MRI and MRCP findings of the pancreas in patients with diabetes mellitus: compared analysis with pancreatic exocrine function determined by fecal elastase 1.

GOALS: To review magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP) findings in patients with diabetes mellitus (DM), with pancreatic exocrine insufficiency, and with combined pancreatic exocrine insufficiency and DM. STUDY: MRI/MRCP findings of 82 consecutive patients with DM (n=28), pancreatic exocrine insufficiency (n=25), and combination of both (n=29) were evaluated and compared with MRI/MRCP findings of 21 healthy volunteers with normal pancreatic exocrine function. Pancreatic exocrine function was determined by fecal elastase 1. MRCP images were evaluated according to the Cambridge classification. MRI of the pancreas was assessed for pancreatic size, signal intensity ratio (SIR), and arterial/venous enhancement ratio (A/V). RESULTS: On MRI, significant difference was present in terms of mean values of pancreatic size (P<0.0001), A/V (P<0.02), and SIR (P<0.005) between the control group and groups of patients with DM, pancreatic exocrine insufficiency, and combined DM and pancreatic exocrine insufficiency. No significant difference was observed between groups of patients with DM and pancreatic exocrine function alone in terms of pancreatic size, A/V, and SIR. Chronic pancreatitis MRCP findings were present with increasing frequency in groups of DM, pancreatic exocrine insufficiency, and combination of both. CONCLUSIONS: MRI/MRCP findings suggesting chronic pancreatitis may exist in patients with DM comparable to patients with pancreatic exocrine insufficiency. The frequency and severity of MRI/MRCP findings increase when the patients have combined DM and pancreatic exocrine insufficiency.

Magnetic resonance imaging and magnetic resonance cholangiopancreatography findings compared with fecal elastase 1 measurement for the diagnosis of chronic pancreatitis.

OBJECTIVES: To correlate magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI) findings of the pancreas with the pancreatic exocrine function determined by fecal elastase 1 concentration. METHODS: Magnetic resonance imaging and MRCP findings of 81 consecutive patients with clinically suspected chronic pancreatitis and 21 healthy volunteers were evaluated. All subjects underwent MRI/MRCP and fecal elastase 1 testing within 1 to 4 weeks' interval. Magnetic resonance cholangiopancreatography images were evaluated according to Cambridge classification. Magnetic resonance imaging of the pancreas was assessed for pancreatic size, signal, and arterial enhancement. RESULTS: All volunteers had normal fecal elastase 1 levels (>200 microg/g) and normal MRI/MRCP findings. Thirty-one of 56 patients revealed MRI and/or MRCP findings despite normal fecal elastase 1 concentration. Four of 25 patients revealed normal MRI and MRCP findings despite low fecal elastase 1 concentration (<200 microg/g). Magnetic resonance imaging findings of size (P = 0.00001), arterial enhancement (P = 0.00001), and parenchymal signal (P = 0.001) were significantly different among the control group, patients with normal fecal elastase 1 levels, and patients with low fecal elastase 1 levels. Magnetic resonance cholangiopancreatography findings (P = 0.00001), pancreatic size (P = 0.00001), arterial enhancement (P = 0.014), and parenchymal signal (P = 0.004) on MRI correlated with the fecal elastase 1 concentration. CONCLUSIONS: Magnetic resonance imaging/MRCP findings correlate with fecal elastase 1 concentration and may precede pancreatic exocrine insufficiency in the early stages of chronic pancreatitis.

Impact of migration on Helicobacter pylori seroprevalence in the offspring of Turkish immigrants in Germany.

Helicobacter pylori (H. pylori) infection rates differ markedly between distinct populations. Consistent with previous findings of high seroprevalences in less developed countries, Turkish people have been reported to constitute a high-risk population. H. pylori prevalence rates have tended to be lower in Turkish individuals living in Germany for more than one generation. We conducted a seroepidemiological study to determine the impact of ethnicity, environmental setting, and sociodemographic factors on H. pylori seropositivity. Three subgroups were recruited encompassing 675 Germans (402 males, 273 females), 260 Turkish people born and raised in Germany (145 males, 115 females) and 148 Turkish people living in Turkey (91 males, 57 females), Ages ranged from newborn to a maximum of 30 years in all subgroups. H. pylori immunoglobulin G serum antibodies were determined by a commercial ELISA. H. pylori age-adjusted overall seroprevalence clearly differed between Germans (13.1%) and Turkish subgroups, with prevalences of 30.4% (Turks in Germany) and 44.5% (Turks in Turkey) seropositive individuals (p<0.001). Infection occurred at a younger age in Turks independent of country. Besides age, ethnicity was the only independent and significant predictor of H. pylori seropositivity using multiple logistic regression analysis (odds ratio 2.5; 1.3-5.0 95% confidence interval CI). Place of residence and number of children tended to influence H. pylori seroprevalence but without achieving statistical significance. Our data suggest that high H. pylori seroprevalence in Turkish people depends on factors that are only insignificantly influenced by migration. The causal environmental factors within this cohort and/or sociocultural practices that perpetuate and encourage the spread of infection remain to be identified.