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Current Opinion in Gastroenterology Sep 2020Pancreatic function tests are mainly used for the diagnosis of exocrine pancreatic insufficiency (EPI) in patients with pancreatic diseases or after pancreatic or... (Review)
Review
PURPOSE OF REVIEW
Pancreatic function tests are mainly used for the diagnosis of exocrine pancreatic insufficiency (EPI) in patients with pancreatic diseases or after pancreatic or gastric surgery. Breath tests evaluate not just pancreatic secretion but the digestion capacity of the pancreas. These tests are good candidates for the diagnosis of EPI as they are noninvasive, accurate and easy to apply to clinical practice.
RECENT FINDINGS
The C-labelled mixed triglyceride (MTG) breath test has been optimized and validated against adequate reference methods for the diagnosis of EPI in patients with chronic pancreatitis and for the evaluation of the efficacy of pancreatic enzyme replacement therapy (PERT). In addition, reported C-MTG breath test results in patients with other pancreatic diseases and after pancreatic and gastric surgery support the accuracy and clinical applicability of this test. The evidence of pancreatic function breath tests with other C-labelled substrates is limited.
SUMMARY
Increasing evidence supports the accuracy and clinical usefulness of the C-MTG breath test for the diagnosis of EPI and the evaluation of the efficacy of PERT in different clinical conditions. Commercial availability of this test is required for a wide clinical use. The use of optimized and validated breath test protocols is mandatory.
Topics: Breath Tests; Exocrine Pancreatic Insufficiency; Humans; Pancreas; Pancreatic Function Tests; Pancreatitis, Chronic
PubMed: 32740002
DOI: 10.1097/MOG.0000000000000664 -
Neurogastroenterology and Motility Mar 2021Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal and hepatic manifestation in up to one fifth of patients. Severe acute respiratory syndrome... (Review)
Review
BACKGROUND
Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal and hepatic manifestation in up to one fifth of patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, infects gastrointestinal epithelial cells expressing angiotensin-converting enzyme 2 (ACE2) receptors triggering a cascade of events leading to mucosal and systemic inflammation. Symptomatic patients display changes in gut microbiota composition and function which may contribute to intestinal barrier dysfunction and immune activation. Evidence suggests that SARS-CoV-2 infection and related mucosal inflammation impact on the function of the enteric nervous system and the activation of sensory fibers conveying information to the central nervous system, which, may at least in part, contribute symptom generation such as vomiting and diarrhea described in COVID-19. Liver and pancreas dysfunctions have also been described as non-respiratory complications of COVID-19 and add further emphasis to the common view of SARS-CoV-2 infection as a systemic disease with multiorgan involvement.
PURPOSE
The aim of this review was to highlight the current knowledge on the pathophysiology of gastrointestinal SARS-CoV-2 infection, including the crosstalk with the gut microbiota, the fecal-oral route of virus transmission, and the potential interaction of the virus with the enteric nervous system. We also review the current available data on gastrointestinal and liver manifestations, management, and outcomes of patients with COVID-19.
Topics: Animals; COVID-19; Diarrhea; Dysbiosis; Enteric Nervous System; Gastrointestinal Diseases; Gastrointestinal Microbiome; Gastrointestinal Tract; Humans; Liver Diseases; Pancreatic Diseases
PubMed: 33591607
DOI: 10.1111/nmo.14104 -
Medicina Clinica Aug 2021
Topics: Choristoma; Diagnosis, Differential; Humans; Pancreatectomy; Pancreatic Diseases; Pancreatic Neoplasms; Spleen
PubMed: 32951885
DOI: 10.1016/j.medcli.2020.05.031 -
Current Opinion in Gastroenterology Sep 2021Diabetes secondary to pancreatic diseases (i.e., acute pancreatitis, chronic pancreatitis, and pancreatic cancer) is increasingly studied, but remains challenging to... (Review)
Review
PURPOSE OF REVIEW
Diabetes secondary to pancreatic diseases (i.e., acute pancreatitis, chronic pancreatitis, and pancreatic cancer) is increasingly studied, but remains challenging to distinguish from type 2 diabetes (T2DM). We review the clinical significance and potential biomarkers that may help differentiate these types of diabetes.
RECENT FINDINGS
Recent studies have identified several complications (including nonvascular) that occur more frequently in patients with diabetes secondary to acute and chronic pancreatitis than T2DM, and biomarkers to differentiate these types of diabetes. There have been advances that may enable the enrichment of a population of adults with new onset diabetes to potentially screen for occult pancreatic cancer, but efforts are needed to identify and validate promising diagnostic biomarkers.
