavian and Baltic countries. METHODS: We retrieved data on demographics, CP related complications and patients' histories of exposure to smoking and alcohol abuse from the Scandinavian Baltic Pancreatic Club database. Associations were investigated by univariate and multivariate logistic regression analyses. Results are presented as odds ratios (OR) with 95% confidence intervals. RESULTS: A complete history of smoking and alcohol exposure was available for 932 patients. In multivariate regression analyses, the presence of pain and exocrine pancreatic insufficiency were both significantly associated with history of smoking (OR 1.94 (1.40-2.68), p < 0.001 and OR 1.89 (1.36-2.62), p < 0.001, respectively) and alcohol abuse (OR 1.66 (1.21-2.26), p = 0.001 and 1.55 (1.14-2.11), p = 0.005, respectively). Smoking was associated with calcifications (OR 2.89 (2.09-3.96), p < 0.001), moderate to severe ductal changes (OR 1.42 (1.05-1.92), p = 0.02), and underweight (OR 4.73 (2.23-10.02), p < 0.001). History of alcohol abuse was associated with pseudocysts (OR 1.38 (1.00-1.90) p = 0.05) and diabetes mellitus (OR 1.44 (1.03-2.01), p = 0.03). There were significantly increased odds-ratios for several complications with increasing exposure to smoking and alcohol abuse. CONCLUSION: Smoking and alcohol abuse are both independently associated with development of complications in patients with CP. There seems to be a dose-dependent relationship between smoking and alcohol abuse and complications in CP.


Asunto(s)
Alcoholismo/complicaciones , Dolor/etiología , Pancreatitis Crónica/complicaciones , Fumar/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Alcoholismo/epidemiología , Países Bálticos/epidemiología , Estudios de Cohortes , Complicaciones de la Diabetes/epidemiología , Insuficiencia Pancreática Exocrina/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conductos Pancreáticos/patología , Pancreatitis Crónica/epidemiología , Pancreatitis Crónica/patología , Factores de Riesgo , Países Escandinavos y Nórdicos/epidemiología , Fumar/epidemiología , Delgadez/complicaciones
4.
Am J Gastroenterol ; 114(4): 656-664, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30741740

RESUMEN

OBJECTIVES: Chronic pancreatitis (CP) is characterized by several disease-related complications and multiple etiological risk factors. Past studies of associations between complications and risk factors have mostly been limited to single complications or highly focused on single etiologies. Using an objective data-driven approach (cluster analysis), we characterized complication clusters and their associations with etiological risk factors in a large cohort of patients with CP. METHODS: This was a multicenter, cross-sectional study including 1,071 patients with CP from the Scandinavian and Baltic countries. Complications to CP were classified according to the M-ANNHEIM system, and treelet transform was used to derive complication clusters. Cluster complication frequencies were analyzed for their association with main etiological risk factors (smoking and alcohol). RESULTS: The mean age of participants was 57 years and 66% were men. Alcohol (55%) and smoking (53%) were the most common etiological risk factors and seen in combination in 36% of patients. Cluster analysis identified 3 distinct complication clusters characterized by inflammation, fibrosis, and pancreatic insufficiencies. An independent association between inflammatory complications and alcoholic etiology was seen (odds ratio [OR] 2.00 [95% CI [confidence interval], 1.38-2.90], P < 0.001), whereas smoking was associated with fibrosis-related complications (OR 2.23 [95% CI, 1.56-2.3.20], P < 0.001) and pancreatic insufficiencies (OR 1.42 [95% CI, 1.00-2.01], P = 0.046). DISCUSSION: Three distinctive clusters of complications to CP were identified. Their differing associations with alcoholic and smoking etiology indicate distinct underlying disease mechanisms.


