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Pancreas Sep 2019Reliable pancreatic function tests in patients with chronic pancreatitis (CP) are needed. This cohort study identified malabsorption in people with CP compared with...
Pancreatic Function in Chronic Pancreatitis: A Cohort Study Comparing 3 Methods of Detecting Fat Malabsorption and the Impact of Short-term Pancreatic Enzyme Replacement Therapy.
OBJECTIVES
Reliable pancreatic function tests in patients with chronic pancreatitis (CP) are needed. This cohort study identified malabsorption in people with CP compared with healthy people and then investigated short-term pancreatic enzyme replacement therapy (PERT) and fat malabsorption, nutritional status, and quality of life (QOL).
METHODS
Subjects with CP were evaluated before and after PERT and compared with the healthy cohort using coefficient of fat absorption (CFA), stool bomb calorimetry, and the malabsorption blood test (MBT). Anthropometrics, micronutrients, and QOL data were collected. Group means at baseline and after PERT were analyzed.
RESULTS
The 24 subjects with CP had greater stool energy loss (5668 cal/g [standard deviation {SD}, 753] vs 5152 cal/g [SD, 418], P < 0.01), reduced triglyceride absorption (MBT, 8.3 mg·h/dL [SD, 4.3] vs 17.7 mg·h/dL [SD, 10.3], P < 0.001), lower fat intake, and poorer QOL. Differences in CFA were not significant (90.9% [SD, 12.8] vs 95.4% [SD, 9.3]). After PERT, triglyceride absorption (Δ = 1.7 [SD, 3], P < 0.05) and QOL increased.
CONCLUSIONS
The MBT detected changes in triglyceride absorption in the absence of CFA changes. The MBT may be helpful in guiding PERT initiation in patients with CP before significant morbidity.
Topics: Adult; Cohort Studies; Enzyme Replacement Therapy; Exocrine Pancreatic Insufficiency; Fats; Female; Humans; Malabsorption Syndromes; Male; Middle Aged; Nutritional Status; Outcome Assessment, Health Care; Pancreas; Pancreatic Function Tests; Pancreatitis, Chronic; Pancrelipase; Quality of Life; Triglycerides
PubMed: 31404029
DOI: 10.1097/MPA.0000000000001381 -
American Journal of Physiology.... Feb 2018The effect of pancreatic exocrine insufficiency (PEI) on protein malabsorption is little documented, partly due to methodological barriers. We aimed to validate...
The effect of pancreatic exocrine insufficiency (PEI) on protein malabsorption is little documented, partly due to methodological barriers. We aimed to validate biomarkers of protein malabsorption using a N test meal in a minipig model of PEI. Six pancreatic duct-ligated minipigs were used as a model of PEI and four nonoperated animals as a control. All animals were equipped with an ileocecal reentrant cannula. Minipigs were given a test meal containing [N]casein. The PEI animals repeated the test three times, in the absence of any pancreatic enzymes, or after pancreatic substitution at two levels [ A or B: 7,500 or 75,000 (lipase) and 388 or 3881 (protease) FIP U]. Ileal chyme, urine, and blood were collected postprandially. Nitrogen and N were measured in digestive and metabolic pools. We obtained a gradient of ileal protein digestibility from 29 ± 11% in PEI to 89 ± 6% in the controls and a dose- dependent response of enzymes. Insulin and gastric inhibitory polypeptide secretions were decreased by PEI, an effect that was counteracted with the enzymes at level B. The total recovery of N in urinary urea and plasma proteins was 14 ± 5.1% in the control group and decreased to 5.5 ± 2.1% by PEI. It was dose dependently restored by the treatment. Both N recovery in plasma and urine were correlated to protein digestibility. We confirm that the N transfer in those pools is a sensitive marker of protein malabsorption. Nevertheless, an optimization of the test meal conditions would be necessary in the view of implementing a clinical test. NEW & NOTEWORTHY We designed an intervention study to create a gradient of ileal protein digestibility in minipigs with pancreatic exocrine insufficiency and to validate reliable metabolic markers using a N oral meal test. N recovery in plasma proteins and to a higher extent in urine was sensitive to protein malabsorption. This test is minimally invasive and could be used to reveal protein malabsorption in patients.
