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Nelson HA. Preanalytical and analytical factors affecting elastase quantitation in stool. Clin Biochem 2024; 131-132:110811. [PMID: 39153524 DOI: 10.1016/j.clinbiochem.2024.110811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024]
Abstract
Exocrine pancreatic insufficiency (EPI) is a condition caused by a deficiency of exocrine pancreatic enzymes, resulting in malabsorption of nutrients. Clinical manifestations of EPI may include steatorrhea, weight loss, diarrhea, and abdominal pain. Although direct testing is the most sensitive and specific for EPI, these tests are invasive, time consuming, expensive, and not well standardized. Fecal elastase (FE-1) has been shown to be an indirect marker of the exocrine secretory capacity of the pancreas and has become the most commonly employed indirect test for diagnosis of EPI. Measurement of fecal elastase consists of two main phases, a preanalytical phase and analytical phase. The preanalytical phase involves stool collection, storage and handling. The second phase is the analytical phase, which includes the actual assay processes and products used to produce a result. For FE-1 this includes sample extraction and measurement on an immunoassay. Each step in the process can influence the result and contribute to heterogeneity in FE-1 measurement, potentially impacting clinical diagnosis and management. Thus, this paper provides an overview of the preanalytical and analytical factors that can affect measurement and interpretation of FE-1 results.
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Affiliation(s)
- Heather A Nelson
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT 84108, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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2
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Narang M, Singh A, Mahapatra SJ, Gunjan D, Sharma S, Srivastava DN, Yadav R, Dash NR, Bansal VK, Pandey RM, Garg PK, Madhusudhan KS. Utility of dual-energy CT and advanced multiparametric MRI based imaging biomarkers of pancreatic fibrosis in grading the severity of chronic pancreatitis. Abdom Radiol (NY) 2024; 49:3528-3539. [PMID: 38900324 DOI: 10.1007/s00261-024-04443-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To non-invasively quantify pancreatic fibrosis and grade severity of chronic pancreatitis (CP) on dual-energy CT (DECT) and multiparametric MRI (mpMRI). METHODS We included 72 patients (mean age:30years; 59 men) with suspected or confirmed CP from December 2019 to December 2021 graded as equivocal(n = 20), mild(n = 18), and moderate-marked(n = 34) using composite imaging and endoscopic ultrasound criteria. Study patients underwent multiphasic DECT and mpMRI of the abdomen. Normalized iodine concentration(NIC) and fat fraction(FF) on 6-minute delayed DECT, and T1 relaxation time(T1Rt), extracellular volume fraction(ECVf), intravoxel incoherent motion-based perfusion fraction(PF), and magnetization transfer ratio(MTR) on mpMRI of pancreas were compared. 20 renal donors(for DECT) and 20 patients with renal mass(for mpMRI) served as controls. RESULTS NIC of pancreas in controls and progressive grades of CP were 0.24 ± 0.05, 0.80 ± 0.18, 1.06 ± 0.23, 1.40 ± 0.36, FF were 9.28 ± 5.89, 14.19 ± 5.29, 17.31 ± 5.99, 29.32 ± 12.22, T1Rt were 590.11 ± 61.13, 801.93 ± 211.01, 1006.79 ± 352.18, 1388.01 ± 312.23ms, ECVf were 0.07 ± 0.03, 0.30 ± 0.12, 0.41 ± 0.12, 0.53 ± 0.13, PF were 0.38 ± 0.04, 0.28 ± 0.07, 0.25 ± 0.09, 0.21 ± 0.05 and MTR were 0.12 ± 0.03, 0.15 ± 0.06, 0.21 ± 0.07, 0.26 ± 0.06, respectively. There were significant differences for all quantitative parameters between controls and mild CP; for NIC, PF, and ECVf between controls and progressive CP grades (p < 0.05). Area under curve for NIC, FF, T1Rt, ECVf, PF, and MTR in differentiating controls and mild CP were 1.00, 0.86, 0.95, 1.00, 0.90 and 0.84 respectively and for NIC, FF, ECVf and PF in differentiating controls and equivocal CP were 1.00, 0.76, 0.95 and 0.92 respectively. CONCLUSION DECT and mpMRI were useful in quantifying pancreatic fibrosis and grading the severity of CP. NIC was the most accurate marker.
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Affiliation(s)
- Mohak Narang
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Anup Singh
- Centre for Biomedical Engineering, Indian Institute of Technology, Hauz Khas, New Delhi, 10029, India
| | - Soumya Jagannath Mahapatra
- Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Deepak Gunjan
- Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Sanjay Sharma
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Deep Narayan Srivastava
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Rajni Yadav
- Departments of Pathology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Nihar Ranjan Dash
- Departments of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Virinder Kumar Bansal
- Departments of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Ravindra Mohan Pandey
- Departments of Biostatistics, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Pramod Kumar Garg
- Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Kumble Seetharama Madhusudhan
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India.
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Tirkes T. Advances in MRI of Chronic Pancreatitis. ADVANCES IN CLINICAL RADIOLOGY 2024; 6:31-39. [PMID: 39185367 PMCID: PMC11339961 DOI: 10.1016/j.yacr.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
MRI and MRCP play an essential role in diagnosing CP by imaging pancreatic parenchyma and ducts. Quantitative and semi-quantitative MR imaging offers potential advantages over conventional MR imaging, including simplicity of analysis, quantitative and population-based comparisons, and more direct interpretation of disease progression or response to drug therapy. Using parenchymal imaging techniques may provide quantitative metrics for determining the presence and severity of acinar cell loss and aid in diagnosing CP. Given that the parenchymal changes of CP precede the ductal involvement, there would be a significant benefit from developing a new MRI/MRCP based, more robust diagnostic criteria combining ductal and parenchymal findings.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA
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Chen Z, Wang H, Jiang T. Value of Two-Dimensional Shear-Wave Elastography in Differentiating Pancreatic Steatosis From Pancreatic Fibrosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39152758 DOI: 10.1002/jum.16541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES Pancreatic steatosis (PS) and pancreatic fibrosis (PF) both show increased pancreatic echogenicity on conventional B-mode ultrasound. In this study, we assessed the applicability of two-dimensional shear-wave elastography (2D-SWE) for their discrimination. METHODS We gathered data from 120 adults with valid 2D-SWE measurements, comprising 40 healthy individuals, 55 individuals diagnosed with PS via non-enhanced computed tomography (CT), and 25 patients clinically diagnosed with non-calcific chronic pancreatitis. The participants were divided into three groups: normal pancreas (NP), PS, and PF. pancreatic echogenicity, pancreatic stiffness, and CT values between groups were analyzed. RESULTS The 2D-SWE and CT values among the NP, PS, and PF groups all showed significant differences (P < .001). For the diagnosis of PS and PF using 2D-SWE, the area under the curve (AUC) values were 0.9100 and 0.9940, respectively, with optimal cut-off values of 5.7 kPa for predicting PS and 8.2 kPa for predicting PF. CONCLUSIONS The 2D-SWE technique enabled rapid and quantitative assessment of the hardness of hyperechoic pancreas visualized on conventional B-mode ultrasound, which holds certain value in distinguishing PS from PF.
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Affiliation(s)
- Zhenzhen Chen
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huiyang Wang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Pulsed Electric Field Technology for Medical Transformation of Zhejiang Province, Hangzhou, China
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Baldaque P, Coutinho G, de Lima Moreira JP, Luiz RR, Fogaça HS, de Souza LMP, de Souza HSP. Chronic Pancreatitis in a Large Developing Country: Temporal Trends of Over 64,000 Hospitalizations from 2009 to 2019. Dig Dis Sci 2024; 69:2817-2827. [PMID: 38816599 DOI: 10.1007/s10620-024-08488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND/OBJECTIVES Chronic pancreatitis (CP) is a progressive inflammatory disorder associated with marked morbidity and mortality and frequently requires hospitalization. This study aimed to investigate the time trends and geographical distribution of hospital admissions, the lethality rate of CP across Brazil, and the potential relationship with social indicators and associated risk factors. METHODS Data were retrospectively obtained from the Brazilian Public Health System Registry between January 2009 and December 2019. The prevalence and lethality rates of CP per 100,000 inhabitants in each municipality were estimated from hospitalizations to in-hospital deaths and classified by age, sex, and demographic features. RESULTS During the study period, 64,609 admissions were retrieved, and most of the patients were males (63.54%). Hospitalization decreased by nearly half (-54.68%) in both sexes. CP rates in males were higher in all age groups. The greatest reduction in admissions (- 64%) was also noted in patients ≥ 70y. CP In-hospital lethality remained stable (5-6%) and similar for males and females. Patients ≥ 70y showed the highest lethality. The greatest increase in CP lethality rates (+ 10%) was observed in municipalities integrated into metropolises, which was mainly driven by small-sized municipalities (+ 124%). CONCLUSIONS CP hospitalizations decrease in both urban and rural areas, particularly in the North, Northeast, and Central-West regions, and in those above 70 years of age, but are not correlated with lethality rates in the South. This suggests ongoing changes in the environmental and socioeconomic factors in Brazil.
