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1.
Wiad Lek ; 74(1): 98-101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851596

RESUMO

OBJECTIVE: The aim: To determine the peculiarities of changes in the homocysteine levels in the patients with chronic pancreatitis and type 2 diabetes blood serum depending on the vitamin status. PATIENTS AND METHODS: Materials and methods: We investigated 36 patients with chronic pancreatitis and type 2 diabetes, who were included in the first group of the patients examined; Group 2 consisted of 34 patients with chronic pancreatitis; and Group 3 of the patients examined consisted of 40 patients with type 2 diabetes. RESULTS: Results: All patients examined were diagnosed with type 2 diabetes mellitus of moderate severity. Also, the diagnosis of chronic pancreatitis was confirmed in all patients with type 2 diabetes, which was manifested by exocrine pancreatic insufficiency according to the results of clinical, laboratory and instrumental methods of examination. There was a significant decrease in the level of all B vitamins and 25-(OH)D in patients with chronic pancreatitis and type 2 diabetes (Group I). An increase in the concentration of homocysteine in the serum in all examined groups of patients was established, with the maximum deviation from the norm in patients with chronic pancreatitis and type 2 diabetes (up to 32.7 ± 0.8 µmol / L <0.01). The correlation analysis revealed a strong direct relationship between the level of homocysteine and vitamins B12, B6, 25-(OH)D and an inverse correlation between vitamin B9 in the group of patients with chronic pancreatitis and type 2 diabetes. CONCLUSION: Conclusions: Patients with chronic pancreatitis and type 2 diabetes have a decreased levels of B vitamins (B1, B6, B9, B12) and 25-(OH)D, which is accompanied by an increase in serum homocysteine. In patients with chronic pancreatitis and type 2 diabetes, the level of homocysteine in the blood serum directly depends on the decrease in the levels of vitamins B6, B12 and 25-(OH)D in blood serum, as well as inverse depends on vitamin B9 levels in these patients.


Assuntos
Diabetes Mellitus Tipo 2 , Pancreatite Crônica , Diabetes Mellitus Tipo 2/complicações , Ácido Fólico , Homocisteína , Humanos , Pancreatite Crônica/complicações , Vitamina B 12
2.
Khirurgiia (Mosk) ; (1): 47-54, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395512

RESUMO

OBJECTIVE: To analyze the effect of timing of surgery, quality of resection and removal of MPD-stones on long-term results of duodenum-preserving pancreatic head resection (DPPHR). MATERIAL AND METHODS: The study included 110 patients with chronic pancreatitis (CP) who underwent DPPHR in 2014-2019. Evaluation of long-term outcomes included pain syndrome severity, exocrine and endocrine insufficiency and quality of life (QoL). Patients were stratified depending on duration of disease (within 36 months, >36 months after manifestation), volume of resected pancreatic head tissue according to CT data, removal of MPD-stones. RESULTS: Surgical treatment within 36 months after clinical manifestation was followed by less pain syndrome (VAS score 1.16±1.76 vs. 2.03±1.87, p=0.02), exocrine insufficiency (69.8% vs. 98.5%, p<0.001). Resection of more than 50% of the pancreatic head and removal of MPD-stones were accompanied by pain relief, improved pancreatic secretory function and quality of life. CONCLUSION: Pancreatic head resection in patients with chronic pancreatitis should be performed within 3 years after clinical manifestation. Resection of more than 50% of the pancreatic head with extraction of MPD-stones ensures pain relief, better endocrine and exocrine function, as well as higher QoL in long-term follow-up period.


Assuntos
Pâncreas/cirurgia , Pancreatite Crônica , Qualidade de Vida , Cálculos/complicações , Cálculos/cirurgia , Humanos , Pâncreas/diagnóstico por imagem , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Pancreatite Crônica/complicações , Pancreatite Crônica/diagnóstico por imagem , Pancreatite Crônica/cirurgia , Fatores de Tempo , Resultado do Tratamento
3.
Vasc Endovascular Surg ; 55(1): 73-76, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32869730

RESUMO

Visceral artery pseudoaneurysms are common complications of pancreatitis that carry a high mortality rate. Early detection and treatment of the pseudoaneurysms should be done as they carry high mortality following rupture. The splenic artery is the commonest artery involved followed by gastroduodenal and pancreaticoduodenal arteries. Gastric artery pseudoaneurysms are less common with less than 50 cases reported in the literature till now. We describe a case of gastric artery pseudoaneurysm secondary to chronic pancreatitis in a patient who presented with intermittent GI bleeding and also describe the role of endovascular management in the treatment of the same.