Topics: Animals; Biomarkers; Blood Glucose; Caseins; Digestion; Disease Models, Animal; Energy Metabolism; Enzyme Replacement Therapy; Exocrine Pancreatic Insufficiency; Gastric Inhibitory Polypeptide; Ileum; Insulin; Malabsorption Syndromes; Pancrelipase; Postprandial Period; Swine; Swine, Miniature; Time Factors; Urea
PubMed: 29074486
DOI: 10.1152/ajpgi.00218.2017 -
Gut Sep 1980Fifteen patients with cystic fibrosis and pancreatic insufficiency were studied during four randomised seven day treatment periods in which they received only pancreatic... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Fifteen patients with cystic fibrosis and pancreatic insufficiency were studied during four randomised seven day treatment periods in which they received only pancreatic supplement (Pancrelipase, 27 capsules per day) or supplement plus cimetidine (20 mg/kg body weight/24 h) or sodium bicarbonate (15 g/m2/24 h) alone or in combination. Dietary intake was not fixed but was restricted to foods of known fat and nitrogen content from which daily intakes could be computed. Faecal fat and nitrogen were calculated as g/24 h and percentage of intake. Addition of either cimetidine or bicarbonate resulted in significant improvement in fat and nitrogen excretion, which was not greater with the combination of both drugs. Cimetidine and sodium bicarbonate in these doses are therefore sufficient to produce maximal improvement in digestive activity of pancreatic supplements. Fat excretion per gram of intake fell with cimetidine and bicarbonate from 12 times the normal level, to normal, in patients consuming less than 120 g fat daily. Above this intake the dose of pancreatic supplement appeared to be inadequate. Faecal nitrogen excretion increased with nitrogen intake in all four periods, but, in contrast with fat excretion, the response to cimetidine and bicarbonate was not affected by the level of intake. Dietary intake appears to be a significant factor in determining the faecal output of fat and nitrogen in patients with pancreatic insufficiency and should be considered when determining the optimum amount of pancreatic supplementation.
Topics: Adolescent; Bicarbonates; Celiac Disease; Child; Cimetidine; Cystic Fibrosis; Dietary Fats; Drug Therapy, Combination; Exocrine Pancreatic Insufficiency; Feces; Guanidines; Humans; Lipase; Nitrogen; Pancreatic Extracts; Pancrelipase
PubMed: 7429342
DOI: 10.1136/gut.21.9.778 -
Plants (Basel, Switzerland) Feb 2024In the present study, different intensities of UV-A were applied to compare their effects on growth, bioactive compounds and hypoglycemia-related enzyme activities in...
In the present study, different intensities of UV-A were applied to compare their effects on growth, bioactive compounds and hypoglycemia-related enzyme activities in broccoli and radish sprouts. The growth of sprouts was decreased after UV-A irradiation. A total of 12 W of UV-A irradiation resulted in the highest content of anthocyanin, chlorophyll, polyphenol and ascorbic acid in broccoli and radish sprouts. The highest soluble sugar content was recorded in sprouts under 8 W of UV-A irradiation, while no significant difference was obtained in soluble protein content among different UV-A intensities. Furthermore, 12 W of UV-A irradiation induced the highest glucosinolate accumulation, especially glucoraphanin and glucoraphenin in broccoli and radish sprouts, respectively; thus, it enhanced sulforaphane and sulforaphene formation. The α-amylase, α-glucosidase and pancrelipase inhibitory rates of two kinds of sprouts were enhanced significantly after UV-A irradiation, indicating UV-A-irradiation-treated broccoli and radish sprouts have new prospects as hypoglycemic functional foods.
