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Bhullar FA, Faghih M, Akshintala VS, Ahmed AI, Lobner K, Afghani E, Phillips AE, Hart PA, Ramsey ML, Bick BL, Kuhlmann L, Drewes AM, Yadav D, Olesen SS, Singh VK. Prevalence of primary painless chronic pancreatitis: A systematic review and meta-analysis. Pancreatology 2022; 22:20-29. [PMID: 34840065 PMCID: PMC8785146 DOI: 10.1016/j.pan.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND/OBJECTIVES While pain is the predominant symptom of chronic pancreatitis (CP), a subset of patients may experience a painless course. This systematic review aimed to determine the prevalence of primary painless CP. METHODS MEDLINE (PubMed), EMBASE and Web of Science Core Collection databases were searched for published studies through September 15, 2020 that included at least 10 consecutive patients with CP and which reported the number with painless CP. The presence of a history of recurrent acute pancreatitis (RAP), exocrine pancreatic insufficiency (EPI), diabetes mellitus (DM) and pancreatic adenocarcinoma (PA) in the painless CP patients was also recorded. A random effects model was used to determine pooled prevalence estimates with 95% confidence intervals (95% CI). RESULTS Among the 5057 studies identified and screened, 42 full-text articles were included in the final analysis. There were a total of 14,277 patients with CP among whom 1569 had painless CP. The pooled prevalence of painless CP was 12% (95% CI 10-15%). Among a subset of studies that reported on calcifications (n = 11), DM (n = 12), EPI (n = 8) and history of RAP (n = 14), the pooled prevalence estimates were 96% (95% CI 73-100%), 51% (95% CI 32-70%), and 47% (95% CI 15-81%), respectively. Alcohol, idiopathic/genetic and other etiologies were attributed to be the cause of painless CP in 32.4%, 56.9% and 8.9% patients, respectively. CONCLUSION Approximately one in ten patients with CP have primary painless disease with the majority being attributable to an idiopathic/genetic etiology. Further research is needed to determine the optimal management of these patients.
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Affiliation(s)
- Furqan A. Bhullar
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mahya Faghih
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Venkata S. Akshintala
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ahmed I. Ahmed
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Katie Lobner
- William H. Welch Medical Library, Johns Hopkins University, Baltimore, MD, USA
| | - Elham Afghani
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA,Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Anna E. Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mitchell L. Ramsey
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin L. Bick
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indiana, USA
| | - Louise Kuhlmann
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn M. Drewes
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Søren S. Olesen
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Vikesh K. Singh
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA,Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Talukdar R, Sarkar P, Jakkampudi A, Sarkar S, Aslam M, Jandhyala M, Deepika G, Unnisa M, Reddy DN. The gut microbiome in pancreatogenic diabetes differs from that of Type 1 and Type 2 diabetes. Sci Rep 2021; 11:10978. [PMID: 34040023 PMCID: PMC8155207 DOI: 10.1038/s41598-021-90024-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
We hypothesized that the gut microbiome in patients with diabetes secondary to chronic pancreatitis (Type 3c) is different from those with Type 1 and Type 2 diabetes. This was a cross-sectional preliminary study that included 8 patients with Type 1, 10 with Type 2, 17 with Type 3c diabetes and 9 healthy controls. Demographic, clinical, biochemical, imaging and treatment data were recorded and sequencing of the V3–V4 region of the bacterial 16SrRNA was done on fecal samples. Bioinformatics and statistical analyses was performed to evaluate the differences in the diversity indices, distance matrices, relative abundances and uniqueness of organisms between the types of diabetes. There was significant difference in the species richness. Beta diversity was significantly different between patients with Type 3c diabetes and the other groups. 31 genera were common to all the three types of diabetes. There was significant differences in the species level taxa between Type 3c diabetes and the other groups. The unique bacterial species signature in Type 3c diabetes compared to Type 1 and Type 2 diabetes included Nesterenkonia sp. AN1, Clostridium magnum, Acinetobacter lwoffii, Clostridium septicum, Porphyromonas somerae, Terrabacter tumescens, and Synechococus sp.