Assuntos
Falso Aneurisma/terapia , Embolização Terapêutica , Artéria Gástrica , Pancreatite Crônica/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Artéria Gástrica/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Crônica/diagnóstico , Resultado do Tratamento
5.
J Postgrad Med ; 66(4): 206-208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33109782

RESUMO

Pancreatic-pleural fistula (PPF) is a rare sequela of pancreatitis. High degree of clinical suspicion is required to diagnose a PPF. Confirmation is done by high amylase content in pleural fluid analysis. Here, we present two cases with varied presentation of PPF. A 43-year-old man presented with acute on chronic pancreatitis with bilateral (predominantly right) pleural effusion. Another 57-year-old man, previously diagnosed with chronic calcific pancreatitis, presented with left pleural effusion. Both cases were effectively managed with endoscopic pancreatic duct stenting.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Ductos Pancreáticos/cirurgia , Fístula Pancreática/cirurgia , Pancreatite Crônica/complicações , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/cirurgia , Stents , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/patologia , Fístula Pancreática/complicações , Fístula Pancreática/diagnóstico por imagem , Pancreatite Crônica/diagnóstico por imagem , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/terapia , Derrame Pleural/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Lancet ; 396(10249): 499-512, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32798493

RESUMO

Chronic pancreatitis is a multifactorial, fibroinflammatory syndrome in which repetitive episodes of pancreatic inflammation lead to extensive fibrotic tissue replacement, resulting in chronic pain, exocrine and endocrine pancreatic insufficiency, reduced quality of life, and a shorter life expectancy. The incidence and prevalence of chronic pancreatitis is rising and no curative treatment is available. Using novel diagnostic algorithms, definitive chronic pancreatitis can be diagnosed by imaging criteria alone, whereas probable chronic pancreatitis requires clinical features and imaging criteria. Criteria for the diagnosis of early chronic pancreatitis are still under discussion and need prospective validation in clinical trials. Cross-sectional imaging should be used first; endoscopic ultrasound is needed only when CT or MRI are inconclusive or to plan therapeutic interventions. Management of chronic pancreatitis requires an interdisciplinary approach including primary care practitioners, gastroenterologists, surgeons, radiologists, pain specialists, and nutritional therapists. Patients with chronic pancreatitis should be seen at least once a year and re-evaluated for causal risk factors, symptom control, and complications such as malnutrition, pancreatic exocrine insufficiency, and diabetes; refer to a specialised centre if symptoms are poorly controlled or there is risk of deterioration. Scoring systems to monitor disease progression have been developed and validated internationally. Interventional treatments for pain or cholestasis should be done by specialists only, and early discussion of treatment approaches should include all medical disciplines involved in care. Throughout this Seminar, we address research needs such as staging of pancreatitis, aspects of malnutrition and pain, and cancer surveillance, to help improve the care of patients.


Assuntos
Pancreatite Crônica , Biomarcadores/análise , Diagnóstico Diferencial , Diagnóstico por Imagem , Progressão da Doença , Humanos , Manejo da Dor , Pancreatite Crônica/complicações , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/terapia , Fatores de Risco , Índice de Gravidade de Doença
10.
Khirurgiia (Mosk) ; (5): 12-19, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500684

RESUMO

OBJECTIVE: To compare different clinical and morphometric features of patients undergoing TPAIT for prediction of postoperative outcomes. MATERIAL AND METHODS: A retrospective review enrolled patients who underwent TPAIT for the period from January 2007 to October 2017. Morphometric parameters were analyzed using preoperative CT scans and patients were grouped to examine association of these characteristics with postoperative morbidity. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on pancreatic islet features, perioperative blood transfusion, ICU- and hospital-stay, complications, repeated admission within 90 days and islet function was assessed. RESULTS: A total of 34 patients were included in this study (12 males and 24 females). At the time of diagnosis, mean age of patients was 43.1 years. Mean body mass index (BMI) in sarcopenic patients was 24.9 kg/m2, mean BMI in those without sarcopenia - 24.8 kg/m2 (p=1.00). Various surgical complications were observed in 11 patients (32.3%). Patients with sarcopenia experienced more complications (83.3%) compared with patients without sarcopenia (50%). However, differences were not significant (p=0.31). Islet characteristics (islet numbers, purity), readmission, ICU- and hospital-stay, incidence of blood transfusion and islet function were also similar in both groups. CONCLUSION: Sarcopenia is not a predictor of postoperative complications and islet cell function in chronic pancreatitis patients following TPAIT.