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Affiliation(s)
- Pedro Baldaque
- Department of Clinical Medicine, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Rio de Janeiro, 21941-913, Brazil
| | - Gabriela Coutinho
- Department of Clinical Medicine, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Rio de Janeiro, 21941-913, Brazil
| | | | - Ronir Raggio Luiz
- Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, 21941-598, Brazil
| | - Homero Soares Fogaça
- Department of Clinical Medicine, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Rio de Janeiro, 21941-913, Brazil
| | - Lucila Marieta Perrotta de Souza
- Department of Clinical Medicine, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Rio de Janeiro, 21941-913, Brazil
| | - Heitor Siffert Pereira de Souza
- Department of Clinical Medicine, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Rio de Janeiro, 21941-913, Brazil.
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, 22281-100, Brazil.
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Siprelle K, Kennedy AJ, Hill EB, Hinton A, Shi N, Madril P, Grainger E, Taylor C, Nahikian-Nelms M, Spees C, Tabung FK, Hart PA, Roberts KM. An Improved Assessment Method to Estimate (Poly)phenol Intake in Adults with Chronic Pancreatitis. Dig Dis Sci 2024; 69:2996-3007. [PMID: 38850506 PMCID: PMC11341752 DOI: 10.1007/s10620-024-08417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/26/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Insights into (poly)phenol exposure represent a modifiable factor that may modulate inflammation in chronic pancreatitis (CP), yet intake is poorly characterized and methods for assessment are underdeveloped. AIMS The aims are to develop and test a method for estimating (poly)phenol intake from a 90-day food frequency questionnaire (FFQ) using the Phenol-Explorer database and determine associations with dietary patterns in CP patients versus controls via analysis of previously collected cross-sectional data. METHODS Fifty-two CP patients and 48 controls were recruited from an ambulatory clinic at a large, academic institution. To assess the feasibility of the proposed methodology for estimating dietary (poly)phenol exposure, a retrospective analysis of FFQ data was completed. Mann-Whitney U tests were used to compare (poly)phenol intake by group; Spearman correlations and multivariable-adjusted log-linear associations were used to compare (poly)phenol intakes with dietary scores within the sample. RESULTS Estimation of (poly)phenol intake from FFQs was feasible and produced estimates within a range of intake previously reported. Total (poly)phenol intake was significantly lower in CP vs controls (463 vs. 567mg/1000kcal; p = 0.041). In adjusted analyses, higher total (poly)phenol intake was associated with higher HEI-2015 (r = 0.34, p < 0.001), aMED (r = 0.22, p = 0.007), EDIH (r = 0.29, p < 0.001), and EDIP scores (r = 0.35, p < 0.001), representing higher overall diet quality and lower insulinemic and anti-inflammatory dietary potentials, respectively. CONCLUSIONS Using enhanced methods to derive total (poly)phenol intake from an FFQ is feasible. Those with CP have lower total (poly)phenol intake and less favorable dietary pattern indices, thus supporting future tailored dietary intervention studies in this population.
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Affiliation(s)
- Katharine Siprelle
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave, Columbus, OH, 43210, USA
- The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - Ashley J Kennedy
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave, Columbus, OH, 43210, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - Emily B Hill
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave, Columbus, OH, 43210, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, 1841 Neil Ave, Columbus, OH, 43210, USA
- The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - Ni Shi
- Molecular Carcinogenesis and Chemoprevention Program, The Ohio State University, Comprehensive Cancer Center, 410 W. 12th Ave, Columbus, OH, 43210, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - Peter Madril
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave, Columbus, OH, 43210, USA
| | - Elizabeth Grainger
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - Christopher Taylor
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave, Columbus, OH, 43210, USA
| | - Marcia Nahikian-Nelms
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave, Columbus, OH, 43210, USA
| | - Colleen Spees
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave, Columbus, OH, 43210, USA
| | - Fred K Tabung
- Molecular Carcinogenesis and Chemoprevention Program, The Ohio State University, Comprehensive Cancer Center, 410 W. 12th Ave, Columbus, OH, 43210, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - Phil A Hart
- The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - Kristen M Roberts
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave, Columbus, OH, 43210, USA.
- The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Columbus, OH, 43210, USA.
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Wekerle M, Murillo K, vonBoscamp M, Hauber V, Ebert MP, Antoni C, Hirth M. Point-shear wave elastography generated by acoustic radiation force impulse in chronic pancreatitis. United European Gastroenterol J 2024; 12:667-677. [PMID: 38363191 PMCID: PMC11250422 DOI: 10.1002/ueg2.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/19/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Transcutaneous point-shear wave elastography (p-SWE) performed using an acoustic radiation force impulse can be used to quantify pancreatic stiffness in chronic pancreatitis (CP). We aimed to evaluate its usefulness to diagnose and monitor CP. METHODS 175 participants were included in this prospective study including patients with CP (n = 65), liver cirrhosis (LC; n = 60), alcohol abuse (n = 10) and healthy controls (n = 40). Point-shear wave elastography of the pancreas was performed and quantified as median shear wave velocity (SWV). In the same way, p-SWE of the spleen served as a marker of portal hypertension. The M-ANNHEIM Severity score was used as global marker for disease activity in CP. RESULTS Compared to healthy controls, pancreatic SWV was significantly elevated in CP (1.38 vs. 0.96 m/s; p < 0.0001, MWU-test). Pancreatic SWV was increased in alcoholic CP but not in hereditary CP. Receiver operating characteristic analysis revealed 1.2 m/s as the optimal cut-off to identify non-heredity-CP subjects (90% specificity; 81% sensitivity; 92% positive predictive value). Pancreatic SWV correlated significantly with the M-ANNHEIM Severity score, severity of CP-typical complications (both p < 0.05, linear regression analysis), morphological changes of the pancreas and need for hospital treatment (both p < 0.05, MWU-test) but not with exocrine or endocrine insufficiency. Pancreatic SWV >1.7 m/s was identified to predict M-ANNHEIM Severity score ≥11 points. Pancreatic SWV was also elevated in LC (1.42 m/s; p < 0.001), correlating with increased splenic SWV. CONCLUSION Transcutaneous pancreatic p-SWE represents a bedside, cost-effective and non-invasive tool which adds valuable information to the process of diagnosing and monitoring CP. By portal hypertension, an increased pancreatic SWV must be expected.
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Affiliation(s)
- Maximilian Wekerle
- Department of Medicine IIMedical Faculty at MannheimUniversity of HeidelbergMannheimGermany
| | - Katharina Murillo
- Department of Medicine IIMedical Faculty at MannheimUniversity of HeidelbergMannheimGermany
| | - Manuel vonBoscamp
- Department of Medicine IIMedical Faculty at MannheimUniversity of HeidelbergMannheimGermany
| | - Veronika Hauber
- Department of Medicine IIMedical Faculty at MannheimUniversity of HeidelbergMannheimGermany
| | - Matthias P. Ebert
- Department of Medicine IIMedical Faculty at MannheimUniversity of HeidelbergMannheimGermany
| | - Christoph Antoni
- Department of Medicine IIMedical Faculty at MannheimUniversity of HeidelbergMannheimGermany
| | - Michael Hirth
- Department of Medicine IIMedical Faculty at MannheimUniversity of HeidelbergMannheimGermany
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Ciccarelli G, Di Giuseppe G, Soldovieri L, Quero G, Nista EC, Brunetti M, Cinti F, Moffa S, Capece U, Tondolo V, Mari A, Gasbarrini A, Pontecorvi A, Alfieri S, Giaccari A, Mezza T. Beta-cell function and glucose metabolism in patients with chronic pancreatitis. Eur J Intern Med 2024:S0953-6205(24)00246-2. [PMID: 38871564 DOI: 10.1016/j.ejim.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/20/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
AIMS Chronic pancreatitis (CP) is - along with acute pancreatitis - the most frequent cause of diabetes of the exocrine pancreas (DEP). Although insulin deficiency is widely accepted as the major feature of DEP, it is still unclear whether diabetes associated with CP is characterized by additional or different functional defects of the insulin secretory machinery. To identify possible functional defects specifically induced by CP, we performed a cross-sectional study in individuals with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes mellitus (DM) comparing patients with and without CP (CP vs. NCP). METHODS We administered an oral glucose tolerance test (OGTT) to all participants and, according to their glucose tolerance, classified them as NGT, IGT and DM. Insulin sensitivity and beta-cell functional parameters were derived from OGTT, hyperglycemic clamp and hyperinsulinemic euglycemic clamp. RESULTS Studying 146 subjects, we found that beta-cell function and insulin secretion were significantly lower in CP compared to NCP patients. However, when we classified the subjects according to OGTT-derived glucose tolerance, we found no differences in beta-cell function or in insulin sensitivity between CP and NCP with the same glucose tolerance status. Of note, we found that arginine-stimulated insulin secretion is reduced only in subjects with CP and DM compared to NCP subjects with DM. CONCLUSIONS Patients with CP had no specific alterations in insulin secretion and beta-cell function. However, in patients diagnosed with diabetes, we found a lower arginine-stimulated insulin secretion, a marker of reduced functional mass.