PubMed: 38337982
DOI: 10.3390/plants13030450 -
Pancreas Jul 2019Pancreatic cancer (PC) and its treatments can result in pancreatic exocrine insufficiency that requires pancreatic enzyme replacement therapy (PERT). Appropriate PERT...
OBJECTIVES
Pancreatic cancer (PC) and its treatments can result in pancreatic exocrine insufficiency that requires pancreatic enzyme replacement therapy (PERT). Appropriate PERT usage is during meals and snacks. The aim was to determine the frequency of appropriate use of PERT and its impact on symptom alleviation in PC through a patient-reported outcomes online platform.
METHODS
Users in the Pancreatic Cancer Action Network's Patient Registry were prompted to answer a standalone questionnaire about their experience with PERT.
RESULTS
Two hundred sixty-two users completed the PERT questionnaire (January 2016-January 2018). Patients who reported taking PERT with meals had higher alleviation of symptoms compared with those taking PERT prior to or after meals. Specifically, "feeling of indigestion," "light-colored or orange stools," and "visible food particles in stool" were significantly decreased. Patients taking PERT with meals reported weight gain and less weight loss.
CONCLUSIONS
Of the 89% of PC patients prescribed PERT, 65% were prescribed PERT appropriately with all meals and snacks. Overall compliance with PERT administration guidelines was low (50% [105/208]). Improvement in symptoms significantly correlated with appropriate use of PERT. Increase in PC patient and provider education about appropriate PERT usage and administration is warranted.
Topics: Adult; Aged; Aged, 80 and over; Enzyme Replacement Therapy; Exocrine Pancreatic Insufficiency; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Neoplasms; Pancrelipase; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Young Adult
PubMed: 31210656
DOI: 10.1097/MPA.0000000000001330 -
Molecules (Basel, Switzerland) May 2012Oxidation of low-density lipoprotein (LDL) is the principal risk factor for the development of atherosclerosis. In this study, we used several methods to investigate the...
Oxidation of low-density lipoprotein (LDL) is the principal risk factor for the development of atherosclerosis. In this study, we used several methods to investigate the ability of the acetone extract from rhizomes, stems, leaves, flowers, pericarps and seeds of Alpinia zerumbet to inhibit atherosclerosis in vitro. The seed extract had the strongest activity against tyrosinase, pancreatic lipase (PL), 15-lipoxygenase (15-LO) and LDL oxidation activities (IC₅₀ = 2.30 ± 0.02, 5.00 ± 0.07, 1.29 ± 0.07 and 15.40 ± 0.86 μg/mL, respectively), amongst all different parts. It also had similar effects to the positive controls. Most of the extracts showed partial agonistic properties towards estrogenic activity. Cholest-4-ene-3,6-dione, a steroid present only in the seed extract seems to be the compound responsible for these activities. The results showed that cholest-4-ene-3,6-dione had similar ability to curcumin and quercetin against PL and LDL oxidation (IC₅₀ = 19.50 ± 1.17 and 16.12 ± 1.43 μg/mL, respectively). Furthermore, cholest-4-ene-3,6-dione (IC₅₀ = 34.21 ± 1.31 μg/mL) had higher inhibition against 15-LO than quercetin (IC₅₀ = 54.79 ± 1.12 μg/mL).
Topics: Acetone; Alpinia; Antioxidants; Atherosclerosis; Dose-Response Relationship, Drug; Enzyme Inhibitors; Gas Chromatography-Mass Spectrometry; Humans; Inhibitory Concentration 50; Lipoproteins, LDL; Lipoxygenase Inhibitors; Monophenol Monooxygenase; Oxidation-Reduction; Pancrelipase; Plant Extracts; Seeds; Solvents
PubMed: 22634836
DOI: 10.3390/molecules17066237 -
Frontiers in Medicine 2022Pancreatic Exocrine Insufficiency (PEI) is a possible cause of recurrent/persistent symptoms in celiac disease. Although pancreatic enzyme supplementation may be used to...
