Use of an In-line Digestive Cartridge With Enteral Nutrition Improves the Weight Trajectory of 2 Children With Cystic Fibrosis Complicated by Another Medical Diagnosis.

This clinical observation describes the enteral nutrition (EN) management of 2 toddlers at high nutrition risk due to cystic fibrosis (CF), exocrine pancreatic insufficiency, and comorbid medical conditions. The first case report describes a boy with severe malabsorption after intestinal resection. The second case report reviews a boy with CF and neuroblastoma. When pancreatic enzyme replacement therapy with EN was not effective or appropriate, use of an in-line digestive cartridge was initiated. While using the digestive cartridge, both children showed improvements in their anthropometric measures. This observation reviews the nutrition management throughout their clinical course and describes the use of a digestive cartridge with EN.

Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: a Dutch national survey.

BACKGROUND: Treating exocrine pancreatic insufficiency with pancreatic enzymes is challenging because there is no fixed dose regimen. The required dose varies per patient, depending on the residual pancreatic function, the gut lumen physiology, and the fat content of each meal. Using a sufficient dose of enzymes is crucial to prevent weight loss, nutritional deficiencies, and to ameliorate steatorrhea-related symptoms. Data regarding the practise of enzyme replacement therapy are lacking. Therefore, we evaluated if patients with exocrine insufficiency caused by chronic pancreatitis receive proper treatment in the Netherlands. METHODS: An anonymous survey was distributed to the members of the Dutch Association of Patients with Pancreatic Disorders. The survey focused on enzyme use, steatorrhea-related symptoms, dietary consultation, and food restrictions. Responding patients were included if they had chronic pancreatitis and were treated for exocrine insufficiency with pancreatic enzymes. RESULTS: The survey was returned by 178 members who suffered from chronic pancreatitis, 161 of whom (90%) met the inclusion criteria. The mean age was 56 years and 53% were male. The median enzyme intake was 6 capsules per day and 25% of patients took 3 or less capsules. Remarkably, 70% of patients still reported steatorrhea-related symptoms, despite treatment. Only 25% of cases were referred to a dietician and 58% kept a restriction of fat (either instructed by a dietician or self-imposed). CONCLUSION: Many patients with exocrine insufficiency caused by chronic pancreatitis are under-treated in the Netherlands, a country with a well-organized healthcare system. To improve treatment efficacy, patients should be educated in adjusting the enzyme dosage according to steatorrhea-related symptoms and dietary fat intake. Moreover, patients should be referred to a well-trained, specialized dietician.

Chronic pancreatitis and persistent steatorrhea: what is the correct dose of enzymes?

Exocrine pancreatic insufficiency with steatorrhea is a major consequence of chronic pancreatitis. Recognition of this entity is highly relevant to avoid malnutrition-related morbidity and mortality. Nutritional counseling and oral pancreatic enzyme replacement are the basis for the therapy for exocrine pancreatic insufficiency. Aim of enzyme therapy is not only to avoid symptoms but also to normalize digestion. With this aim, oral administration of pancreatic enzymes in the form of enteric-coated minimicrospheres is the therapy of choice. This enzyme preparation avoids acid-mediated lipase inactivation and ensures gastric emptying of enzymes in parallel with nutrients. Despite that, factors like an acidic intestinal pH and bacterial overgrowth may prevent normalization of fat digestion even in compliant patients. The present article reviews the current evidence on therapy of exocrine pancreatic insufficiency in chronic pancreatitis patients, with special attention to different potential endpoints to select the optimal enzyme dose for individual patients.

¿Es la esteatorrea un hallazgo frecuente en pacientes con celiaquia en un hospital de tercer nivel de laciudad de La Paz? / Steatorrhea Is a common finding in patients with celiac disease in a tertiary level city of La Paz?

Pregunta de investigación: Cual será la frecuencia de esteatorrea asociada a celiaquia en pacientes que consultan por diarrea crónica en un Hospital de tercer nivel? Objetivo general: Conocer los aspectos epidemiologicos y clínicos de los pacientes con celiaquia. Objetivos especificos: 1.- Determinar la frecuencia de esteatorrea asociada a enfermedad celiaca.2.- Conocer la correlación del resultado de biopsias del duodeno y las pruebas serológicas especificas de la enfermedad.3.- Determinar la efi cacia del tratamiento dietético en pacientes portadores de esta entidad. Diseño: Serie de casos. Lugar: Instituto de Gastroenterología Boliviano –Japones de la ciudad de La Paz. Participantes Trece pacientes. Metodos: Se estudiaron trece pacientes, ocho mujeres y cinco varones, con un rango de edad de 37 a 68 años. Todos portadores de diarrea crónica.Se les determinó marcadores serológicos específi cos y se les realizó biopsias de duodeno distal. Todos fueron valorados con parâmetros antropométricos al inicio del diagnóstico y seis meses después se correlacionó la respuesta a la dieta sin gluten. Resultados: Los resultados mostraron que la esteatorrea no es el síntoma mas común, los marcadores serológicos de mayor representatividad sonlos anticuerpos antiendomisio y antitransglutaminasa, no así los antigliadina y las biopsias de duodeno demostraron lesiones infiltrativase hiperplasicas, no se evidenció ninguna lesión destructiva. La respuesta a la dieta sin gluten fue en todos los casos favorable y contundente.

