Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up. PANCR-EVOL Study.

BACKGROUND/OBJECTIVES: Exocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL). METHODS: This was a cross-sectional, multicenter Spanish study. CP patients without follow-up by a gastroenterologist or surgeon in at least 2 years were included. EPI was defined as fecal elastase test <200mcg/g. For nutritional assessment, laboratory and anthropometric data were obtained. QoL was investigated using the EORTC QLQ-C30 questionnaire. RESULTS: 64 patients (mean age 58.8±10.3 years, 85.9% men) from 10 centers were included. Median time since diagnosis of CP was 58.7 months [37.7-95.4]. Forty-one patients (64.1%) had EPI. Regarding nutritional status, the following differences were observed (EPI vs. Non-EPI): BMI (23.9±3.5kg/m2 vs. 25.7±2.5, p=0.03); glucose (121 [96-189] mg/dL vs. 98 [90-116], p=0.006); HbA1c 6.6% [6.0-8.4] vs. 5.5 [5.3-6.0], p=0.0005); Vitamin A (0.44mg/L [0.35-0.57] vs. 0.53 [0.47-0.63], p=0.048) and Vitamin E (11.2±5.0µg/ml vs. 14.4±4.3, p=0.03). EPI group showed a worse EORTC QLQ-C30 score on physical (93.3 [66.7-100] vs. 100 [93.3-100], p=0.048) and cognitive function (100 [83.3-100] vs. 100 [100-100], p=0.04). CONCLUSIONS: Prevalence of EPI is high in patients with CP without follow-up. EPI group had higher levels of glucose, lower levels of vitamins A and E and worse QoL.

[Oral budesonide in the treatment of chronic refractory pouchitis]. / Budesonida oral en el tratamiento de la reservoritis crónica refractaria.

BACKGROUND AND OBJECTIVE: Pouchitis is the most frequent complication following total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Up to 15% of patients with pouchitis experience a chronic course, which can be resistant to antibiotic therapy and may lead to surgical excision of the pouch. Further therapeutic options are therefore needed. Oral budesonide, a corticosteroid with topical activity in the terminal ileum (controlled ileal release [CIR] capsules), may be an alternative. MATERIAL AND METHOD: We performed a prospective, open study of five patients with chronic refractory pouchitis. Patients were treated with 9 mg of budesonide capsules after other causes of the lack of treatment response were excluded. Assessments included clinical, endoscopic and histological evaluation at baseline and after 8 weeks of treatment. Efficacy was evaluated using the pouchitis disease activity index (PDAI) global scores as well as the clinical, endoscopic and histological subscores at baseline and 8 weeks. Remission was defined as a global score < 7. Variations in laboratory parameters and tolerance were also assessed. RESULTS: Four out of five patients went into remission at 8 weeks and a significant decrease was observed in the median total PDAI score from 14 (range, 12-15) to 4 (range, 4-11) (p = 0.0422) and in the three subscores: clinical from 4 (range, 4-5) to 1 (range, 0-4) (p = 0.0394), endoscopic from 5 (range, 4-6) to 2 (range, 1-5) (p = 0.0394), and histologic from 4 (range, 4-5) to 2 (range, 2-2) (p = 0.0339). No significant adverse effects were reported. CONCLUSIONS: Oral budesonide CIR capsules may be an option to induce remission in active chronic refractory pouchitis. Because tolerance is good, the use of enemas may be avoided.

Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up. PANCR-EVOL Study / Prevalencia de insuficiencia pancreática exocrina en pacientes con pancreatitis crónica sin segruimiento. Estudio PANCR-EVOL

Background/objectives. Exocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL). Methods. This was a cross-sectional, multicenter Spanish study. CP patients without follow-up by a gastroenterologist or surgeon in at least 2 years were included. EPI was defined as fecal elastase test <200mcg/g. For nutritional assessment, laboratory and anthropometric data were obtained. QoL was investigated using the EORTC QLQ-C30 questionnaire. Results. 64 patients (mean age 58.8±10.3 years, 85.9% men) from 10 centers were included. Median time since diagnosis of CP was 58.7 months [37.7-95.4]. Forty-one patients (64.1%) had EPI. Regarding nutritional status, the following differences were observed (EPI vs. Non-EPI): BMI (23.9±3.5kg/m2 vs. 25.7±2.5, p=0.03); glucose (121 [96-189] mg/dL vs. 98 [90-116], p=0.006); HbA1c 6.6% [6.0-8.4] vs. 5.5 [5.3-6.0], p=0.0005); Vitamin A (0.44mg/L [0.35-0.57] vs. 0.53 [0.47-0.63], p=0.048) and Vitamin E (11.2±5.0μg/ml vs. 14.4±4.3, p=0.03). EPI group showed a worse EORTC QLQ-C30 score on physical (93.3 [66.7-100] vs. 100 [93.3-100], p=0.048) and cognitive function (100 [83.3-100] vs. 100 [100-100], p=0.04). Conclusions. Prevalence of EPI is high in patients with CP without follow-up. EPI group had higher levels of glucose, lower levels of vitamins A and E and worse QoL (AU)