BACKGROUND
Pancreatic Exocrine Insufficiency (PEI) is a possible cause of recurrent/persistent symptoms in celiac disease. Although pancreatic enzyme supplementation may be used to treat non-responsive celiac disease (NRCD) in clinical practice, clinical outcomes are variable and there is limited and low quality evidence to support this practice. The aim of this study was to assess the efficacy of pancreatic enzyme supplements (PES) for improvement of gastrointestinal symptoms in NRCD.
METHODS
Prospective, randomized, placebo-controlled, double-blind, cross-over trial in adults with NRCD examining Celiac Disease-Gastrointestinal Symptom Rating Scale (CeD-GSRS) scores on PES (pancrelipase co-administered with omeprazole) versus placebo (omeprazole only) during a 10-day treatment period. The study was registered under the clinical trials registry (https://clinicaltrials.gov/ number, NCT02475369) on 18 Jun 2015.
RESULTS
Twelve participants (nine female) were included in the per-protocol analysis; one participant had low fecal elastase-1. Pancrelipase was not associated with significant change in CeD-GSRS compared to placebo (-0.03 versus -0.26; = 0.366). There was a significant decrease in mean values of total CeD-GSRS scores (3.58 versus 2.90, = 0.004), abdominal pain (2.92 versus 2.42, = 0.009), and diarrhea sub-scores (3.44 versus 2.92, = 0.037) during the run-in period with omeprazole.
CONCLUSION
In this prospective, cross-over randomized, placebo-controlled study, PES did not improve symptoms in patients with NRCD. It is unclear whether this is a trial effect or related to administration of omeprazole.
PubMed: 36687454
DOI: 10.3389/fmed.2022.1001879 -
Bioscience, Biotechnology, and... Jan 2003The differences are reported in the triacylglycerol (TG) structures of oils containing gamma-linolenic acid (GLA) from Oenothera biennis Linn seed oil (OBLO) from the...
The differences are reported in the triacylglycerol (TG) structures of oils containing gamma-linolenic acid (GLA) from Oenothera biennis Linn seed oil (OBLO) from the wild plant, evening primrose seed oil (EPO) from a cultured plant, and bio-GLA oil (BIO) from a mold, the physiological functions of which were ascertained by animal testing. Reverse-phase high-performance liquid chromatographic separation detected 12 TG peaks each for OBLO and EPO, and 28 TG peaks for BIO. TG-containing GLA were composed of five molecular species each in OBLO and EPO, and ten molecular species in BIO. The totals of the molecular species containing GLA were 29.8% in OBLO, 23.8% in EPO, and 56.6% in BIO. In OBLO, the GLA level at the sn-2 position of the major TG species was higher than that in EPO. In BIO, the GLA level at the sn-2 position of the major TG species was lower than those in OBLO and EPO.
Topics: Chromatography, Gas; Chromatography, High Pressure Liquid; Fatty Acids; Fatty Acids, Essential; Hydrolysis; Linoleic Acids; Linseed Oil; Oenothera biennis; Pancrelipase; Plant Oils; Seeds; Triglycerides; gamma-Linolenic Acid
PubMed: 12619674
DOI: 10.1271/bbb.67.60 -
American Journal of Physiology. Cell... Jan 2001Immunocytochemistry showed expression of aquaporin-1 (AQP1) water channels at sites involved in dietary fat processing, including intrahepatic cholangiocytes,...