Asunto(s)
Pancreatitis Crónica/complicaciones , Consumo de Bebidas Alcohólicas/efectos adversos , Países Bálticos , Estudios Transversales , Diabetes Mellitus/etiología , Insuficiencia Pancreática Exocrina/etiología , Femenino , Fibrosis/etiología , Humanos , Inflamación/etiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Países Escandinavos y Nórdicos , Fumar/efectos adversos
5.
Pancreatology ; 19(7): 922-928, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31462382

RESUMEN

BACKGROUND: Pancreatic calcifications is a common finding in patients with chronic pancreatitis (CP), but the underlying pathophysiology is incompletely understood. Past studies for risk factors of calcifications have generally been focused on single parameters or limited by small sample sizes. The aim of this study was to explore several patient and disease characteristics and their associations with pancreatic calcifications in a large cohort of CP patients with diverse aetiological risk factors. METHODS: This was a multicentre, cross-sectional study including 1509 patients with CP. Patient and disease characteristics were compared for patients with calcifications (n = 912) vs. without calcifications (n = 597). Multivariable logistic regression was performed to assess the parameters independently associated with calcifications. RESULTS: The mean age of patients was 53.9 ±â€¯14.5 years and 1006 (67%) were men. The prevalence of calcifications was 60.4% in the overall patient cohort, but highly variable between patients with different aetiological risk factors (range: 2-69%). On multivariate analysis, alcoholic aetiology (OR 1.76 [95% CI, 1.39-2.24]; p < 0.001) and smoking aetiology (OR 1.77 [95% CI, 1.39-2.26], p < 0.001) were positively associated with the presence of calcifications, while an autoimmune aetiology was negatively associated with calcifications (OR 0.15 [95% CI, 0.08-0.27], p < 0.001). Patients with pancreatic calcifications were more likely to have undergone pancreatic duct stenting (OR 1.59 [95%CI, 1.16-2.19], p = 0.004). CONCLUSION: The presence of pancreatic calcifications is associated with diverse aetiological risk factors in patients with CP. This observation attest to the understanding of CP as a complex disease and may have implications for disease classification.


Asunto(s)
Calcinosis , Pancreatitis Crónica/complicaciones , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
6.
Ultraschall Med ; 40(5): 609-617, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29579746

RESUMEN

PURPOSE: We aimed to evaluate the agreement of single criteria and dedicated scores from transabdominal ultrasound of the pancreas (US) compared to standards by endoscopic ultrasound (EUS) and computed tomography (CT). MATERIALS AND METHODS: In this observational cohort study performed in a tertiary care center, US and EUS were performed in 110 patients referred for suspected CP. Based on the Mayo score, 52 patients were diagnosed with CP. The sonographic findings obtained by both methods were registered. The number of criteria was counted and scored according to the Rosemont score. RESULTS: Agreement between the number of detected US and EUS criteria was substantial (ICC = 0.74 [0.61-0.83]. Adding Rosemont weighting improved the agreement (ICC = 0.88 [0.81-0.92]). Regarding individual criteria, the agreement was substantial for the detection of calcifications (κ = 0.86) and moderate for cysts and irregular or dilated pancreatic duct (κ = 0.42-0.58). Agreement for the other criteria was poorer (κ≤ 0.40). The diagnostic performance indices [95 % CI] of US for diagnosing CP (using Mayo score as reference standard) were for the unweighted score: Sensitivity: 0.65 [0.51-0.78], specificity: 0.97 [0.87-1.00]; and for Rosemont score: Sensitivity: 0.75 [0.61-0.86], specificity: 0.95 [0.83-0.99]. CONCLUSION: The agreement between US and EUS for the unweighted and weighted scores was substantial. For the features calcifications, cysts and main pancreatic duct (MPD) changes, agreement was moderate to substantial. For the other detected US criteria, the agreement with EUS was too poor to be clinically relevant.


Asunto(s)
Endosonografía/métodos , Pancreatitis Crónica , Ultrasonografía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Pancreatitis Crónica/diagnóstico por imagen , Sensibilidad y Especificidad , Adulto Joven
7.
Eur Radiol ; 28(4): 1495-1503, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29134356