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Affiliation(s)
- Gea Ciccarelli
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Di Giuseppe
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Soldovieri
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Quero
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Celestino Nista
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Pancreas Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Michela Brunetti
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Cinti
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Moffa
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Capece
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Andrea Mari
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Antonio Gasbarrini
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Pancreas Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrea Giaccari
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Teresa Mezza
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Pancreas Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
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Othman MO, Forsmark C, Yadav D, Singh VK, Lara LF, Park W, Zhang Z, Yu J, Kort JJ. Development of clinical screening tool for exocrine pancreatic insufficiency in patients with definite chronic pancreatitis. Pancreatology 2024; 24:545-552. [PMID: 38693039 DOI: 10.1016/j.pan.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND/OBJECTIVES No simple, accurate diagnostic tests exist for exocrine pancreatic insufficiency (EPI), and EPI remains underdiagnosed in chronic pancreatitis (CP). We sought to develop a digital screening tool to assist clinicians to predict EPI in patients with definite CP. METHODS This was a retrospective case-control study of patients with definite CP with/without EPI. Overall, 49 candidate predictor variables were utilized to train a Classification and Regression Tree (CART) model to rank all predictors and select a parsimonious set of predictors for EPI status. Five-fold cross-validation was used to assess generalizability, and the full CART model was compared with 4 additional predictive models. EPI misclassification rate (mRate) served as primary endpoint metric. RESULTS 274 patients with definite CP from 6 pancreatitis centers across the United States were included, of which 58 % had EPI based on predetermined criteria. The optimal CART decision tree included 10 variables. The mRate without/with 5-fold cross-validation of the CART was 0.153 (training error) and 0.314 (prediction error), and the area under the receiver operating characteristic curve was 0.889 and 0.682, respectively. Sensitivity and specificity without/with 5-fold cross-validation was 0.888/0.789 and 0.794/0.535, respectively. A trained second CART without pancreas imaging variables (n = 6), yielded 8 variables. Training error/prediction error was 0.190/0.351; sensitivity was 0.869/0.650, and specificity was 0.728/0.649, each without/with 5-fold cross-validation. CONCLUSION We developed two CART models that were integrated into one digital screening tool to assess for EPI in patients with definite CP and with two to six input variables needed for predicting EPI status.
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Affiliation(s)
| | | | | | | | | | | | - Zuoyi Zhang
- AbbVie Inc., Data & Statistical Sciences, North Chicago, IL, USA
| | - Jun Yu
- AbbVie Inc., Data & Statistical Sciences, North Chicago, IL, USA
| | - Jens J Kort
- AbbVie Inc., Medical Affairs, Mettawa, IL, USA
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10
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Gumpper-Fedus K, Crowe O, Hart PA, Pita-Grisanti V, Velez-Bonet E, Belury MA, Ramsey M, Cole RM, Badi N, Culp S, Hinton A, Lara L, Krishna SG, Conwell DL, Cruz-Monserrate Z. Differences in Plasma Fatty Acid Composition Related to Chronic Pancreatitis: A Pilot Study. Pancreas 2024; 53:e416-e423. [PMID: 38530954 PMCID: PMC11087201 DOI: 10.1097/mpa.0000000000002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Chronic pancreatitis (CP) is an inflammatory disease affecting the absorption of fat-soluble nutrients. Signaling in pancreatic cells that lead to inflammation may be influenced by fatty acids (FAs) through diet and de novo lipogenesis. Here, we investigated the relationship between plasma FA composition in CP with heterogeneity of etiology and complications of CP. MATERIALS AND METHODS Blood and clinical parameters were collected from subjects with CP (n = 47) and controls (n = 22). Plasma was analyzed for FA composition using gas chromatography and compared between controls and CP and within CP. RESULTS Palmitic acid increased, and linoleic acid decreased in CP compared with controls. Correlations between age or body mass index and FAs are altered in CP compared with controls. Diabetes, pancreatic calcifications, and substance usage, but not exocrine pancreatic dysfunction, were associated with differences in oleic acid and linoleic acid relative abundance in CP. De novo lipogenesis index was increased in the plasma of subjects with CP compared with controls and in calcific CP compared with noncalcific CP. CONCLUSIONS Fatty acids that are markers of de novo lipogenesis and linoleic acid are dysregulated in CP depending on the etiology or complication. These results enhance our understanding of CP and highlight potential pathways targeting FAs for treating CP.
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Affiliation(s)
- Kristyn Gumpper-Fedus
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Olivia Crowe
- The Ohio State University College of Medicine, Columbus, OH
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Valentina Pita-Grisanti
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
- Program of Human Nutrition, College of Education and Human Ecology, The Ohio State University Columbus, OH
| | - Ericka Velez-Bonet
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
- Program of Human Nutrition, College of Education and Human Ecology, The Ohio State University Columbus, OH
| | - Martha A. Belury
- Department of Food Science and Technology, College of Food, Agriculture, and Environmental Sciences, The Ohio State University Columbus, OH
| | - Mitchell Ramsey
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rachel M Cole
- Department of Food Science and Technology, College of Food, Agriculture, and Environmental Sciences, The Ohio State University Columbus, OH
| | - Niharika Badi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Stacey Culp
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alice Hinton
- Division of Biostatistics, College of Public Heath, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Luis Lara
- Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Darwin L. Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
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11
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Omer E, Chiodi C. Fat digestion and absorption: Normal physiology and pathophysiology of malabsorption, including diagnostic testing. Nutr Clin Pract 2024; 39 Suppl 1:S6-S16. [PMID: 38429963 DOI: 10.1002/ncp.11130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/06/2023] [Accepted: 12/28/2023] [Indexed: 03/03/2024] Open
Abstract
Fat digestion and absorption play crucial roles in maintaining energy homeostasis and supporting essential physiological functions. The initial stage of fat digestion occurs in the stomach, where gastric lipase begins the hydrolysis of triglycerides. However, most fat digestion takes place in the small intestine via pancreatic enzymes and bile salts. Emulsification of fat by bile acids facilitates enzymatic action, breaking down triglycerides into free fatty acids and monoglycerides, which are then able to be absorbed by enterocytes. Fat malabsorption can result from various underlying conditions, such as exocrine pancreatic insufficiency, bile acid disorders, or intestinal diseases. The clinical manifestations of fat malabsorption include steatorrhea, malnutrition, and deficiencies of fat-soluble vitamins. Diagnostic approaches involve assessing fecal fat levels, imaging studies, and various functional tests to identify the specific etiology. This review article will describe the normal physiologic process of fat digestion and absorption and discuss various pathophysiology that can lead to fat malabsorption within the gastrointestinal tract as well as their respective diagnostic testing modalities. Effective digestion of fat is essential for overall health, because it allows for absorption of many essential nutrients, plays an integral role in cellular and structural function, and supplies energy to the body. When this is dysfunctional, disorders of malabsorption can occur. This article will give a brief overview of the physiologic process of fat digestion and absorption in healthy individuals as well as review important pathophysiology that can lead to fat malabsorption within the gastrointestinal tract and current diagnostic testing modalities.
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Affiliation(s)
- Endashaw Omer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Cristina Chiodi
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
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12
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Hart PA, Osypchuk Y, Hovbakh I, Shah RJ, Nieto J, Cote GA, Avgaitis S, Kremzer O, Buxbaum J, Inamdar S, Fass R, Phillips RW, Yadav D, Ladd AM, Al-Assi MT, Gardner T, Conwell DL, Irani S, Sheikh A, Nuttall J. A Randomized Controlled Phase 2 Dose-Finding Trial to Evaluate the Efficacy and Safety of Camostat in the Treatment of Painful Chronic Pancreatitis: The TACTIC Study. Gastroenterology 2024; 166:658-666.e6. [PMID: 38103842 DOI: 10.1053/j.gastro.2023.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND & AIMS Chronic pancreatitis (CP) causes an abdominal pain syndrome associated with poor quality of life. We conducted a clinical trial to further investigate the efficacy and safety of camostat, an oral serine protease inhibitor that has been used to alleviate pain in CP. METHODS This was a double-blind randomized controlled trial that enrolled adults with CP with a baseline average daily worst pain score ≥4 on a numeric rating system. Participants were randomized (1:1:1:1) to receive camostat at 100, 200, or 300 mg 3 times daily or placebo. The primary end point was a 4-week change from baseline in the mean daily worst pain intensity score (0-10 on a numeric rating system) using a mixed model repeated measure analysis. Secondary end points included changes in alternate pain end points, quality of life, and safety. RESULTS A total of 264 participants with CP were randomized. Changes in pain from baseline were similar between the camostat groups and placebo, with differences of least squares means of -0.11 (95% CI, -0.90 to 0.68), -0.04 (95% CI, -0.85 to 0.78), and -0.11 (95% CI, -0.94 to 0.73) for the 100 mg, 200 mg, and 300 mg groups, respectively. Multiple subgroup analyses were similar for the primary end point, and no differences were observed in any of the secondary end points. Treatment-emergent adverse events attributed to the study drug were identified in 42 participants (16.0%). CONCLUSION We were not able to reject the null hypothesis of no difference in improvements in pain or quality of life outcomes in participants with painful CP who received camostat compared with placebo. Studies are needed to further define mechanisms of pain in CP to guide future clinical trials, including minimizing placebo responses and selecting targeted therapies. CLINICALTRIALS gov, Number: NCT02693093.