SUMMARY
High-quality studies are needed to more precisely understand the risk factors and natural course of diabetes secondary to pancreatic diseases. Mechanistic and interventional studies are awaited to provide insights that will distinguish diabetes secondary to pancreatic diseases and refine the management of hyperglycemia in this patient population.
Topics: Acute Disease; Adult; Diabetes Mellitus; Diabetes Mellitus, Type 2; Humans; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis
PubMed: 34265796
DOI: 10.1097/MOG.0000000000000754 -
Laboratory Medicine Mar 2020Metabolomics is a powerful new analytical method to describe the set of metabolites within cellular tissue and bodily fluids. Metabolomics can uncover detailed... (Review)
Review
Metabolomics is a powerful new analytical method to describe the set of metabolites within cellular tissue and bodily fluids. Metabolomics can uncover detailed information about metabolic changes in organisms. The morphology of these metabolites represents the metabolic processes that occur in cells, such as anabolism, catabolism, inhomogeneous natural absorption and metabolism, detoxification, and metabolism of biomass energy. Because the metabolites of different diseases are different, the specificity of the changes can be found by metabolomics testing, which provides a new source of biomarkers for the early identification of diseases and the difference between benign and malignant states. Metabolomics has a wide application potential in pancreatic diseases, including early detection, diagnosis, and identification of pancreatic diseases. However, there are few studies on metabolomics in pancreatic diseases in the literature. This article reviews the application of metabolomics in the diagnosis, prognosis, treatment, and evaluation of pancreatic diseases.
Topics: Biomarkers; Diagnostic Tests, Routine; Disease Management; Early Diagnosis; Humans; Metabolomics; Pancreatic Diseases; Prognosis; Sensitivity and Specificity
PubMed: 31340007
DOI: 10.1093/labmed/lmz046 -
Scandinavian Journal of Gastroenterology 2023The prevalence of non-alcoholic fatty pancreas disease (NAFPD) is estimated as 2-46% among patients without known pancreatic diseases. An association between NAFPD and...
INTRODUCTION
The prevalence of non-alcoholic fatty pancreas disease (NAFPD) is estimated as 2-46% among patients without known pancreatic diseases. An association between NAFPD and non-alcoholic fatty liver disease (NAFLD) has been proposed, as well as an association between NAFPD and pancreatic exocrine insufficiency (PEI).
PATIENTS AND METHODS
Patients with histologically confirmed NAFLD were included in the study. The control group consisted of individuals included in a surveillance screening program. Magnetic resonance imaging (MRI) of the pancreas was performed in all patients and fat measurement was made using 2-point Dixon imaging. Fecal elastase-1 (FE-1) was performed to evaluate pancreatic exocrine function. Additionally, a C-mixed triglyceride breath test (13 C-MTG-BT) was performed in patients with FE-1 < 200 μg/g.
RESULTS
Imaging signs of NAFPD were present in 17 (71%) patients; 11 (85%) from the NAFLD group and 6 (55%) from the control group. FE-1 < 200 μg/g was found in six (25%) patients (four in the NAFLD group and two in the control group); however, none of them had clinical symptoms of PEI. Therefore, in five out of six patients with low FE-1, a C-MTG-BT was performed, showing normal results (>20.9%) in all tested patients. Furthermore, the serum nutritional panel was normal in all patients with low FE-1. A systematic review identified five studies relevant to the topic.
CONCLUSION
NAFPD was found in 85% of patients with NAFLD and in 55% of control patients. We did not diagnose PEI in either group. A literature review showed PEI in 9-56% of patients with NAFPD.
Topics: Humans; Non-alcoholic Fatty Liver Disease; Pilot Projects; Pancreatic Diseases; Exocrine Pancreatic Insufficiency; Pancreas
PubMed: 37088949
DOI: 10.1080/00365521.2023.2200452 -
Romanian Journal of Internal Medicine =... Sep 2019Obesity is a growing health burden worldwide, increasing the risk for several diseases featuring the metabolic syndrome - type 2 diabetes mellitus, dyslipidemia,... (Review)
Review
Obesity is a growing health burden worldwide, increasing the risk for several diseases featuring the metabolic syndrome - type 2 diabetes mellitus, dyslipidemia, non-alcoholic fatty liver disease and cardiovascular diseases. With the increasing epidemic of obesity, a new pathologic condition has emerged as a component of the metabolic syndrome - that of non-alcoholic fatty pancreas disease (NAFPD). Similar to non-alcoholic fatty liver disease (NAFLD), NAFPD comprises a wide spectrum of disease - from deposition of fat in the pancreas - fatty pancreas, to pancreatic inflammation and possibly pancreatic fibrosis. In contrast with NAFLD, diagnostic evaluation of NAFPD is less standardized, consisting mostly in imaging methods. Also the natural evolution of NAFPD and its association with pancreatic cancer is much less studied. Not least, the clinical consequences of NAFPD remain largely presumptions and knowledge about its metabolic impact is limited. This review will cover epidemiology, pathogenesis, diagnostic evaluation tools and treatment options for NAFPD, with focus on practices for clinicians.