RESUMEN

OBJECTIVES: Secretin-stimulated magnetic resonance imaging (s-MRI) is the best validated radiological modality assessing pancreatic secretion. The purpose of this study was to compare volume output measures from secretin-stimulated transabdominal ultrasonography (s-US) to s-MRI for the diagnosis of exocrine pancreatic failure in cystic fibrosis (CF). METHODS: We performed transabdominal ultrasonography and MRI before and at timed intervals during 15 minutes after secretin stimulation in 21 CF patients and 13 healthy controls. To clearly identify the subjects with reduced exocrine pancreatic function, we classified CF patients as pancreas-sufficient or -insufficient by secretin-stimulated endoscopic short test and faecal elastase. RESULTS: Pancreas-insufficient CF patients had reduced pancreatic secretions compared to pancreas-sufficient subjects based on both imaging modalities (p < 0.001). Volume output estimates assessed by s-US correlated to that of s-MRI (r = 0.56-0.62; p < 0.001). Both s-US (AUC: 0.88) and s-MRI (AUC: 0.99) demonstrated good diagnostic accuracy for exocrine pancreatic failure. CONCLUSIONS: Pancreatic volume-output estimated by s-US corresponds well to exocrine pancreatic function in CF patients and yields comparable results to that of s-MRI. s-US provides a simple and feasible tool in the assessment of pancreatic secretion. KEY POINTS: • Cystic fibrosis patients with affected pancreas have reduced pancreatic secretions. • Secretin-stimulated sonography is a simple and feasible method to assess pancreatic output. • Secretin-simulated MRI is a more precise method to assess pancreatic secretions. • The sonographic and MRI methods yielded comparable pancreatic secretory output estimates.


Asunto(s)
Fibrosis Quística/diagnóstico , Insuficiencia Pancreática Exocrina/metabolismo , Imagen por Resonancia Magnética/métodos , Páncreas Exocrino/diagnóstico por imagen , Jugo Pancreático/metabolismo , Secretina/metabolismo , Ultrasonografía/métodos , Adulto , Fibrosis Quística/complicaciones , Fibrosis Quística/metabolismo , Endoscopía , Insuficiencia Pancreática Exocrina/diagnóstico , Insuficiencia Pancreática Exocrina/etiología , Femenino , Humanos , Masculino , Páncreas Exocrino/metabolismo
8.
Scand J Gastroenterol ; 53(10-11): 1206-1211, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30353747

RESUMEN

BACKGROUND: Direct pancreas function testing (DPFT) has been regarded as gold standard for assessment of exocrine pancreas function. One of the outcomes from DPFT is pancreatic lipase activity in duodenal juice, but no standard assay for measuring pancreas lipase activity in duodenal juice exists. AIMS: To optimize and evaluate an autoanalyzer assay for measuring lipase activity in duodenal juice. METHODS: We used samples of duodenal juice from our biobank, collected through a short endoscopic secretin test in patients with suspected exocrine pancreas insufficiency. Samples were analyzed on a Cobas autoanalyzer (Roche Diagnostics), using a colorimetric, kinetic enzyme activity assay. We compared stability of samples diluted in saline to samples diluted in 3-(N-morpholino) propane sulfonic acid (MOPS) buffer added bovine serum albumin (BSA). Results from the Cobas assay were compared to Confluolip method, a fluorometric, kinetic enzyme assay, modified to fit into a microplate setting. RESULTS: We tested the stability of 54 samples from 21 patients. Diluting samples with MOPS buffer added BSA gave stable results, and was superior to diluting samples in saline. We compared the two assays in 50 samples from 20 patients and found a good correlation between the two assays (r = 0.91, p < .001). There was a significant proportional bias between the two assays, but no significant systematic bias. CONCLUSION: Pancreatic lipase activity in duodenal juice samples diluted in MOPS buffer added BSA is stable for one hour at room temperature. Quantification of lipase activity in duodenal juice using a standard automated activity assay has comparable accuracy to a manual fluorometric method.


Asunto(s)
Duodeno/metabolismo , Fluorometría/métodos , Lipasa/análisis , Jugo Pancreático/enzimología , Espectrofotometría/métodos , Adulto , Anciano , Automatización , Insuficiencia Pancreática Exocrina/diagnóstico , Insuficiencia Pancreática Exocrina/enzimología , Femenino , Humanos , Modelos Lineales , Lipasa/metabolismo , Masculino , Persona de Mediana Edad , Páncreas/enzimología , Manejo de Especímenes/métodos , Espectrofotometría/instrumentación
9.
Scand J Gastroenterol ; 53(9): 1132-1138, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30193081