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Affiliation(s)
- Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Yurii Osypchuk
- Department of General Surgery, Odesa Regional Hospital, Odesa, Ukraine
| | - Iryna Hovbakh
- Department of General Practice-Family Medicine, Kharkov Medical Academy of Postgraduate Education, Kharkiv, Ukraine
| | - Raj J Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jose Nieto
- Advanced Therapeutic Endoscopy Center, Borland Groover Clinic, Jacksonville, Florida
| | - Gregory A Cote
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | | | | | - James Buxbaum
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Cleveland, Ohio
| | | | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Antonio Mendoza Ladd
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
| | | | - Timothy Gardner
- Division of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shayna Irani
- Division of Gastroenterology, Virginia Mason Hospital and Medical Center, Seattle, Washington
| | - Aasim Sheikh
- Gastrointestinal Specialists of Georgia, Marietta, Georgia
| | - Janet Nuttall
- Kangen Pharmaceuticals, America LLC, Kansas City, Kansas
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13
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Samanta A, Vadlapudi SS, Srivastava A, Mohindra S, Sen Sarma M, Poddar U, Saraswat VA, Mishra P. Risk Factors for Post-Endoscopic Retrograde Cholangio-Pancreatography Pancreatitis in Children With Chronic Pancreatitis and Its Prediction Using 4-Hour Postprocedure Serum Amylase and Lipase Levels. Pancreas 2024; 53:e247-e253. [PMID: 38227737 DOI: 10.1097/mpa.0000000000002296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP) is seen in 3% to 16% of children undergoing therapeutic endoscopic retrograde cholangio-pancreatography (ERCP). We evaluated the risk factors of PEP and utility of 4-hour post-ERCP amylase and lipase for early prediction of PEP in children with chronic pancreatitis (CP). MATERIALS AND METHODS Thirty children with CP (boys 20, 14.3 [interquartile range, 9.3-16] years) who underwent 62 ERCP procedures were studied. Clinical and procedural details with outcome were noted. Serum amylase and lipase were measured before, 4 hours, and 24 hours after ERCP. Multivariate analysis was done to identify risk factors for PEP. Cutoff scores of 4-hour amylase and lipase were identified. RESULTS PEP occurred in 14.5% (9/62) of ERCP procedures (mild, 8; moderate, 1) with no mortality. On univariate analysis, endoscopic sphincterotomy ( P = 0.04), difficult cannulation ( P = 0.004), and prior PEP ( P = 0.036) were risk factors, while prior ERCP ( P = 0.04) was protective. Difficult cannulation (odds ratio, 5.83; 95% confidence interval, 1.329-25.592) was the independent risk factor on multivariate analysis overall and for first ERCP session alone. Amylase >3.3 times upper limit of normal (ULN) and lipase of >5 times ULN at 4 hours had best sensitivity and specificity for diagnosis of PEP. All cases with PEP were symptomatic by 6 hours and none had amylase/lipase <3 ULN at 4 hours. Amylase/lipase of <3 ULN at 4 hours could exclude PEP with good sensitivity (100%) and specificity (76% and 81%, respectively). CONCLUSIONS PEP occurred in 14.5% of procedures in children with CP, with difficult cannulation being the independent risk factor. Asymptomatic patients with 4-hour amylase/lipase <3 times ULN can be safely discharged.
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Affiliation(s)
| | | | | | | | | | - Ujjal Poddar
- From the Departments of Pediatric Gastroenterology
| | | | - Prabhakar Mishra
- Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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14
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Hines OJ, Pandol SJ. Management of chronic pancreatitis. BMJ 2024; 384:e070920. [PMID: 38408777 DOI: 10.1136/bmj-2023-070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Chronic pancreatitis results from repeated episodes of pancreatic inflammation and associated fibrosis leading to the loss of functional exocrine and endocrine pancreatic function. The disease is manifested by abdominal pain, deterioration in quality of life, food maldigestion and malabsorption, diabetes, and an increased risk for pancreatic adenocarcinoma. This review summarizes the latest evidence on the diagnosis and management of chronic pancreatitis and its manifestations. In particular, this review discusses advances in understanding of the role of genetic disorders in the mechanisms of the disease and surgical options for patients refractory to medical therapy. Furthermore, clinical trials are under way to develop medical therapeutics.
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Affiliation(s)
- O Joe Hines
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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15
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Sun Y, Lu M, Feldman R, Saul M, Althouse A, Arteel G, Yadav D. Positive Predictive Value of Cirrhosis and Chronic Pancreatitis Diagnoses in Individuals with Alcohol Use Disorder: A Single-Center Study. Dig Dis Sci 2024; 69:596-602. [PMID: 38019381 DOI: 10.1007/s10620-023-08183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Although accuracy of diagnosis codes for cirrhosis and chronic pancreatitis (CP) has been evaluated in multiple studies, none have focused on patients with alcohol use disorders (AUD). We evaluated the positive predictive value (PPV) for a verified diagnosis of cirrhosis and CP in AUD patients treated at a tertiary care center. METHODS We performed a detailed review of electronic health records for AUD patients assigned ICD-9 or 10 codes for alcoholic cirrhosis (ALC) (n = 199), CP (n = 200), or both (n = 200). We calculated PPV for a verified diagnosis of cirrhosis and CP and performed multivariable regression analysis to assess the impact of relevant factors on PPV for a verified diagnosis. RESULTS PPV of cirrhosis was 81.2% (95% CI 77.0 to 84.9%) which increased to 87.5% (95% CI 83.8 to 90.6%) if the definition was relaxed to include alcohol-related hepatitis. PPV of CP was 54.5% (95% CI 49.5 to 59.5%) which increased to 78% (95% CI 73.6 to 82.0%) when recurrent acute pancreatitis was included in the definition. In multivariable analyses, the odds of a verified diagnosis were significantly higher in individuals aged 65+ years for both cirrhosis (OR 12.23, 95% CI 2.19 to 68.42) and CP (OR 8.84, 95% CI 2.7 to 28.93) and in ever smokers for CP (OR 1.95, 95% CI 1.05 to 3.65). CONCLUSION PPV for diagnosis codes in AUD patients is high for a verified diagnosis of cirrhosis but only modest for CP. While administrative datasets can provide reliable information for cirrhosis, future studies should focus on ways to boost the diagnostic validity of administrative datasets for CP.
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Affiliation(s)
- Yujie Sun
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Lu
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Feldman
- Center for Research on Health Care Data Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melissa Saul
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew Althouse
- Center for Research on Health Care Data Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gavin Arteel
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop Street, M2, C-wing, Pittsburgh, PA, 15213, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop Street, M2, C-wing, Pittsburgh, PA, 15213, USA.
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16
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Tirkes T, Yadav D, Conwell DL, Territo PR, Zhao X, Persohn SA, Dasyam AK, Shah ZK, Venkatesh SK, Takahashi N, Wachsman A, Li L, Li Y, Pandol SJ, Park WG, Vege SS, Hart PA, Topazian M, Andersen DK, Fogel EL. Diagnosis of chronic pancreatitis using semi-quantitative MRI features of the pancreatic parenchyma: results from the multi-institutional MINIMAP study. Abdom Radiol (NY) 2023; 48:3162-3173. [PMID: 37436452 PMCID: PMC10650972 DOI: 10.1007/s00261-023-04000-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To determine the diagnostic performance of parenchymal MRI features differentiating CP from controls. METHODS This prospective study performed abdominal MRI scans at seven institutions, using 1.5 T Siemens and GE scanners, in 50 control and 51 definite CP participants, from February 2019 to May 2021. MRI parameters included the T1-weighted signal intensity ratio of the pancreas (T1 score), arterial-to-venous enhancement ratio (AVR) during venous and delayed phases, pancreas volume, and diameter. We evaluated the diagnostic performance of these parameters individually and two semi-quantitative MRI scores derived using logistic regression: SQ-MRI Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume). RESULTS When compared to controls, CP participants showed a significantly lower mean T1 score (1.11 vs. 1.29), AVR venous (0.86 vs. 1.45), AVR delayed (1.07 vs. 1.57), volume (54.97 vs. 80.00 ml), and diameter of the head (2.05 vs. 2.39 cm), body (2.25 vs. 2.58 cm), and tail (1.98 vs. 2.51 cm) (p < 0.05 for all). AUCs for these individual MR parameters ranged from 0.66 to 0.79, while AUCs for the SQ-MRI scores were 0.82 and 0.81 for Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume), respectively. After propensity-matching adjustments for covariates, AUCs for Models A and B of the SQ-MRI scores increased to 0.92 and 0.93, respectively. CONCLUSION Semi-quantitative parameters of the pancreatic parenchyma, including T1 score, enhancement ratio, pancreas volume, diameter and multi-parametric models combining these parameters are helpful in diagnosis of CP. Longitudinal analyses including more extensive population are warranted to develop new diagnostic criteria for CP.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA.