Topics: Adipose Tissue; Endosonography; Humans; Metabolic Syndrome; Obesity; Pancreatic Diseases; Tomography, X-Ray Computed
PubMed: 30901317
DOI: 10.2478/rjim-2019-0005 -
Gastrointestinal Endoscopy Clinics of... Oct 2023Chronic pancreatitis (CP) is an ongoing inflammatory disease with most patients developing pancreatic calculi during their course of disease. Extracorporeal shock wave... (Review)
Review
Chronic pancreatitis (CP) is an ongoing inflammatory disease with most patients developing pancreatic calculi during their course of disease. Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment option in patients with large lumen obstructing pancreatic duct (PD) stones. In patients with CP and PD dilatation, digital single-operator pancreatoscopy (DSOP)-guided lithotripsy seems to be an appealing option to ESWL and surgery. DSOP-guided lithotripsy for the treatment of large symptomatic PD-stones has been demonstrated to be safe, technically, and clinically effective, and should be regarded as an alternative endoscopic treatment of certain patients.
Topics: Humans; Pancreatic Diseases; Pancreatitis, Chronic; Lithotripsy; Endoscopes, Gastrointestinal; Pancreatic Ducts
PubMed: 37709413
DOI: 10.1016/j.giec.2023.04.001 -
The Israel Medical Association Journal... Apr 2020Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence...
BACKGROUND
Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence and outcome of pancreatic injuries are scarce.
OBJECTIVES
To assess the frequency and the clinical significance of pancreatic injuries during nephrectomy.
METHODS
A retrospective analysis was conducted of all patients who underwent nephrectomy over a period of 30 years (1987-2016) in a large tertiary medical center. Demographic, clinical, and surgical data were collected and analyzed.
RESULTS
A total of 1674 patients underwent nephrectomy during the study period. Of those, 553 (33%) and 294 patients (17.5%) underwent left nephrectomy and radical left nephrectomy, respectively. Among those, four patients (0.2% of the total group, 0.7% of the left nephrectomy group, and 1.36% of the radical left nephrectomy) experienced iatrogenic injuries to the pancreas. None of the injuries were recognized intraoperatively. All patients were treated with drains in an attempt to control the pancreatic leak and one patient required additional surgical interventions. Average length of stay was 65 days (range 15-190 days). Mean follow-up was 23.3 months (range 7.7-115 months).
CONCLUSIONS
Pancreatic injuries during nephrectomy are rare and carry a significant risk for postoperative morbidity.
Topics: Age Factors; Aged; Aged, 80 and over; Carcinoma, Renal Cell; Cohort Studies; Conservative Treatment; Female; Follow-Up Studies; Humans; Iatrogenic Disease; Israel; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Pancreas; Pancreatic Diseases; Reoperation; Retrospective Studies; Risk Assessment; Sex Factors; Survival Rate; Tertiary Care Centers
PubMed: 32286029
DOI: No ID Found -
Current Medicinal Chemistry 2022There has been substantial progress in artificial intelligence (AI) algorithms and their medical sciences applications in the last two decades. AI-assisted programs have... (Review)
Review
There has been substantial progress in artificial intelligence (AI) algorithms and their medical sciences applications in the last two decades. AI-assisted programs have already been established for remote health monitoring using sensors and smartphones. A variety of AI-based prediction models are available for gastrointestinal, inflammatory, non-malignant diseases, and bowel bleeding using wireless capsule endoscopy, hepatitis-associated fibrosis using electronic medical records, and pancreatic carcinoma utilizing endoscopic ultrasounds. AI-based models may be of immense help for healthcare professionals in the identification, analysis, and decision support using endoscopic images to establish prognosis and risk assessment of patients' treatment employing multiple factors. Enough randomized clinical trials are warranted to establish the efficacy of AI-algorithms assisted and non-AI-based treatments before approval of such techniques from medical regulatory authorities. In this article, available AI approaches and AI-based prediction models for detecting gastrointestinal, hepatic, and pancreatic diseases are reviewed. The limitations of AI techniques in such diseases' prognosis, risk assessment, and decision support are discussed.
Topics: Algorithms; Artificial Intelligence; Gastroenterology; Gastrointestinal Diseases; Humans; Pancreatic Diseases
PubMed: 33820515
DOI: 10.2174/0929867328666210405114938