RESUMEN

BACKGROUND: Chronic pancreatitis (CP) can lead to severe pancreatic exocrine insufficiency (PEI). Pancreatic enzyme replacement therapy (PERT) is well established, but knowledge of the physiological response to increasing doses on fecal fat- and energy loss is scarce. METHODS: We included 10 patients with CP and established PEI and 12 healthy controls for a prospective interventional study. Subjects received no PERT in the first week followed by four weeks PERT incrementally increasing doses every week. For each week, three-day stool collection followed three days registration of nutritional intake. We measured the fecal output of fat and energy by van de Kamer titration and decomposition vessel calorimetry, respectively. We calculated fecal fat- and energy loss per day, the coefficient of fat absorption (CFA) and coefficient of energy absorption (CEA). RESULTS: Without PERT treatment, CP patients with PEI had significantly higher daily fecal fat and energy loss (p = .022; p = .035) compared to HC. In CP patients, there was a significant reduction of fecal fat and energy loss (p = .045; p = .037) when PERT doses reached maximum intake of 75,000 units per meal. In CP patients, there was a strong positive correlation between fecal loss of energy and fat (r = 0.99), and between fecal loss of energy and daily stool weight (r = 0.97). CFA and CEA correlated negatively with daily fecal fat loss (r = -0.72) and fecal energy loss (r = -0.65). CONCLUSIONS: PERT reduces fecal energy and fat loss in patients with CP and PEI. Fecal energy loss in CP patients is strongly dependent on fecal fat loss, and on fecal weight.


Asunto(s)
Metabolismo Energético , Terapia de Reemplazo Enzimático , Insuficiencia Pancreática Exocrina/terapia , Heces/química , Pancreatitis Crónica/terapia , Adulto , Anciano , Peso Corporal , Calorimetría , Insuficiencia Pancreática Exocrina/metabolismo , Ácidos Grasos/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Pancreatitis Crónica/metabolismo , Estudios Prospectivos
10.
BMC Med Imaging ; 18(1): 14, 2018 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-29764411

RESUMEN

BACKGROUND: Perfusion assessment of the pancreas is challenging and poorly evaluated. Pancreatic affection is a prevalent feature of cystic fibrosis (CF). Little is known about pancreatic perfusion in CF. We aimed to assess pancreatic perfusion by contrast-enhanced ultrasound (CEUS) analysed in the bolus-and-burst model and software. METHODS: We performed contrast enhanced ultrasound of the pancreas in 25 CF patients and 20 healthy controls. Perfusion data was analysed using a dedicated perfusion model providing the mean capillary transit-time (MTT), blood flow (BF) and blood-volume (BV). CF patients were divided according to exocrine function. RESULTS: The pancreas insufficient CF patients had longer MTT (p ≤ 0.002), lower BF (p < 0.001) and lower BV (p < 0.05) compared to the healthy controls and sufficient CF patients. Interrater analysis showed substantial agreement for the analysis of mean transit time. CONCLUSION: The bolus-and-burst method used on pancreatic CEUS-examinations demonstrates reduced perfusion in CF patients with pancreas affection. The perfusion model and software requires further optimization and standardization to be clinical applicable for the assessment of pancreatic perfusion.


Asunto(s)
Fibrosis Quística/diagnóstico por imagen , Páncreas/diagnóstico por imagen , Imagen de Perfusión/métodos , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Programas Informáticos , Ultrasonografía
11.
Pancreatology ; 17(2): 182-187, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28190684

RESUMEN

OBJECTIVE: The measurement of duodenal amylase by a colorimetric end-point assay has been the most used method for amylase activity analyses. The method is manual, time consuming and dependent on specialized equipment. In this study, we compare an automated kinetic spectrophotometric method for pancreatic amylase measurement in duodenal juice with a standardized colorimetric end-point assay. METHODS: We used specimen of duodenal juice at random from a biobank obtained by short endoscopic secretin test in patients with suspected exocrine pancreatic failure of different reasons. Duodenal juice was tested for amylase activity with a conservative manual colorimetric endpoint assay (Phadebas Amylase test, Magle AB) and an automated enzymatic kinetic spectrophotometric method using standard reagents for pancreatic amylase activity for Cobas c111 (Roche Diagnostics). RESULTS: 52 samples for assay of amylase were analyzed in pairs. Correlation between measurements with the two methods was r = 0.99 (p < 0.001), linear regression 0.99 (p < 0.001). CONCLUSION: Quantification of duodenal amylase activity with automated spectrophotometry has excellent correlation to measurements made by the manual method. This allows for standardized, center independent analyses of duodenal amylase for the assessment of acinar pancreatic function.