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Darwin L Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Paul R Territo
- Division of Clinical Pharmacology, Stark Neurosciences Research Institute, Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Xuandong Zhao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Scott A Persohn
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zarine K Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Ashley Wachsman
- Department of Imaging, University of California in Los Angeles, Los Angeles, CA, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yan Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | | | - Phil A Hart
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Evan L Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN, USA
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17
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Coluzzi M, Takita M, Saracino G, Rub Hakim Mohammed A, Darden CM, Testa G, Beecherl E, Onaca N, Naziruddin B. Improved Quality of Life Among Chronic Pancreatitis Patients Undergoing Total Pancreatectomy With Islet Autotransplantation-Single Center Experience With Large Cohort of Patients. Transpl Int 2023; 36:11409. [PMID: 37727384 PMCID: PMC10505652 DOI: 10.3389/ti.2023.11409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Total pancreatectomy with islet autotransplantation (TPIAT) is the treatment of choice to preserve pancreatic endocrine function, alleviate pain, and improve quality of life (QoL) when other strategies are ineffective for chronic pancreatitis (CP) patients. This study utilized pancreatic disease-specific surveys developed by the European Organisation for Research and Treatment of Cancer (EORTC) to conduct a comprehensive, single-center examination of a large cohort of patients to gain understanding of QoL post-TPIAT. Two validated QoL surveys of the EORTC-QLQ-C30 and QLQ-PAN26-were administered in a prospective cohort of CP patients during pre-and post-operative scheduled visits. A total of 116 patients responded to the preoperative survey and were included in this study. The global health scale of QLQ-C30 was significantly improved after TPIAT when compared to baseline with delta scores of 24.26, 20.54, and 26.7 at 1, 2, and 3 years post-TPIAT (p < 0.001). The EORTC-PAN26 revealed significant improvements in symptom scales for pancreatic pain, bloating, digestive symptoms, taste, indigestion, weight loss, body image, and future worries. The comprehensive surveys in such a large cohort expands the QoL criterion in CP patients and indicates significant improvement in QoL post-TPIAT, further validating TPIAT as a treatment option for refractory CP.
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Affiliation(s)
- Mariagrazia Coluzzi
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, United States
- Unit of General and Emergency Surgery, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Morihito Takita
- Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan
| | - Giovanna Saracino
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, United States
| | | | - Carly M. Darden
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, United States
| | - Giuliano Testa
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, United States
| | - Ernest Beecherl
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, United States
| | | | - Bashoo Naziruddin
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, United States
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18
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Hsieh CC, Fu YH, Ku NE, Hsia CC, Hung YT, Hsu TJ, Chen SH, Kuo SJ. The Impact of Chronic Pancreatitis on the Occurrences of Human Cancers: Real-World Data. J Clin Med 2023; 12:5102. [PMID: 37568504 PMCID: PMC10420038 DOI: 10.3390/jcm12155102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Chronic pancreatitis (CP) may induce systemic inflammation, potentially increasing cancer susceptibility. However, the link between CP and extra-pancreatic cancer remains underexplored. Employing Taiwanese National Health Insurance Database data from 2000 to 2017, we compared 5394 CP patients with 21,576 non-CP individuals through propensity score matching. CP patients exhibited a significantly higher cancer risk (adjusted hazard ratio (aHR) of 1.32 for females and 1.68 for males) and cumulative incidence (p < 0.001) compared to non-CP individuals. CP showed notable associations with pancreatic (aHR = 3.51), liver (aHR = 1.62), stomach (aHR = 2.01), and other cancers (aHR = 2.09). In terms of liver cancer, CP was significantly associated with patients without viral hepatitis, regardless of gender (aHR = 2.01 for women; aHR = 1.54 for men). No significant cancer occurrences were observed within the first year following CP diagnosis. Pancreatic or liver cancer developed in approximately half of CP patients within 2-3 years, while gastric cancer in male CP patients predominantly occurred around the fifth year after diagnosis. These findings inform potential cancer-screening plans for CP patients.
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Affiliation(s)
- Chi-Chia Hsieh
- Department of Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Yi-Hsiu Fu
- Department of Education, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Nien-En Ku
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan; (N.-E.K.); (C.-C.H.)
| | - Chia-Chun Hsia
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan; (N.-E.K.); (C.-C.H.)
| | - Yu-Tung Hung
- Management Office for Health Data, China Medical University Hospital, Taichung 404327, Taiwan; (Y.-T.H.); (T.-J.H.)
| | - Tzu-Ju Hsu
- Management Office for Health Data, China Medical University Hospital, Taichung 404327, Taiwan; (Y.-T.H.); (T.-J.H.)
| | - Sung-Hsiung Chen
- Department of Orthopedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan
| | - Shu-Jui Kuo
- School of Medicine, China Medical University, Taichung 404328, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan
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19
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Yattoo GN, Mushfiq S, Kaushik S, Dar GA, Parveen S, Dhar N. Clinical Profile, Etiology and Role of Endotherapy in Chronic Calcific Pancreatitis: An Experience from North India. Middle East J Dig Dis 2023; 15:190-195. [PMID: 38023463 PMCID: PMC10660324 DOI: 10.34172/mejdd.2023.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background: In recent years, we have witnessed an evolving landscape in the management of chronic pancreatitis (CP). Endoscopy plays a pivotal role in CP management. Because the management of CP is problematic, we aimed to review and evaluate the role of endoscopy in the management of CP. Methods: This study was carried out in patients with painful chronic calcific pancreatitis who were admitted to the Department of Gastroenterology at the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar. This was an observational prospective study. We included 67 patients with painful chronic calcific pancreatitis and pancreatic duct abnormalities (stones, strictures, or ductal variations) in our study. These patients had to access exocrine and endocrine status before any therapeutic measures. All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP) as a therapeutic measure. After ERCP, the patients were followed up for 2 years to assess improvement in pain (visual analog scale score reduction), endocrine status (HBA1C reduction), or exocrine status (Fecal elastase reduction). Results: 67 patients were included in the study. Among them males were 32 (47.8%), females were 35(52.5%) and the age distribution studied were as in the age group of 15-30 years, patients were 23 (34.3%), in 30-45 years, there was 20 (29.9%), in age group of 45-60 year, patients were 20 (29.9%), and in the age group of 60-75 years, the patients were 4 (6%). Etiology was sought in all patients; alcohol-related CP was seen in three patients (4.5%), genetic in 11 (16.4%), IgG4 in one (1.5%), pancreatic divisum in 6 (9.0%), hyperparathyroidism in on1e (1.5%), and idiopathic in 45 (67.2%). All patients underwent ERCP for their symptoms to reduce ductal pressure, which is postulated as one of the hypotheses for pain in CP. Pancreatic duct (PD) clearance was attempted in all patients (complete in 42 [62.7%], partial in 17 [25.4%], and failed in 8 [11.9%]). These patients were followed for a period of two years after endotherapy, and the important predictors for pain reduction were single PD stones, disease in the head and body, and non-stricturing disease. Conclusion: Endotherapy offers a high rate of success in selected patients, clearance being better in distal disease and CP without PD strictures, suggesting early disease usually gets cleared very easily.
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Affiliation(s)
- G N Yattoo
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Syed Mushfiq
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Saurabh Kaushik
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Gulzar Ahmad Dar
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Shaheena Parveen
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Neeraj Dhar
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
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20
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Yuzyuk TN, Nelson HA, Johnson LM. Inherited causes of exocrine pancreatic insufficiency in pediatric patients: clinical presentation and laboratory testing. Crit Rev Clin Lab Sci 2023:1-16. [PMID: 36876586 DOI: 10.1080/10408363.2023.2179968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Pediatric patients with exocrine pancreatic insufficiency (EPI) have symptoms that include abdominal pain, weight loss or poor weight gain, malnutrition, and steatorrhea. This condition can be present at birth or develop during childhood for certain genetic disorders. Cystic fibrosis (CF) is the most prevalent disorder in which patients are screened for EPI; other disorders also are associated with pancreatic dysfunction, such as hereditary pancreatitis, Pearson syndrome, and Shwachman-Diamond syndrome. Understanding the clinical presentation and proposed pathophysiology of the pancreatic dysfunction of these disorders aids in diagnosis and treatment. Testing pancreatic function is challenging. Directly testing aspirates produced from the pancreas after stimulation is considered the gold standard, but the procedures are not standardized or widely available. Instead, indirect tests are often used in diagnosis and monitoring. Although indirect tests are more widely available and easier to perform, they have inherent limitations due to a lack of sensitivity and/or specificity for EPI.
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Affiliation(s)
- Tatiana N Yuzyuk
- Department of Pathology, University of Utah/ARUP Laboratories, Salt Lake City, UT, USA
| | - Heather A Nelson
- Department of Pathology, University of Utah/ARUP Laboratories, Salt Lake City, UT, USA
| | - Lisa M Johnson
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA
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21
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Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic Approach. Cancers (Basel) 2023; 15:cancers15030761. [PMID: 36765725 PMCID: PMC9913572 DOI: 10.3390/cancers15030761] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Chronic pancreatitis is one of the main risk factors for pancreatic cancer, but it is a rare event. Inflammation and oncogenes work hand in hand as key promoters of this disease. Tobacco is another co-factor. During alcoholic chronic pancreatitis, the cumulative risk of cancer is estimated at 4% after 15 to 20 years. This cumulative risk is higher in hereditary pancreatitis: 19 and 12% in the case of PRSS1 and SPINK1 mutations, respectively, at an age of 60 years. The diagnosis is difficult due to: (i) clinical symptoms of cancer shared with those of chronic pancreatitis; (ii) the parenchymal and ductal remodeling of chronic pancreatitis rendering imaging analysis difficult; and (iii) differential diagnoses, such as pseudo-tumorous chronic pancreatitis and paraduodenal pancreatitis. Nevertheless, the occurrence of cancer during chronic pancreatitis must be suspected in the case of back pain, weight loss, unbalanced diabetes, and jaundice, despite alcohol withdrawal. Imaging must be systematically reviewed. Endoscopic ultrasound-guided fine-needle biopsy can contribute by targeting suspicious tissue areas with the help of molecular biology (search for KRAS, TP53, CDKN2A, DPC4 mutations). Short-term follow-up of patients is necessary at the clinical and paraclinical levels to try to diagnose cancer at a surgically curable stage. Pancreatic surgery is sometimes necessary if there is any doubt.