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Affiliation(s)
- Rupjyoti Talukdar
- Pancreas Research Group and Division of Gut Microbiome Research, Wellcome DBT India Alliance Laboratories, Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, 500032, India. .,Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
| | - Priyanka Sarkar
- Pancreas Research Group and Division of Gut Microbiome Research, Wellcome DBT India Alliance Laboratories, Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, 500032, India
| | - Aparna Jakkampudi
- Pancreas Research Group and Division of Gut Microbiome Research, Wellcome DBT India Alliance Laboratories, Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, 500032, India
| | - Subhaleena Sarkar
- Pancreas Research Group and Division of Gut Microbiome Research, Wellcome DBT India Alliance Laboratories, Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, 500032, India
| | - Mohsin Aslam
- Department of Endocrinology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manasa Jandhyala
- Pancreas Research Group and Division of Gut Microbiome Research, Wellcome DBT India Alliance Laboratories, Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, 500032, India
| | - G Deepika
- Department of Biochemistry, Asian Institute of Gastroenterology, Hyderabad, India
| | - Misbah Unnisa
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Talukdar R, Reddy DN, Tandan M, Gupta R, Lakhtakia S, Ramchandani M, Kalapala R, Basha J, Nabi Z, Reddy M, Darishetty S, Koppoju V, Pradeep R, Rao GV. Impact of ductal interventions on diabetes in patients with chronic pancreatitis. J Gastroenterol Hepatol 2021; 36:1226-1234. [PMID: 33000865 DOI: 10.1111/jgh.15279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/29/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Even though ductal interventions in chronic pancreatitis (CP) are known to improve pain, its impact on diabetes is unclear. In this cohort study, we evaluated the impact of ductal interventions on diabetes in these patients. METHODS Consecutive patients with CP visiting the pancreas clinic between August 1, 2011, and July 21, 2012, were enrolled and followed until December 2018. Detailed clinical, laboratory, imaging, and treatment data were recorded at enrolment and follow-up. Patients were followed up every 6 months through hospital visit and/or telephonic interview. Risk factors for diabetes were evaluated using logistic regression. The impact of ductal interventions on diabetes was evaluated using Kaplan-Meier survival analyses and Cox proportional hazards. RESULTS A total of 644 patients were enrolled of which 137 were excluded. Of these, 326 (64.3%) patients had idiopathic CP, and 283 (55.8%) patients underwent ductal intervention. The cumulative incidence of diabetes was 57.9%. Median duration between symptom onset and ductal intervention was similar irrespective of diabetes (2.6 [0.6-6.0] vs 3.0 [1.0-5.5] years; P = 0.69). Alcohol intake and pancreatic ductal calculi were independent risk factors for diabetes (odds ratio [95% confidence interval] of 2.05 (1.18-3.55), P = 0.01, and 2.05 (1.28-3.28), P = 0.003, respectively). Kaplan-Meier analyses revealed that diabetes free interval was significantly longer in patients undergoing ductal interventions, predominantly in those with idiopathic CP with obstructive ductal calculi (hazard ratio [95% confidence interval] 0.39 [0.28-0.55]; P < 0.0001). There were no differences in glycemic status in patients with non-idiopathic CP and those with pre-existing diabetes. CONCLUSION Early ductal intervention could delay development of diabetes in patients with idiopathic CP with obstructive ductal calculi.
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Affiliation(s)
- Rupjyoti Talukdar
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.,Wellcome DBT Laboratories, Institute of Basic Sciences and Translational Research, Hyderabad, India.,Pancreas Research Group, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rakesh Kalapala
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jahangeer Basha
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manohar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Santosh Darishetty
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Vinod Koppoju
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - R Pradeep
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - G Venkat Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Anand U, Khandelwal C, Senthilnathan P, Sabnis SC, Palanivelu C, Kumar B, Kumar R, Priyadarshi RN, Parasar K. The Current Concepts and Management of Idiopathic (Tropical) Chronic Pancreatitis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Aslam M, Jagtap N, Karyampudi A, Talukdar R, Reddy DN. Risk factors for development of endocrine insufficiency in chronic pancreatitis. Pancreatology 2021; 21:15-20. [PMID: 33257226 DOI: 10.1016/j.pan.2020.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
UNLABELLED Endocrine insufficiency is a common and frequent complication of chronic pancreatitis. Identifying the role of pancreatic damage in the development of diabetes is important for early identification and appropriate management. METHODS All consecutive CP patients between January 2019 and May 2020 were retrospectively studied. Relevant statistical tests were performed. A two sided p value < 0.05 was considered statistically significant. RESULTS Total 587 chronic pancreatitis patients were included of which 118 (20.1%) patients developed diabetes with duration of 12 (IQR 4-48) months. Older age (OR 1.079; 95% CI 1.045-1.113; p < 0.001), presence of pancreatic parenchymal (OR 2.284; 95% CI 1.036-5.038; p = 0.041) and ductal (OR 2.351; 95% CI 1.062-5.207; p = 0.035) calcifications, exocrine insufficiency (OR 6.287; 95% CI 2.258-17.504; p < 0.001), and pancreatic duct stricture (OR 3.358; 95% CI 1.138-9.912; p = 0.028) were independently associated with development of diabetes mellitus in chronic pancreatitis patients. On cox-regression analysis, smoking (HR 2.370; 95% CI 1.290-4.354; p = 0.005) and pancreatic ductal calcification (HR 2.033; 95% CI 1.286-3.212; p = 0.002) were independently associated with earlier onset of diabetes mellitus in patients with chronic pancreatitis. CONCLUSION Pancreatic calcification, pancreatic duct stricture and pancreatic exocrine insufficiency are associated with development of diabetes mellitus in chronic pancreatitis indicating disease progression. Smoking is the modifiable risk factors associated with early onset of diabetes mellitus in CP patients.