Asunto(s)
Amilasas/química , Amilasas/metabolismo , Colorimetría/métodos , Jugo Pancreático/química , Espectrofotometría/métodos , Automatización , Humanos , Sensibilidad y Especificidad
12.
Scand J Gastroenterol ; 52(8): 909-915, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28471312

RESUMEN

OBJECTIVES: Chronic pancreatitis (CP) is a multifaceted disease associated with several risk factors and a complex clinical presentation. We established the Scandinavian Baltic Pancreatic Club (SBPC) Database to characterise and study the natural history of CP in a Northern European cohort. Here, we describe the design of the database and characteristics of the study cohort. METHODS: Nine centres from six different countries in the Scandinavian-Baltic region joined the database. Patients with definitive or probable CP (M-ANNHEIM diagnostic criteria) were included. Standardised case report forms were used to collect several assessment variables including disease aetiology, duration of CP, preceding acute pancreatitis, as well as symptoms, complications, and treatments. The clinical stage of CP was characterised according to M-ANNNHEIM. Yearly follow-up is planned for all patients. RESULTS: The study cohort comprised of 910 patients (608 men: 302 women; median age 58 (IQR: 48-67) years with definite 848 (93%) or probable CP 62 (7%). Nicotine (70%) and alcohol (59%) were the most frequent aetiologies and seen in combination in 44% of patients. A history of recurrent acute pancreatitis was seen in 49% prior to the development of CP. Pain (69%) and exocrine pancreatic insufficiency (68%) were the most common complications followed by diabetes (43%). Most patients (30%) were classified as clinical stage II (symptomatic CP with exocrine or endocrine insufficiency). Less than 10% of the patients had undergone pancreatic surgery. CONCLUSION: The SBPC database provides a mean for future prospective, observational studies of CP in the Northern European continent.


Asunto(s)
Bases de Datos como Asunto , Insuficiencia Pancreática Exocrina/epidemiología , Pancreatitis Crónica/etiología , Pancreatitis Crónica/fisiopatología , Pancreatitis Crónica/terapia , Enfermedad Aguda , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/epidemiología , Dolor/etiología , Pancreatitis Crónica/complicaciones , Factores de Riesgo , Países Escandinavos y Nórdicos
13.
Pancreatology ; 16(2): 231-7, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26876799

RESUMEN

OBJECTIVES: We have recently evaluated a short endoscopic secretin test for exocrine pancreatic function. Bicarbonate concentration in duodenal juice is an important parameter in this test. Measurement of bicarbonate by back titration as the gold standard method is time consuming, expensive and technically difficult, thus a simplified method is warranted. We aimed to evaluate an automated spectrophotometric method in samples spanning the effective range of bicarbonate concentrations in duodenal juice. We also evaluated if freezing of samples before analyses would affect its results. METHODS: Patients routinely examined with short endoscopic secretin test suspected to have decreased pancreatic function of various reasons were included. Bicarbonate in duodenal juice was quantified by back titration and automatic spectrophotometry. Both fresh and thawed samples were analysed spectrophotometrically. RESULTS: 177 samples from 71 patients were analysed. Correlation coefficient of all measurements was r = 0.98 (p < 0.001). Correlation coefficient of fresh versus frozen samples conducted with automatic spectrophotometry (n = 25): r = 0.96 (p < 0.001) CONCLUSIONS: The measurement of bicarbonate in fresh and thawed samples by automatic spectrophotometrical analysis correlates excellent with the back titration gold standard. This is a major simplification of direct pancreas function testing, and allows a wider distribution of bicarbonate testing in duodenal juice. Extreme values for Bicarbonate concentration achieved by the autoanalyser method have to be interpreted with caution.