Immunocytochemistry showed expression of aquaporin-1 (AQP1) water channels at sites involved in dietary fat processing, including intrahepatic cholangiocytes, gallbladder, pancreatic microvascular endothelium, and intestinal lacteals. To determine whether AQP1 has a role in dietary fat digestion and/or absorption, mice were placed on a diet that contained 50% fat. Whereas wild-type mice (3-3.5 wk of age, 10-12 g) gained 49 +/- 5% (SE, n = 50) body weight in 8 days, and heterozygous mice gained 46 +/- 4%, AQP1 null mice gained only 4 +/- 3%; weights became similar after return to a 6% fat diet after 6 days. The null mice on a high-fat diet acquired an oily appearance, developed steatorrhea with increased stool triglyceride content, and manifested serum hypotriglyceridemia. Supplementation of the high-fat diet with pancreatic enzymes partially corrected the decreased weight gain in null mice. Absorption of [(14)C]oleic acid from small intestine was not affected by AQP1 deletion, as determined by blood radioactivity after duodenal infusion. Lipase activity in feces and small intestine was remarkably greater in AQP1 null than wild-type mice on low- and high-fat diets. Fluid collections done in older mice (that are less sensitive to a high-fat diet) by ductal cannulation showed threefold increased pancreatic fluid flow in response to secretin/cholecystokinin, but volumes, pH, and amylase activities were affected little by AQP1 deletion, nor were bile flow rates and bile salt concentrations. Together, these results establish a dietary fat misprocessing defect in AQP1 null mice.
Topics: Age Factors; Animals; Aquaporin 1; Aquaporins; Body Weight; Celiac Disease; Dietary Fats; Digestive System; Digestive System Diseases; Eating; Fatty Acids; Food, Formulated; Gallbladder; Intestine, Small; Lipase; Liver; Mice; Mice, Knockout; Mice, Transgenic; Pancreas; Pancrelipase
PubMed: 11121384
DOI: 10.1152/ajpcell.2001.280.1.C126 -
PloS One 2017Type 1 diabetes (T1D) is an autoimmune proinflammatory disease with no effective intervention. A major obstacle in developing new immunotherapies for T1D is the lack of...
Type 1 diabetes (T1D) is an autoimmune proinflammatory disease with no effective intervention. A major obstacle in developing new immunotherapies for T1D is the lack of means for monitoring immune responsiveness to experimental therapies. The LEW1.WR1 rat develops autoimmunity following infection with the parvovirus Kilham rat virus (KRV) via mechanisms linked with activation of proinflammatory pathways and alterations in the gut bacterial composition. We used this animal to test the hypothesis that intervention with agents that block innate immunity and diabetes is associated with a shift in the gut microbiota. We observed that infection with KRV results in the induction of proinflammatory gene activation in both the spleen and pancreatic lymph nodes. Furthermore, administering animals the histone deacetylase inhibitor ITF-2357 and IL-1 receptor antagonist (Anakinra) induced differential STAT-1 and the p40 unit of IL-12/IL-23 gene expression. Sequencing of bacterial 16S rRNA genes demonstrated that both ITF-2357 and Anakinra alter microbial diversity. ITF-2357 and Anakinra modulated the abundance of 23 and 8 bacterial taxa in KRV-infected animals, respectively, of which 5 overlapped between the two agents. Lastly, principal component analysis implied that ITF-2357 and Anakinra induce distinct gut microbiomes compared with those from untreated animals or rats provided KRV only. Together, the data suggest that ITF-2357 and Anakinra differentially influence the innate immune system and the intestinal microbiota and highlight the potential use of the gut microbiome as a surrogate means of assessing anti-inflammatory immune effects in type 1 diabetes.
Topics: Animals; Biodiversity; Biomarkers; Diabetes Mellitus, Type 1; Feces; High-Throughput Nucleotide Sequencing; Hydroxamic Acids; Immunity, Innate; Interleukin 1 Receptor Antagonist Protein; Intestines; Lymph Nodes; Microbiota; Pancrelipase; Parvovirus; Principal Component Analysis; RNA, Ribosomal, 16S; Rats; Rats, Inbred Lew; Spleen
PubMed: 28301545
DOI: 10.1371/journal.pone.0173968