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22
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Gumpper-Fedus K, Crowe O, Hart PA, Pita-Grisanti V, Velez-Bonet E, Belury MA, Ramsey M, Cole RM, Badi N, Culp S, Hinton A, Lara L, Krishna SG, Conwell DL, Cruz-Monserrate Z. Changes in Plasma Fatty Acid Abundance Related to Chronic Pancreatitis: A Pilot Study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.05.522899. [PMID: 36711757 PMCID: PMC9881940 DOI: 10.1101/2023.01.05.522899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives Chronic pancreatitis (CP) is an inflammatory disease that affects the absorption of nutrients like fats. Molecular signaling in pancreatic cells can be influenced by fatty acids (FAs) and changes in FA abundance could impact CP-associated complications. Here, we investigated FA abundance in CP compared to controls and explored how CP-associated complications and risk factors affect FA abundance. Methods Blood and clinical parameters were collected from subjects with (n=47) and without CP (n=22). Plasma was analyzed for relative FA abundance using gas chromatography and compared between controls and CP. Changes in FA abundance due to clinical parameters were also assessed in both groups. Results Decreased relative abundance of polyunsaturated fatty acids (PUFAs) and increased monounsaturated fatty acids (MUFAs) were observed in subjects with CP in a sex-dependent manner. The relative abundance of linoleic acid increased, and oleic acid decreased in CP subjects with exocrine pancreatic dysfunction and a history of substance abuse. Conclusions Plasma FAs like linoleic acid are dysregulated in CP in a sex-dependent manner. Additionally, risk factors and metabolic dysfunction further dysregulate FA abundance in CP. These results enhance our understanding of CP and highlight potential novel targets and metabolism-related pathways for treating CP.
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23
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Jeon C, Hart PA, Li L, Yang Y, Chang E, Bellin MD, Fisher WE, Fogel EL, Forsmark CE, Park WG, Van Den Eeden SK, Vege SS, Serrano J, Whitcomb DC, Andersen DK, Conwell DL, Yadav D, Goodarzi MO. Development of a Clinical Prediction Model for Diabetes in Chronic Pancreatitis: The PREDICT3c Study. Diabetes Care 2023; 46:46-55. [PMID: 36382801 PMCID: PMC9797648 DOI: 10.2337/dc22-1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Diabetes that arises from chronic pancreatitis (CP) is associated with increased morbidity and mortality. Methods to predict which patients with CP are at greatest risk for diabetes are urgently needed. We aimed to examine independent risk factors for diabetes in a large cohort of patients with CP. RESEARCH DESIGN AND METHODS This cross-sectional study comprised 645 individuals with CP enrolled in the PROCEED study, of whom 276 had diabetes. We conducted univariable and multivariable regression analyses of potential risk factors for diabetes. Model performance was assessed by area under the receiver operating characteristic curve (AUROC) analysis, and accuracy was evaluated by cross validation. Exploratory analyses were stratified according to the timing of development of diabetes relative to the diagnosis of pancreatitis. RESULTS Independent correlates of diabetes in CP included risk factors for type 2 diabetes (older age, overweight/obese status, male sex, non-White race, tobacco use) as well as pancreatic disease-related factors (history of acute pancreatitis complications, nonalcoholic etiology of CP, exocrine pancreatic dysfunction, pancreatic calcification, pancreatic atrophy) (AUROC 0.745). Type 2 diabetes risk factors were predominant for diabetes occurring before pancreatitis, and pancreatic disease-related factors were predominant for diabetes occurring after pancreatitis. CONCLUSIONS Multiple factors are associated with diabetes in CP, including canonical risk factors for type 2 diabetes and features associated with pancreatitis severity. This study lays the groundwork for the future development of models integrating clinical and nonclinical data to identify patients with CP at risk for diabetes and identifies modifiable risk factors (obesity, smoking) on which to focus for diabetes prevention.
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Affiliation(s)
- Christie Jeon
- Samuel Oschin Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Liang Li
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Yunlong Yang
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Eleanor Chang
- Samuel Oschin Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Melena D. Bellin
- Division of Endocrinology and Metabolism, Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN
| | | | - Evan L. Fogel
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, IN
| | - Christopher E. Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL
| | - Walter G. Park
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - David C. Whitcomb
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh and UPMC Medical Center, Pittsburgh, PA
| | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh and UPMC Medical Center, Pittsburgh, PA
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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24
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Borgbjerg J, Steinkohl E, Olesen SS, Akisik F, Bethke A, Bieliuniene E, Christensen HS, Engjom T, Haldorsen IS, Kartalis N, Lisitskaya MV, Naujokaite G, Novovic S, Ozola-Zālīte I, Phillips AE, Swensson JK, Drewes AM, Frøkjær JB. Inter- and intra-observer variability of computed tomography-based parenchymal- and ductal diameters in chronic pancreatitis: a multi-observer international study. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:306-317. [PMID: 36138242 DOI: 10.1007/s00261-022-03667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The need for incorporation of quantitative imaging biomarkers of pancreatic parenchymal and ductal structures has been highlighted in recent proposals for new scoring systems in chronic pancreatitis (CP). To quantify inter- and intra-observer variability in CT-based measurements of ductal- and gland diameters in CP patients. MATERIALS AND METHODS Prospectively acquired pancreatic CT examinations from 50 CP patients were reviewed by 12 radiologists and four pancreatologists from 10 institutions. Assessment entailed measuring maximum diameter in the axial plane of four structures: (1) pancreatic head (PDhead), (2) pancreatic body (PDbody), (3) main pancreatic duct in the pancreatic head (MPDhead), and (4) body (MPDbody). Agreement was assessed by the 95% limits of agreement with the mean (LOAM), representing how much a single measurement for a specific subject may plausibly deviate from the mean of all measurements on the specific subject. Bland-Altman limits of agreement (LoA) were generated for intra-observer pairs. RESULTS The 16 observers completed 6400 caliper placements comprising a first and second measurement session. The widest inter-observer LOAM was seen with PDhead (± 9.1 mm), followed by PDbody (± 5.1 mm), MPDhead (± 3.2 mm), and MPDbody (± 2.6 mm), whereas the mean intra-observer LoA width was ± 7.3, ± 5.1, ± 3.7, and ± 2.4 mm, respectively. CONCLUSION Substantial intra- and inter-observer variability was observed in pancreatic two-point measurements. This was especially pronounced for parenchymal and duct diameters of the pancreatic head. These findings challenge the implementation of two-point measurements as the foundation for quantitative imaging scoring systems in CP.
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Affiliation(s)
- Jens Borgbjerg
- Department of Radiology, Akershus University Hospital, 1478, Nordbyhagen, Norway
| | - Emily Steinkohl
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark.,Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Søren S Olesen
- Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Fatih Akisik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Ste 0663, Indianapolis, IN, 46202, USA
| | - Anne Bethke
- Department of Radiology, Akershus University Hospital, 1478, Nordbyhagen, Norway
| | - Edita Bieliuniene
- Department of Radiology, Lithuanian University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania
| | - Heidi S Christensen
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Trond Engjom
- Department of Medicine, University of Bergen, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway
| | - Ingfrid S Haldorsen
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway.,Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Ulriksdal 8, 5009, Bergen, Norway
| | - Nikolaos Kartalis
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, O-huset 42, 14186, Stockholm, Sweden.,Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, 14186, Stockholm, Sweden
| | - Maria V Lisitskaya
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark.,Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
| | - Gintare Naujokaite
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark
| | - Srdan Novovic
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Imanta Ozola-Zālīte
- Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Pilsoņu iela 13, Zemgales priekšpilsēta, Riga, 1002, Latvia
| | - Anna E Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jordan K Swensson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Ste 0663, Indianapolis, IN, 46202, USA
| | - Asbjørn M Drewes
- Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Jens B Frøkjær
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark.
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Han S, Conwell DL, Li L, Cervantes A, Hart PA, Cruz-Monserrate Z, Hao W, Lesinski GB, Mace T, Palermo TM, Saloman JL, Yadav D, Vege SS, Topazian M. The phase 1/2 trial of indomethacin in chronic pancreatitis (The PAIR trial): Protocol for a parallel multi-center randomized controlled trial. Pancreatology 2023; 23:42-47. [PMID: 36535851 PMCID: PMC9839482 DOI: 10.1016/j.pan.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/03/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES Current treatments for chronic pancreatitis focus on symptom management and therapeutics targeting disease reversal are lacking. Given the role of the cyclooxygenase-2 (COX-2) enzyme in producing prostaglandin E2 (PGE2), a key component in the inflammatory pathway of chronic pancreatitis, this study evaluates the physiologic effect of oral indomethacin, a COX-2 inhibitor, on PGE2 levels in pancreatic fluid. METHODS This pilot two-center randomized controlled trial seeks to examine 32 subjects with chronic pancreatitis who have no contraindications to indomethacin. Subjects will be randomized to either oral indomethacin 50 mg twice a day or placebo twice a day for a total of 28 days. Baseline (pre-treatment) assessment of pain and quality of life will be performed using the Brief Pain Inventory and the PROMIS-10 questionnaires, respectively. Biological specimens including blood, urine, and saliva will be collected at pre-treatment and post-treatment(day 28). Endoscopic pancreatic function testing with concomitant pancreatic fluid collection will also be performed pre- and post-treatment to assess the change in pancreatic fluid PGE2 levels. The relationship between pancreatic fluid PGE2 levels with blood and saliva PGE2 levels will be examined. CONCLUSIONS This study will elucidate the effect of oral indomethacin on PGE2 levels in the pancreas to assess its role in the inflammatory pathway of chronic pancreatitis. Should indomethacin significantly reduce PGE2 levels, this may represent a potential disease-altering treatment for chronic pancreatitis.