Research question: ¿Is the steatorrea the most frecuent sintom in patients with celiac disease at the third level hospital in La Paz city? General objetivs; To identifi ty the epidemiological and clinical caracteristics in patients with celiac disease especific aims: 1.- To identifi ty the esteatorrea frecuency in patients with celiac disease at Instituto de Gastroenterologia Boliviano-Japones in La Paz city. 2.- To establish the correlation betwen the duodenal biopsys and serological test in this illnes.3.- To determine the effectiveness dietoterapic diet in this patients. Desig Serial cases. PlaceInstituto de Gastroenterologia Boliviano Japones at La Paz city. Participants Thirteen patients.Methods: We studied thirteen patients, eight female and fi ve male, 37 to 68 age. All the patients present cronic diarrea. In all we determinate serological marks and duodenal biopsys. We determined antropometric parameters and value the answer the diet without gluten. Results and discusionWe found the esteatorrea isn’t the most sign. The most specifi cal serologycal marks are antiendomisy and antitransglutamins antibodies. Respect to the duodenal biopsys show us infi ltrative and hiperplasic lesions. The diet answer without gluten was in all cases the best answer.

[Fat absorption after total gastrectomy in rats submitted to Roux-en-Y or Rosanov-like double-transit technique]. / Absorção de gordura após gastrectomia total em ratos com reconstrução em Y de Roux e em duplo trânsito tipo Rosanov modificado.

PURPOSE: Steatorrhea is one of the most common complications in reconstruction after total gastrectomy. Many reconstruction techniques after total gastrectomy have been developed in order to avoid these undesirable effects, but each one of them has some inconvenience. In this experiment, a modified Rosanov technique that keeps duodenal transit, evaluation of fat absorption after gastrectomy was tested. METHODS: Three groups of rats with the same characteristics were used. Total gastrectomy was performed in two groups: one was operated on and transit was reestablished by the Roux-en-Y technique (group Y), while the other was submitted to the modified Rosanov technique (group R). Following surgery, a handmade hyper fatty diet (11% of fat) was offered. A third group (control - group C) was not operated but was submitted to the same conditions of the other groups, and used for reference steatocrit values. The animals underwent laparotomy 14 days after surgery and had their feces collected from cecum to determine their steatocrit by analysis of their values. RESULTS: Steatocrit values for groups R and C (mean 5.16% and 4.15% respectively) were similar (p > 0.1), while group Y had significantly higher values (mean = 28.18%, p = 0.0001 - p < 0,05). This was attributed to the fact that group R animals had their duodenal transit patent, decreasing the complications expected in the Roux-en-Y reconstruction. CONCLUSIONS: Steatorrhea in the modified Rosanov technique was similar to the control group, while Roux-en-Y reconstruction presented higher steatorrhea and fat malabsorption.

Quality of life assessment after pancreatic enzyme replacement therapy in chronic pancreatitis.

GOALS: To evaluate the quality of life (QoL) of patients with chronic pancreatitis before and after pancreatic enzyme replacement therapy in a prospective, multicentre, follow-up study. STUDY: Two groups of patients were evaluated. Group 1 consisted of 31 patients with newly diagnosed chronic pancreatitis who had never been treated with pancreatic enzyme preparations. Group 2 consisted of 39 patients whose disease was diagnosed on average 3.4 years before the start of the study. The latter group of patients had undergone pancreatic enzyme replacement therapy, but during follow-up this treatment proved to be insufficient. The dose of pancreatic enzyme replacement therapy was tailored in accordance with the degree of pancreatic exocrine insufficiency measured by means of exocrine pancreatic function tests. A modified European Organizaton for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was used to assess QoL. RESULTS: The social functioning and financial strain were significantly better, while the levels of hope and confidence were significantly reduced in group 1 compared with group 2. A significant gain in body weight and a significantly reduced defecation rate were found in both groups one month after the beginning of the pancreatic enzyme replacement therapy when compared with the pretreatment values. The prevalence of general and disease-specific symptoms and the intensity of pain were reduced in both groups after one month of enzyme substitution therapy. The working ability, the financial strain and the overall QoL scores were improved significantly in both groups, while the cognitive functioning score was found to be significantly improved during the follow-up only in group 1. The overall increase in the QoL score correlated significantly with the increase in body weight and the decrease in defecation number in both groups. CONCLUSIONS: Pancreatic enzyme replacement therapy in patients with chronic pancreatitis not only reduced the extent of steatorrhea and pain, but also significantly improved a variety of other symptoms and the patient's QoL. Individually tailored enzyme replacement therapy improved the QoL not only in the untreated chronic pancreatitis patients, but also in the inadequately treated group. This study demonstrated that the EORTC QLQ-C30 questionnaire, with the addition of two further questions about steatorrhea, is a useful tool for the evaluation of QoL in patients with chronic pancreatitis.