Asunto(s)
Bicarbonatos/química , Jugo Pancreático/química , Espectrofotometría/métodos , Volumetría/métodos , Automatización , Humanos
14.
Scand J Gastroenterol ; 50(5): 601-10, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25623422

RESUMEN

OBJECTIVE: Volume output failure is a feature of decreasing exocrine pancreatic function. This parameter is assessed by secretin-stimulated MRI in several studies. Our purpose was to evaluate ultrasonography of the fluid in the descending duodenum and Wirsung duct (WD) after secretin stimulation as a measure of pancreatic fluid flow in patients expected to have severe output failure. MATERIAL AND METHODS: We included subjects with chronic pancreatitis (CP), cystic fibrosis (CF) and a group of healthy controls in a prospective observation study. Transabdominal ultrasonography was performed before and during 15 min after secretin i.v. duodenal juice was collected by endoscopic short test (EST), and bicarbonate concentration measured. Patient groups were classified according to exocrine pancreatic function. RESULTS: Pancreatic insufficient CF (CFI) patients and CP insufficient (CPI) patients showed less duodenal fluid filling compared to other groups (p < 0.001). Measures of the WD diameter could only identify the most severe failure in the CFI group (p < 0.001). CONCLUSION: Secretin-stimulated ultrasonography can be used to assess pancreatic fluid flow and may be combined with EST in the evaluation of exocrine pancreatic function. Fluid filling in the descending part of duodenum was the most accurate predictor of pancreatic insufficiency in both patient groups. The test demonstrated better diagnostic accuracy diagnosing exocrine pancreatic failure in the CF patients than in CP patients.


Asunto(s)
Fibrosis Quística/diagnóstico por imagen , Insuficiencia Pancreática Exocrina/diagnóstico por imagen , Jugo Pancreático/diagnóstico por imagen , Pancreatitis Crónica/diagnóstico por imagen , Secretina/administración & dosificación , Adolescente , Adulto , Anciano , Bicarbonatos/química , Estudios de Casos y Controles , Duodeno/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conductos Pancreáticos/diagnóstico por imagen , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Ultrasonografía , Adulto Joven
15.
United European Gastroenterol J ; 10(8): 844-853, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35981311

RESUMEN

OBJECTIVES: Pancreatic exocrine insufficiency (PEI) is a common complication in patients with chronic pancreatitis (CP), leading to increased morbidity and mortality if not treated adequately. Pancreatic enzyme replacement therapy|pancreas enzyme replacement therapy (PERT) is the cornerstone in treatment of patients with PEI. In the present study, we use data from the Scandinavian Baltic Pancreatic Club database to examine adherence of PERT according to United European Gastroenterology evidence-based guidelines treatment of CP. PATIENTS AND METHODS: Patients with definitive or probable CP according to M-ANNHEIM diagnostic criteria were included. We collected information on exposures, exocrine function, intake of pancreatic enzymes, and markers of nutrition. Fecal elastase <200 µg/g was defined as a marker for PEI. Enzyme replacement therapy of 100,000 lipase units or more was defined as adequate treatment. RESULTS: We included 1006 patients from 8 centers in five countries. Sixty-four percent of the patients were correctly treated. Twenty-five per cent of PEI patients were not taking enzymes at all, and 20% of PEI patients were undertreated with insufficient PERT doses according to the guidelines. Fourteen percent of patients with sufficient pancreatic function were receiving enzymes despite normal exocrine pancreatic function. There were center differences. Current smoking was associated with lack of treatment and alcohol abuse was associated with under-treatment. There were no associations between "no treatment" or "under-treatment" for underweight or vitamin D deficiency. CONCLUSION: In our CP expert centers, the adherence to guidelines for enzyme treatment is insufficient. Both patient factors and center differences have influence on treatment adherence.


Asunto(s)
Terapia de Reemplazo Enzimático , Insuficiencia Pancreática Exocrina , Pancreatitis Crónica , Insuficiencia Pancreática Exocrina/tratamiento farmacológico , Insuficiencia Pancreática Exocrina/etiología , Humanos , Lipasa/uso terapéutico , Elastasa Pancreática , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/tratamiento farmacológico
16.
Scand J Gastroenterol ; 45(5): 603-7, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20201717