Assuntos
Transplante das Ilhotas Pancreáticas , Pancreatectomia , Pancreatite Crônica/cirurgia , Sarcopenia/fisiopatologia , Tecido Adiposo/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pancreatite Crônica/complicações , Pancreatite Crônica/fisiopatologia , Estudos Retrospectivos , Sarcopenia/complicações , Transplante Autólogo , Resultado do Tratamento
11.
Chirurgia (Bucur) ; 115(2): 185-190, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369722

RESUMO

The objective of this work was to review the entire literature on pancreatic surgery in order to best define the surgical indications and the specifics of their management. The bibliographic research was done on Pubmed over the period from January 1995 to June 2015, using French and English as the languages of publication. The two main indications discussed here are the management of cancer and chronic pancreatitis. Surgery in the cirrhotic patient exposes the patient to a higher risk of complications than in the non-cirrhotic patient. Child-Pugh and MELD scores should be used to assess risk and guide operative decision. Child-Pugh classes B and a MELD score value greater than 15 are associated with higher morbidity and mortality. However, if suitable selection is made of cirrhotic patients who are candidates for pancreatic surgery, long-term survival seems to be equivalent to the non-cirrhotic group. No risk factors for long-term survival have been reported. In conclusion, cirrhotic patients, candidates for pancreatic surgery must be correctly selected, cirrhosis exposes to a higher risk of postoperative morbidity and mortality.


Assuntos
Cirrose Hepática/complicações , Pâncreas/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Pancreatite Crônica/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Pancreatopatias/cirurgia , Neoplasias Pancreáticas/complicações , Pancreatite Crônica/complicações , Fatores de Risco , Índice de Gravidade de Doença
12.
Curr Diab Rep ; 20(6): 16, 2020 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-32221727

RESUMO

PURPOSE OF REVIEW: The aim was to review evidence about diabetes secondary to hereditary pancreatitis, seeking novel diagnostic and treatment features. RECENT FINDINGS: Hereditary pancreatitis (HP) is an autosomal dominant condition, characterized by recurrent episodes of acute pancreatitis, progression to fibrosis, and chronic pancreatitis. Clinical presentation includes diabetes of the exocrine pancreas (DEP). HP prevalence ranges from 0.3 to 0.57 per 100,000 people, with up to 80% of these develop DEP. This condition often requires specific interventions: with regard to metabolic control, metformin is the first choice for those with mild DEP, and for those in advanced disease, insulin is considered the first-line therapy. Insulin analogues and insulin pump therapy are preferred due to the brittle glycemic pattern and risk of hypoglycemia. In case of exocrine insufficiency, pancreatic enzyme replacement therapy is recommended. Pancreatic polypeptide administration is a promising novel treatment feature. DEP due to HP appears to be a misdiagnosed condition. The requirement of specific management demonstrates the importance of this matter; therefore, appropriate recognition and classification are important.


Assuntos
Diabetes Mellitus/genética , Pâncreas Exócrino/patologia , Pancreatite Crônica/genética , Tripsina/genética , Doença Aguda , Carcinoma Ductal Pancreático/etiologia , Quimotripsina/genética , Complicações do Diabetes/complicações , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/terapia , Insuficiência Pancreática Exócrina/genética , Insuficiência Pancreática Exócrina/fisiopatologia , Insuficiência Pancreática Exócrina/terapia , Fibrose/etiologia , Humanos , Pâncreas Exócrino/fisiopatologia , Neoplasias Pancreáticas/etiologia , Pancreatite Crônica/complicações , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/fisiopatologia , Recidiva , Fatores de Risco , Inibidor da Tripsina Pancreática de Kazal/genética
13.
Am J Gastroenterol ; 115(3): 322-339, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32022720