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Affiliation(s)
- Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Darwin L Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alejandra Cervantes
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Wenrui Hao
- Department of Mathematics, Pennsylvania State University, University Park, PA, USA
| | - Gregory B Lesinski
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas Mace
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Jami L Saloman
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Mark Topazian
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
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26
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González J, Ayala D, Caballero N, Rey Chaves CE, Conde D, Sabogal Olarte JC. Outcomes after Frey's procedure for chronic pancreatitis: a 8-year single-center experience in Colombia. BMC Surg 2022; 22:424. [PMID: 36503674 PMCID: PMC9743672 DOI: 10.1186/s12893-022-01839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic pancreatitis is an inflammatory disease characterized by irreversible morphological changes due to chronic pancreatic fibrosis. The treatment goals are to relieve pain, preserve function, and prevent further pathological consequences. Endoscopic treatment, surgery, or both are options for untreatable pain or suspected malignancy. Frey procedure is a reasonable surgical intervention because of its hybrid character, combining resection and drainage. Unfortunately, there is limited information about the outcomes of this procedure in Latin America, and few cases described in Colombia. This study aims to describe the experience of a pancreatic surgery reference center in the management of patients undergoing Frey's surgery for chronic pancreatitis. METHODS A retrospective review of a prospectively collected database of patients who underwent a Frey procedure due to chronic pancreatitis between January 2014 to February 2022 in a hospital in Bogotá, Colombia, was made. A demographic, clinical, and postoperative outcome description was performed. Mann-Whitney Willcoxon test was performed between operative variables and long-term outcomes. RESULTS Eighteen patients met the inclusion criteria. 55.5% of patients were male. Chronic pancreatitis etiology in most cases (83.3% n = 15) was idiopathic. The median duration of symptoms and chronic pancreatitis diagnosis before surgery was 6.15 months (IQR 5;97). Overall morbidity was 38.88%. One patient died at 30 days of follow-up. The median follow-up time was 42.5 (IQR 19;65 months). The median pain reduction was 3 points according to the visual analog score. Six patients were diagnosed with malignant conditions after surgery (mean 27.8 ± 7.5 months). Wirsung's duct size was statistically related with malignancy presentation after Frey's procedure (Z = 2.54; P = 0.01). CONCLUSION According to our data, Frey's procedure remains safe and feasible, with acceptable outcomes in terms of pain relief and pancreatic function. The study confirms the importance of a longstanding follow-up due to an inherent risk of pancreatic malignancy. Our data suggest that pancreatic duct size could be related with the malignancy diagnosis after Frey's procedure; however, further prospective studies with a larger sample size would be helpful to confirm these results.
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Affiliation(s)
- Juliana González
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Daniela Ayala
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Nicolás Caballero
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Eduardo Rey Chaves
- grid.41312.350000 0001 1033 6040School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia ,111011 Bogotá D.C, Colombia
| | - Danny Conde
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia ,Hospital Universitario Mayor Méderi, Bogotá, Colombia
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Zhang J, Fan H, Gross M, Liu N, Carlson H, Wood A, Hoffman K, Petrosino J, Pankratz N, Thyagarajan B, Fisher W. Progressive reduction in circulating levels of carotenoids and other micronutrients in patients with chronic pancreatitis. Pancreatology 2022; 22:1126-1133. [PMID: 36198488 DOI: 10.1016/j.pan.2022.09.243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/26/2022] [Accepted: 09/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although micronutrients modulate immunity and inflammation, it remains elusive whether they are implicated in the development and progression of chronic pancreatitis (CP). This study aimed to investigate differences in the circulating levels of selected carotenoids and vitamins between CP and controls and trends in the levels of these micronutrients across controls, early CP, and definite CP. METHODS Demographic and lifestyle data were extracted from medical records for 53 patients with CP (13 early and 38 definite) and obtained using a questionnaire for 52 controls. Plasma β-carotene, lycopene, cryptoxanthin, zeaxanthin, and α-tocopherol and serum 25(OH)D, folate, IL-6, TNF-α, and MCP-1 were measured with state-of-the-art methods. RESULTS The levels of all micronutrients (except folate) were significantly lower in CP than in controls. There was a progressive decrease in the levels of these micronutrients across controls, early CP, and definite CP (all p values for trend: ≤0.0012); e.g., plasma lycopene was 36.6, 21.5, and 14.5 μg/dL for controls, early CP, and definite CP, respectively. After adjustment for confounders, there were strong, inverse associations between the levels of all micronutrients (except folate) and CP (e.g., OR (95% CI) for ≥ median vs. <median: 0.10 (0.04, 0.27) for lycopene, 0.15 (0.05, 0.38) for α-tocopherol, and 0.24 (0.09, 0.64) for 25(OH)D). These associations became weaker after additional adjustment for inflammation markers (IL-6, TNF-α, and MCP-1). CONCLUSIONS The circulating levels of some carotenoids, α-tocopherol, and vitamin D were reduced in CP patients compared with controls and this reduction was more pronounced in definite CP than in early CP.
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Affiliation(s)
- Jianjun Zhang
- Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA; Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA.
| | - Hao Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Myron Gross
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Nianjun Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Hannah Carlson
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Amy Wood
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Kristi Hoffman
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Petrosino
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Nathan Pankratz
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - William Fisher
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Tirkes T, Dasyam AK, Shah ZK, Fogel EL, Vege SS, Li L, Li S, Chang ST, Farinas CA, Grajo JR, Mawad K, Takahashi N, Venkatesh SK, Wachsman A, Fisher WE, Forsmark CE, Hart PA, Pandol SJ, Park WG, Van Den Eeden SK, Yang Y, Topazian M, Andersen DK, Serrano J, Conwell DL, Yadav D. T1 signal intensity ratio of the pancreas as an imaging biomarker for the staging of chronic pancreatitis. Abdom Radiol (NY) 2022; 47:3507-3519. [PMID: 35857066 PMCID: PMC10020893 DOI: 10.1007/s00261-022-03611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Our purpose was to validate the T1 SIR (T1 score) as an imaging biomarker for the staging of CP in a large, multi-institutional, prospective study. METHODS The prospective study population included 820 participants enrolled in the PROCEED study from nine clinical centers between June 2017 and December 2021. A radiologist at each institution used a standardized method to measure the T1 signal intensity of the pancreas and the reference organs (spleen, paraspinal muscle, liver), which was used to derive respective T1 scores. Participants were stratified according to the seven mechanistic stages of chronic pancreatitis (MSCP 0-6) based on their clinical history, MRCP, and CT findings. RESULTS The mean pancreas-to-spleen T1 score was 1.30 in participants with chronic abdominal pain, 1.22 in those with acute or recurrent acute pancreatitis, and 1.03 in definite CP. After adjusting for covariates, we observed a linear, progressive decline in the pancreas-to-spleen T1 score with increasing MSCP from 0 to 6. The mean pancreas-to-spleen T1 scores were 1.34 (MSCP 0), 1.27 (MSCP 1), 1.21 (MSCP 2), 1.16 (MSCP 3), 1.18 (MSCP 4), 1.12 (MSCP 5), and 1.05 (MSCP 6) (p < 0.0001). The pancreas-to-liver and pancreas-to-muscle T1 scores showed less linear trends and wider confidence intervals. CONCLUSION The T1 score calculated by SIR of the pancreas-to-spleen shows a negative linear correlation with the progression of chronic pancreatitis. It holds promise as a practical imaging biomarker in evaluating disease severity in clinical research and practice.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology & Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA.