RESUMEN

OBJECTIVE: Intestinal malabsorption is a serious condition which unfortunately may remain unrecognized due to methodological problems. The old titration method of van de Kamer is still the gold standard. We present a modification of the method, pointing out practical improvements and pitfalls. MATERIAL AND METHODS: Our method uses less than one tenth of the amount of feces originally described, which implies proper mixing and homogenization of all feces collected over 72 hrs. Validation is performed by measuring fat concentration in commercial milk products. RESULTS: Reproducibility and validity were satisfactory. Concentration and output of fecal fat was poorly correlated, indicating that fecal output is required for diagnosing intestinal malabsorption. Our experiments also highlight the importance of using a non-polar extraction agent because polar agents take up water-soluble short chain fatty acids which are derived from fermentation of carbohydrates and give erroneous results. CONCLUSION: The modified method is reliable and robust and minimizes the aesthetical problems associated with fecal fat determination.


Asunto(s)
Grasas/análisis , Heces/química , Síndromes de Malabsorción/diagnóstico , Volumetría/métodos , Ácido Acético , Alcanos , Éter , Humanos , Reproducibilidad de los Resultados , Solventes , Manejo de Especímenes
17.
Pancreas ; 49(3): 361-367, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32132505

RESUMEN

OBJECTIVES: Secretin-stimulated magnetic resonance imaging (s-MRI) is the best validated radiological modality assessing pancreatic exocrine secretion. In this prospective observational study, we compare the diagnostic accuracy of s-MRI for exocrine pancreatic failure due to different pancreatic diseases and healthy controls. METHODS: We performed s-MRI in 21 cystic fibrosis (CF) patients, 78 patients with chronic pancreatitis (CP) and 20 healthy controls. Exocrine failure was defined by fecal elastase-1 of less than 200 µg/g or bicarbonate concentration from endoscopic secretin test of less than 80 mmol/L. RESULTS: Eleven CF and 61 CP patients were exocrine insufficient. Insufficient CF patients had lower s-MRI volume output compared with all other groups (P < 0.05). Insufficient CP patients had reduced volume output compared with controls and sufficient CF (P < 0.05). Secretin-stimulated MRI yielded overall accuracy of 0.78 (95% confidence interval [CI], 0.70-0.86) for exocrine failure. When divided according to etiology, the test yielded accuracy of 0.95 (95% CI, 0.90-1) in CF and 0.73 (95% CI, 0.64-0.82) in CP. CONCLUSIONS: The accuracy of s-MRI volume output measures to diagnose exocrine failure was higher in CF than in CP. Differences in s-MRI volume output in patients with exocrine failure may be due to different etiological and pathogenic mechanisms in CF and CP.


Asunto(s)
Fibrosis Quística/diagnóstico por imagen , Insuficiencia Pancreática Exocrina/diagnóstico por imagen , Imagen por Resonancia Magnética , Pruebas de Función Pancreática , Pancreatitis Crónica/diagnóstico por imagen , Secretina/administración & dosificación , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Fibrosis Quística/complicaciones , Dinamarca , Insuficiencia Pancreática Exocrina/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis Crónica/complicaciones , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Adulto Joven
18.
Scand J Gastroenterol ; 44(9): 1055-9, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19670077

RESUMEN

OBJECTIVE: To investigate whether the use of carbon dioxide (CO(2)) compared with air insufflation during colonoscopy improves ultrasonography after the procedure. MATERIAL AND METHODS: In a double-blind trial, 30 patients were randomized to insufflation with CO(2) or air. Thirty minutes after colonoscopy abdominal ultrasound was performed. Immediately after ultrasonography, the ultrasound quality of the liver, gallbladder, biliary ducts, pancreas, spleen, kidneys, abdominal vessels, antrum, bowel, urinary bladder and prostate/uterus was evaluated for optimal ultrasound scanning quality, minor reduction of scanning conditions, major reduction of scanning conditions and unacceptable scanning conditions. RESULTS: Ultrasound quality 30 min after colonoscopy was significantly better when using CO(2) insufflation instead of air (p<0.003). Significant improvement in imaging quality was observed for the liver, portal vein, splenic vein, all three divisions of the pancreas, aorta, coeliac trunk, superior mesenteric artery, iliac vessels, left kidney and uterus. CONCLUSIONS: Ultrasound investigation can be done after a colonoscopy with CO(2) insufflation, whereas it is not recommended after a colonoscopy with air insufflation. In selected cases, this approach may enable and improve post-colonoscopy ultrasound scanning.