Antecedentes/objetivos. la insuficiencia pancreática exocrina (IPE) es una importante complicación de la pancreatitis crónica (PC). Las guías recomiendan el seguimiento de la IPE en PC, para identificar a aquellos pacientes que puedan beneficiarse del tratamiento enzimático sustitutivo. El objetivo de este estudio fue evaluar la prevalencia de IPE en pacientes con PC sin seguimiento en los últimos 2 años y describir su estado nutricional y calidad de vida (QoL). Métodos. estudio trasversal, multicéntrico, español. Se incluyeron pacientes con PC sin seguimiento por un gastroenterólogo/cirujano en los últimos 2años. Se definió IPE como elastasa fecal<200mcg/g. Se recogieron parámetros de laboratorio y datos antropométricos para el análisis nutricional. Para la evaluación de QoL se utilizó el cuestionario EORTC QLQ-C30. Resultados. se incluyeron prospectivamente 64 pacientes (58,8±10,3 años, media 85,9%) de 10 centros. Tiempo medio desde el diagnóstico de PC: 58,7meses [37,7-95,4]. 41 pacientes (64,1%) tenían IPE. Estado nutricional: se observaron las siguientes diferencias (IPE vs No-IPE): IMC (23,9±3,5kg/m2 vs. 25,7±2,5,p=0,03); glucosa 121 [96-189] mg/dL vs. 98 [90-116];p =0,006); HbA1c 6,6% [6,0-8,4] vs. 5,5 [5,3-6,0],p=0,0005); Vitamina-A (0,44mg/L [0,35-0,57] vs. 0,53 [0,47-0,63],p=0,048), Vitamina-E (11,2±5,0μg/ml vs. 14,4±4,3,p=0,03). El grupo de IPE mostró una peor puntuación en el EORTC QLQ-C30 en las funciones física (93,3 [66,7-100] vs. 100 [93,3-100], p=0,048) y cognitiva (100 [83,3-100] vs. 100 [100-100],p=0,04). Conclusiones. la prevalencia de IPE en pacientes con PC sin seguimiento es elevada. En el grupo de IPE se observaron niveles elevados de glucosa, bajos de vitaminas A y E y peor calidad de vida (AU)

Budesonida oral en el tratamiento de la reservoritis crónica refractaria / Orañ budesonide in the treatment of chronic refractory pouchitis

INTRODUCCIÓN Y OBJETIVO: La reservoritis es la principalcomplicación, tras la proctocolectomía total con anastomosisileoanal y reservorio, en la colitis ulcerosa. En un 15% de loscasos sigue un curso crónico y, a veces, refractario al tratamientoantibiótico, y puede terminar en exéresis del reservorio.Por ello, son necesarias otras opciones terapéuticas. Budesonidaes un corticoide de acción tópica que, en cápsulasorales de liberación en el íleon terminal (CIR), puede seruna posible alternativa terapéutica.MATERIAL Y MÉTODO: Estudio prospectivo, abierto, realizadoen 5 pacientes con reservoritis crónica refractaria. Descartadasotras causas de refractariedad, se trata a los pacientescon budesonida oral 9 mg/día. Se realiza unaevaluación clínica, endoscópica e histológica basal y tras 8semanas de tratamiento. La eficacia se evalúa mediante lacomparación del índice de actividad de reservoritis (PDAI) ysus subíndices clínico, endoscópico e histológico, antes y despuésdel tratamiento. Se establece como remisión un índice< 7. Se valora, asimismo, la modificación de diversos parámetrosanalíticos y la tolerancia.RESULTADOS: Cuatro de 5 pacientes logran la remisión tras 8semanas de tratamiento y se constata un descenso significativoen la mediana del PDAI global de 14 (rango, 12-15) a 4(rango, 4-11) (p = 0,0422), así como en sus 3 subíndices: clínicode 4 (rango, 4-5) a 1 (rango, 0-4) (p = 0,0394), endoscópicode 5 (rango, 4-6) a 2 (rango, 1-5) (p = 0,0394) e histológicode 4 (rango, 4-5) a 2 (rango, 2-2) (p = 0,0339). No seregistraron efectos secundarios.CONCLUSIONES: Budesonida oral en cápsulas de liberaciónileal controlada puede ser una opción terapéutica para inducirla remisión en la reservoritis activa, crónica y refractaria.La tolerancia es buena y se puede evitar su aplicación enforma de enemas

BACKGROUND AND OBJECTIVE: Pouchitis is the most frequentcomplication following total proctocolectomy with ilealpouch-anal anastomosis for ulcerative colitis. Up to 15% ofpatients with pouchitis experience a chronic course, whichcan be resistant to antibiotic therapy and may lead to surgicalexcision of the pouch. Further therapeutic options aretherefore needed. Oral budesonide, a corticosteroid with topicalactivity in the terminal ileum (controlled ileal release[CIR] capsules), may be an alternative.MATERIAL AND METHOD: We performed a prospective, openstudy of five patients with chronic refractory pouchitis. Patientswere treated with 9 mg of budesonide capsules afterother causes of the lack of treatment response were excluded.Assessments included clinical, endoscopic and histologicalevaluation at baseline and after 8 weeks of treatment. Efficacywas evaluated using the pouchitis disease activityindex (PDAI) global scores as well as the clinical, endoscopicand histological subscores at baseline and 8 weeks. Remissionwas defined as a global score < 7. Variations in laboratoryparameters and tolerance were also assessed.RESULTS: Four out of five patients went into remission at 8weeks and a significant decrease was observed in the mediantotal PDAI score from 14 (range, 12-15) to 4 (range, 4-11) (p= 0.0422) and in the three subscores: clinical from 4 (range,4-5) to 1 (range, 0-4) (p = 0.0394), endoscopic from 5 (range,4-6) to 2 (range, 1-5) (p = 0.0394), and histologic from 4(range, 4-5) to 2 (range, 2-2) (p = 0.0339). No significant adverseeffects were reported.CONCLUSIONS: Oral budesonide CIR capsules may be an optionto induce remission in active chronic refractory pouchitis.Because tolerance is good, the use of enemas may beavoided