RESUMO

Chronic pancreatitis (CP) is historically defined as an irreversible inflammatory condition of the pancreas leading to varying degrees of exocrine and endocrine dysfunction. Recently however, the paradigm for the diagnosis has changed in that it breaks with the traditional clinicopathologic-based definition of disease, focusing instead on diagnosing the underlying pathologic process early in the disease course and managing the syndrome more holistically to change the natural course of disease and minimize adverse disease effects. Currently, the most accepted mechanistically derived definition of CP is a pathologic fibroinflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress. The most common symptom of CP is abdominal pain, with other symptoms such as exocrine pancreatic insufficiency and diabetes developing at highly variable rates. CP is most commonly caused by toxins such as alcohol or tobacco use, genetic polymorphisms, and recurrent attacks of acute pancreatitis, although no history of acute pancreatitis is seen in many patients. Diagnosis is made usually on cross-sectional imaging, with modalities such as endoscopic ultrasonography and pancreatic function tests playing a secondary role. Total pancreatectomy represents the only known cure for CP, although difficulty in patient selection and the complications inherent to this intervention make it usually an unattractive option. This guideline will provide an evidence-based practical approach to the diagnosis and management of CP for the general gastroenterologist.


Assuntos
Pancreatite Crônica , Tomada de Decisão Clínica/métodos , Gastroenterologia/métodos , Gastroenterologia/normas , Humanos , Pancreatectomia , Pancreatite Crônica/complicações , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/terapia , Seleção de Pacientes
16.
JAMA ; 323(3): 237-247, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31961419

RESUMO

Importance: For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function. Objective: To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes. Design, Setting, and Participants: The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for ≤2 months or weak opioids for ≤6 months) were included. The 18-month follow-up period ended in March 2018. Interventions: There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed. Main Outcomes and Measures: The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality. Results: Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P < .001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach. Conclusions and Relevance: Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings. Trial Registration: ISRCTN Identifier: ISRCTN45877994.


Assuntos
Cálculos/terapia , Drenagem , Endoscopia , Litotripsia , Manejo da Dor/métodos , Ductos Pancreáticos/cirurgia , Pancreatite Crônica/terapia , Adulto , Analgésicos Opioides/uso terapêutico , Área Sob a Curva , Cálculos/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Pancreatite Crônica/complicações , Pancreatite Crônica/cirurgia
17.
J Gastroenterol Hepatol ; 35(7): 1099-1106, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31900986

RESUMO

BACKGROUND AND AIM: Recently, there has been burgeoning interest in the utilization of fully covered self-expandable metal stents (FCSEMSs) for managing main pancreatic duct strictures (MPDS) in chronic pancreatitis (CP). The primary aim was to investigate stricture resolution and recurrence rates of FCSEMS placement in patients with symptomatic CP complicated with MPDS. METHODS: MEDLINE, EMBASE, and ISI Web of Science and Cochrane Library (up to December 2019) were searched to identify eligible studies. A meta-analysis of stricture resolution and recurrence rates was carried out using R. The crude rate of adverse events related to stent therapy was also calculated. RESULTS: Ten studies involving 163 patients were included. The weighted pooled rate of MPDS resolution was 93% (95% confidence interval [95%CI] 84-99%) with substantial heterogeneity (I2  = 63%). Duration of stent placement more than 3 months did not result in a significantly higher resolution rate than that of 3 months or less (93% vs 93%, P = 0.91). The weighted pooled rate of stricture recurrence was 5% (95%CI: 0-12%). The stricture recurrence rate for patients with duration of stent placement more than 3 months (3%; 95%CI: 0-10%) was lower than that in patients with 3 months or less of stent placement (7%; 95%CI: 0-23%), but not significantly (P = 0.45). The overall rate of adverse events related to stent therapy was 34.9%, and spontaneous stent migration occurred in 14.1% of patients. CONCLUSIONS: The use of FCSEMSs appears to be effective and safe in the management of MPDS caused by symptomatic CP.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Ductos Pancreáticos/fisiologia , Ductos Pancreáticos/cirurgia , Pancreatite Crônica/complicações , Pancreatite Crônica/cirurgia , Stents Metálicos Autoexpansíveis , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Humanos , Recidiva , Reoperação , Segurança , Stents Metálicos Autoexpansíveis/efeitos adversos , Resultado do Tratamento
18.
Pancreatology ; 20(1): 25-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31787527