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Affiliation(s)
- Mohsin Aslam
- Asian Institute of Gastroenterology, Hyderabad, India.
| | - Nitin Jagtap
- Asian Institute of Gastroenterology, Hyderabad, India
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Paengsai N, Jourdain G, Salvadori N, Tantraworasin A, Mary JY, Cressey TR, Chaiwarith R, Bowonwatanuwong C, Bhakeecheep S, Kosachunhanun N. Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings. Open Forum Infect Dis 2019; 6:ofz298. [PMID: 31660327 PMCID: PMC6778321 DOI: 10.1093/ofid/ofz298] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/06/2019] [Indexed: 01/21/2023] Open
Abstract
Objective The use of some antiretroviral drugs has been associated with a higher risk of diabetes mellitus (DM) in HIV-infected patients, but the risk associated with antiretroviral drug combinations remains unclear. We investigated the association between first-line antiretroviral therapy (ART) regimens, recommended by the World Health Organization (WHO) in 2016, and the risk of DM in adults. Method We selected all HIV-infected adults within the Thai National AIDS Program who started a first-line ART regimen consisting the following between October 2006 and September 2013: zidovudine+lamivudine+nevirapine; tenofovir disoproxil fumarate (TDF)+lamivudine+nevirapine; zidovudine+lamivudine+efavirenz; TDF+lamivudine/emtricitabine+efavirenz; zidovudine+lamivudine+ritonavir-boosted lopinavir (LPV/r); or TDF+lamivudine+LPV/r. Diagnosis of DM was defined as having at least 2 of the following characteristics: fasting plasma glucose ≥126 mg/dl, 2010 WHO ICD-10 codes E11-E14, or prescription of antidiabetic drugs. To identify ART regimens associated with DM, we used competing risks regression models that considered mortality without DM as a competing event and adjusted for sex, age, pancreas disease, and stratified by groups defined by a score summarizing the propensity to receive a specific first-line ART regimen. Results Data from 35 710 adults (49.1% male; median age, 35.0 years; median follow-up, 2.0 years) were included. In the multivariable analysis with zidovudine+lamivudine+nevirapine as the reference group, a higher risk of DM was observed with TDF+lamivudine/emtricitabine+efavirenz (adjusted sub-distribution hazard ratio [aSHR], 1.6; 95% confidence interval [CI], 1.3–1.9), zidovudine+lamivudine+efavirenz (aSHR, 2.0; 95% CI, 1.7–2.3), and TDF+lamivudine+LPV/r (aSHR, 2.7; 95% CI, 1.9–3.9). Conclusions Several of the WHO recommended ART regimens, particularly tenofovir + lamivudine +LPV/r and regimens containing efavirenz, may be associated with an increased risk of DM.
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Affiliation(s)
- Ninutcha Paengsai
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Thailand.,National Health Security Office, Bangkok, Thailand
| | - Gonzague Jourdain
- Institut de Recherche pour le Developpement (IRD), France.,Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Apichat Tantraworasin
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand
| | - Jean Yves Mary
- INSERM UMR 1135, Equipe ECSTRA, Centre de Recherche Epidémiologie et Biostatistique Sorbonne Paris Cité, Université Paris Diderot, France
| | - Tim Roy Cressey
- Institut de Recherche pour le Developpement (IRD), France.,Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Molecular and Clinical Pharmacology, University of Liverpool, United Kingdom
| | - Romanee Chaiwarith
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand
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