Asunto(s)
Abdomen/diagnóstico por imagen , Aire , Dióxido de Carbono , Colonoscopía , Aumento de la Imagen/métodos , Insuflación/métodos , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadísticas no Paramétricas , Ultrasonografía
19.
PLoS One ; 13(7): e0201019, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30048483

RESUMEN

OBJECTIVE: Fatty infiltration of the pancreas is a dominating feature in cystic fibrosis (CF). We evaluate the association between pancreatic fat content assessed by Dixon magnetic resonance imaging (MRI), pancreatic echogenicity at ultrasonography (US) and exocrine function in CF patients and healthy controls (HC). MATERIAL AND METHODS: Transabdominal US, pancreatic Dixon-MRI and diffusion-weighted imaging (DWI) were performed in 21 CF patients and 15 HCs. Exocrine function was assessed by endoscopic secretin test and fecal elastase. RESULTS: CF patients were grouped according to exocrine pancreatic function as subjects with normal (CFS: n = 11) or reduced (CFI: n = 10) function. Among CFI 90% (9/10) had visual hyperechogenicity. CFI also had increased echo-level values (p<0.05 vs others). All CFI (10/10) had markedly increased pancreatic fat content estimated by MRI compared to sufficient groups, p<0.001). Among CFS patients and HC, 27% (3/11) and 33% (5/15), respectively, had hyperechoic pancreas. However, all these had low pancreatic fat-content at MRI compared to CFI. In CFI, pancreatic fat content was correlated to ADC (r = -0.93, p<0.001). CONCLUSION: Pancreas insufficient CF patients exhibit severe pancreatic fatty-infiltration at MRI and hyperechoic pancreas at US. Pancreas hyperechogenicity in pancreatic sufficient subjects does not co-exist with fatty infiltration at MRI. MRI evaluates pancreatic fatty infiltration more accurately than US and fat infiltration estimated by MRI outperforms sonographic hyper-echogenicity as a marker for exocrine pancreatic failure in CF.


Asunto(s)
Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/patología , Fibrosis Quística/diagnóstico por imagen , Fibrosis Quística/fisiopatología , Imagen de Difusión por Resonancia Magnética , Páncreas Exocrino/fisiopatología , Adulto , Factores de Edad , Índice de Masa Corporal , Fibrosis Quística/complicaciones , Fibrosis Quística/patología , Insuficiencia Pancreática Exocrina/complicaciones , Femenino , Humanos , Masculino , Ultrasonografía
20.
PLoS One ; 12(1): e0169993, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28095460

RESUMEN

OBJECTIVE: Quantitative determination of fecal fat still is the gold standard for measuring malabsorption. We evaluated the importance of standardized food intake before and under the collection of feces. MATERIAL AND METHODS: In a project, evaluating patients with suspected chronic pancreatitis (CP) and healthy volunteers (HC), stools were collected for 72 hours coupled to registration of nutritional intake over five consecutive days. Patient groups were created by a modified Layer score, which includes imaging findings, clinical parameters and pancreas function testing. RESULTS: We found 12 patients with CP, 11 patients without CP and 13 healthy individuals in our database. Median fecal fat in CP patients was 12 g/day, in non-CP patients 5 g/day and in healthy controls 5 g/day. Median fat absorption coefficient was 81% in those with chronic pancreatitis, 92% in those without CP and 92% in healthy controls. Corresponding median fat intake was 65 g/day, 68 g/day and 81 g/day in the respective groups. Spearman Rank Order Correlation between fecal fat (g/d) and fat absorption coefficient in all study subjects (n = 36) was good (-0.88 (p<0.001)). When we stratified groups according to fat intake, correlation between fecal fat and fat absorption was also good (-0.86 to -0.95). CONCLUSION: In the diagnoses of fat malabsorption, calculating the ratio of fat absorption did not give additional information compared to fecal fat.


Asunto(s)
Ingestión de Alimentos/fisiología , Grasas/administración & dosificación , Grasas/análisis , Heces/química , Síndromes de Malabsorción/diagnóstico , Pancreatitis Crónica/complicaciones , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Absorción Intestinal , Síndromes de Malabsorción/etiología , Masculino , Persona de Mediana Edad
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