RESUMO

BACKGROUND AND AIMS: Pain is the primary symptom of chronic pancreatitis (CP), but methods for sensory testing and pain characterization have not previously been validated for clinical use. We present a clinically feasible method for the assessment and characterization of pain mechanisms in patients with CP based on quantitative sensory testing (QST). METHODS: This was a cross-sectional, multicenter study of 122 control subjects without pancreatic disease and another 60 patients with painful CP. All subjects underwent standardized QST assessments including a cold pressor test, a conditioned pain modulation paradigm, repetitive pin-prick stimuli (temporal summation) and pressure stimulation of the upper abdominal (pancreatic) and control dermatomes. The effects of age and gender on QST assessment parameters were investigated and normative reference values based on quartile regression were derived and implemented in algorithms to categorize patients according to their patterns of central pain processing (normal vs. segmental sensitization vs. widespread sensitization). RESULTS: Absolute pressure thresholds were subject to clinically relevant gender effects (all p < 0.001), while the remainder of QST parameters were unaffected by age and gender. The algorithm with the best discriminatory capacity showed good separation between patients and controls (p < 0.001); 50% of patients had normal central pain processing, 23% had evidence of segmental sensitization and 27% had evidence of widespread sensitization. CONCLUSION: We show normative reference values for a clinically feasible method for assessment and characterization of pain mechanisms in patients with CP. Application of this method streamlines the evaluation of pancreatic pain and may be used to inform treatment. CLINICALTRIALS. GOV ID: NCT03434392.


Assuntos
Medição da Dor/métodos , Dor/etiologia , Pancreatite Crônica/complicações , Adulto , Envelhecimento , Estudos de Casos e Controles , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Fatores Sexuais
19.
Radiology ; 294(1): 234-237, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31846410

RESUMO

HistoryA 55-year-old man with a history of chronic pancreatitis secondary to chronic alcohol abuse presented to the hospital with acute abdominal pain, generalized weakness, weight loss, and pyrexia. A clinical examination revealed he was tender to touch in the upper abdomen. Laboratory tests revealed a serum alkaline phosphatase level of 370 U/L (6.1 µkat/L) (normal range, 30-130 U/L [0.5-2.2 µkat/L]), a lipase level of 172 U/L (2.9 µkat/L) (normal range, 0-60 U/L [0-1.0 µkat/L]), a C-reactive protein level of 159 mg/L (1514 nmol/L) (normal value, <8.0 mg/L [76.2 nmol/L]), and a white cell count of 7 × 109/L (normal range, [4-11] × 109/L). During the present admission, the patient underwent urgent CT for his acute symptoms. His relevant medical history included a hospital admission 2 months earlier for abdominal discomfort. Given his history of chronic pancreatitis, baseline abdominal MRI was performed to determine the cause of his symptoms and to assess the pancreas.


Assuntos
Fístula do Sistema Digestório/diagnóstico por imagem , Fístula do Sistema Digestório/etiologia , Ductos Pancreáticos/diagnóstico por imagem , Pancreatite Crônica/complicações , Flebite/diagnóstico por imagem , Flebite/etiologia , Veia Porta/diagnóstico por imagem , Fístula do Sistema Digestório/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Stents , Tomografia Computadorizada por Raios X
20.
Diabetes Res Clin Pract ; 160: 107993, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31877344

RESUMO

AIM: To study the incidence of glucose intolerance in CP patients without diabetes by performing oral glucose tolerance test (OGTT). METHODS: We screened consecutive Indian CP patients without diabetes over 6 months by performing OGTT and correlated with physical characteristics and glycated hemoglobin (HbA1c). We also compared c-peptide and pancreatic polypeptide response in different groups based on OGTT. Relevant statistical tests were performed. P < 0.05 was considered significant. RESULTS: Total of 171 patients were screened. Mean duration of CP was 5.03 ± 4.32 years. 55 were detected to have prediabetes and 40 DM on OGTT. CP patients with diabetes and prediabetes had significantly dilated pancreatic duct compared to non-diabetic CP (4.2 ± 2.7 mm, 3.6 ± 2.7 mm, 2.84 ± 2.25 mm; p = 0.018). Fasting blood glucose (FBS) and 2-hour OGTT were 109.35 ± 19.06, 97.47 ± 11.94, 85.24 ± 9.95 and 236.13 ± 31.42, 154.65 ± 19.53, 112.89 ± 16.32 in patients with DM, prediabetes and CP patients without diabetes (p < 0.0001). There was a good c-peptide response (p = 0.001) and reduced pancreatic polypeptide response (p = 0.003) in CP patients compared to controls. CONCLUSION: Early in the course of disease reduced pancreatic polypeptide response in the presence of good c-peptide response may result in development of DM.


Assuntos
Glicemia/metabolismo , Peptídeo C/metabolismo , Intolerância à Glucose/sangue , Pancreatite Crônica/complicações , Adulto , Feminino , Humanos , Masculino , Pancreatite Crônica/sangue
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