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zarine K Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Evan L Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shuang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephanie T Chang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Carlos A Farinas
- Baylor College of Medicine, Radiology Department, TX, Houston, USA
| | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Kareem Mawad
- The Permanente Medical Group, South San Francisco Medical Center, South San Francisco, CA, 94080, USA
| | | | | | - Ashley Wachsman
- Department of Radiology, Cedars-Sinai Medical Center, University of California in Los Angeles, Los Angeles, CA, USA
| | - William E Fisher
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Christopher E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, 32610, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Walter G Park
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | | | - Yunlong Yang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Darwin L Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Dhiraj Yadav
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Sarkar S, Sarkar P, M R, Hazarika D, Prasanna A, Pandol SJ, Unnisa M, Jakkampudi A, Bedarkar AP, Dhagudu N, Reddy DN, Talukdar R. Pain, depression, and poor quality of life in chronic pancreatitis: Relationship with altered brain metabolites. Pancreatology 2022; 22:688-697. [PMID: 35710761 DOI: 10.1016/j.pan.2022.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND To evaluate if altered brain metabolites are connected to pain, depression and affective responses in CP. METHODS In this prospective study we evaluated pain characteristics, QOL (EORTC QLQc30+PAN28), depression (Beck depression inventory [BDI] II) in 558 patients with CP and 67 healthy controls. Brain metabolites were evaluated using magnetic resonance spectroscopy (MRS) in 49 patients and 5 healthy controls. We measured plasma metabolites using gas chromatography-mass spectrometry (GC-MS/MS). Relationship between metabolomic alterations, pain, depression and QOL components were assessed using statistical/bioinformatics methods. Benjamini-Hochberg FDR correction was applied for multiple testing. RESULTS 261 (46.8%) patients had depression compared to 5 (7.5%) among healthy controls [n = 67](p < 0.0001). Risk [OR (95% CI) of developing depression in the presence of pain was 1.9 (1.33-1.68); p = 0.0004. The depression scores correlated negatively with functional components and positively with symptom components of EORTC QLQ30. Significant negative correlation, though based on a small sample size, was observed between N-acetyl aspartate in the left hippocampus and choline in the left prefrontal cortex with emotional and cognitive functions. PLS-DA modelling revealed significant alteration in the plasma metabolomic profile among patients with CP who had depression. Six metabolites were significantly different between CP with depression and healthy controls, of which glycine contributed most significantly to the PLS-DA model (VIP score of 3.5). CONCLUSIONS A significant proportion of patients with CP develops depression that correlate with poor QOL functions. Pain, depression, and emotional components of QOL in patients with CP correlated with N-acetyl aspartate and choline in the left hippocampus and left prefrontal cortex of the brain.
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Affiliation(s)
- Subhaleena Sarkar
- Wellcome-DBT India Alliance Labs., Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India
| | - Priyanka Sarkar
- Wellcome-DBT India Alliance Labs., Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India
| | - Revanth M
- Department of Radiodiagnosis, Asian Institute of Gastroenterology, Hyderabad, India
| | - Dibyamohan Hazarika
- Department of Radiodiagnosis, Asian Institute of Gastroenterology, Hyderabad, India
| | - Ambika Prasanna
- Wellcome-DBT India Alliance Labs., Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Misbah Unnisa
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Aparna Jakkampudi
- Wellcome-DBT India Alliance Labs., Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Naveen Dhagudu
- Division of Psychiatry, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupjyoti Talukdar
- Wellcome-DBT India Alliance Labs., Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India; Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
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Murruste M, Kirsimägi Ü, Kase K, Veršinina T, Talving P, Lepner U. Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification. World J Clin Cases 2022; 10:7808-7824. [PMID: 36158501 PMCID: PMC9372835 DOI: 10.12998/wjcc.v10.i22.7808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/22/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic pancreatitis (CP) is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification.
AIM The aims of this study were to: Propose a pathophysiological classification of the complications of CP; evaluate their prevalence in a surgical cohort prior to, and following surgical management; and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up. We hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications, with the exclusion of pancreatic insufficiency. The primary outcomes were prevalence of complications of CP at baseline (prior to surgical treatment) and occurrence of new complications during follow-up.
METHODS After institutional review board approval, a prospective observational cohort study with long-term follow-up (up to 20.4 years) was conducted. All consecutive single-center adult patients (≥ 18 years of age) with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021, were included. The prevalence of CP complications evaluated, according to the proposed classification, in a surgical cohort of 166 patients. Development of the pathophysiological classification was based on a literature review on the clinical presentation, course, and complications of CP, as well a review of previous classification systems of CP.
RESULTS We distinguished four groups of complications: Pancreatic duct complications, peripancreatic complications, pancreatic hemorrhages, and pancreatic insufficiency (exocrine and endocrine). Their baseline prevalence was 20.5%, 23.5%, 10.2%, 31.3%, and 27.1%, respectively. Surgical treatment was highly effective in avoiding new complications in the first and third groups. In the group of peripancreatic complications, the 15-year Kaplan-Meier prevalence of new complications was 12.1%. The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up, being 66.4% and 47.1%, respectively, at 15 years following surgery. Pancreatoduodenal resection resulted optimal results in avoiding new peripancreatic complications, but was associated with the highest rate of pancreatic exocrine insufficiency.
CONCLUSION The proposed complication classification improves the understanding of CP. It could be beneficial for clinical decision making, as it provides an opportunity for more comprehensive judgement on patient’s needs on the one hand, and on the pros and cons of the treatment under consideration, on the other. The presence of complications of CP and the risk of development of new ones should be among the main determinants of surgical choice.
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Affiliation(s)
- Marko Murruste
- Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia
| | - Ülle Kirsimägi
- Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia
| | - Karri Kase
- Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia
| | - Tatjana Veršinina
- Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia
| | - Peep Talving
- Department of Surgery, Board, North Estonia Medical Centre, Tallinn 13419, Estonia
| | - Urmas Lepner
- Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia
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Shi SY, Wang L, Peng Z, Wang Y, Lin Z, Hu X, Yuan J, Huang L, Feng ST, Luo Y. Multi-frequency magnetic resonance elastography of the pancreas: measurement reproducibility and variance among healthy volunteers. Gastroenterol Rep (Oxf) 2022; 10:goac033. [PMID: 35910246 PMCID: PMC9336557 DOI: 10.1093/gastro/goac033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/08/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Patients with chronic pancreatitis often have irreversible pancreatic insufficiency before a clinical diagnosis. Pancreatic cancer is a fatal malignant tumor in the advanced stages. Patients having high risk of pancreatic diseases must be screened early to obtain better outcomes using new imaging modalities. Therefore, this study aimed to investigate the reproducibility of tomoelastography measurements for assessing pancreatic stiffness and fluidity and the variance among healthy volunteers. Methods Forty-seven healthy volunteers were prospectively enrolled and underwent two tomoelastography examinations at a mean interval of 7 days. Two radiologists blindly and independently measured the pancreatic stiffness and fluidity at the first examination to determine the reproducibility between readers. One radiologist measured the adjacent pancreatic slice at the first examination to determine the reproducibility among slices and measured the pancreas at the second examination to determine short-term repeatability. The stiffness and fluidity of the pancreatic head, body, and tail were compared to determine anatomical differences. The pancreatic stiffness and fluidity were compared based on sex, age, and body mass index (BMI). Results Bland–Altman analyses (all P > 0.05) and intraclass correlation coefficients (all >0.9) indicated near perfect reproducibility among readers, slices, and examinations at short intervals. Neither stiffness (P = 0.477) nor fluidity (P = 0.368) differed among the pancreatic anatomical regions. The mean pancreatic stiffness was 1.45 ± 0.09 m/s; the mean pancreatic fluidity was 0.83 ± 0.06 rad. Stiffness and fluidity did not differ by sex, age, or BMI. Conclusion Tomoelastography is a promising and reproducible tool for assessing pancreatic stiffness and fluidity in healthy volunteers.
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Affiliation(s)
- Si-Ya Shi
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Liqin Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yangdi Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zhi Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xuefang Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Jiaxin Yuan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Li Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
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Milosavljevic V, Tadic B, Grubor N, Knezevic D. The “Rocky” Pancreas. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02951-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Pancreatic Elastography Predicts Endoscopic Secretin-Pancreatic Function Test Result in Patients With Early Changes of Chronic Pancreatitis: A Prospective, Cross-Sectional, Observational Study. Am J Gastroenterol 2022; 117:1264-1268. [PMID: 35926493 DOI: 10.14309/ajg.0000000000001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/27/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The endoscopic pancreatic function test (ePFT) has been proposed for the evaluation of patients with suspected early chronic pancreatitis (CP) in the appropriate clinical context, but the cost and duration of the test limit its clinical applicability. Pancreatic secretion decreases as pancreatic fibrosis develops in CP. Pancreatic fibrosis can be quantified by endoscopic ultrasound-elastography (EUS-E). We aim at evaluating whether EUS-E correlates with and could replace ePFT for the evaluation of patients with suspected CP. METHODS A prospective, cross-sectional, and observational study of patients with clinical suspicion of CP and inconclusive EUS findings was conducted. EUS-E and ePFT were performed. Diagnosis of CP was supported if the ePFT result (bicarbonate peak) was abnormally low (<80 mEq/L). Correlation between EUS-E (strain ratio [SR]) and ePFT results was analyzed by linear regression. Diagnostic accuracy of EUS-E for CP was calculated using ePFT as a reference method. RESULTS Sixty-one patients were included and analyzed. The mean peak bicarbonate concentration at the ePFT was 63.8 ± 23.6 mEq/L, and it was abnormally low in 50 patients (82.0%). The mean SR was 3.85 ± 1.24. Correlation between SR and bicarbonate secretion was highly significant ( r = 0.715, P < 0.0001). Diagnostic accuracy of EUS-E for CP was 93.4%. DISCUSSION The degree of pancreatic fibrosis as evaluated by EUS-E correlates significantly with the secretin-stimulated pancreatic secretion of bicarbonate in patients with clinical suspicion of CP and inconclusive EUS findings of the disease. EUS-E could replace ePFT for the evaluation of these patients in clinical practice.
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Jia X, Zhang X, Sun D, Yang N, Li R, Luo Z. Triglyceride to HDL-C ratio is associated with plasma D-dimer levels in different types of pancreatitis. Sci Rep 2022; 12:12952. [PMID: 35902759 PMCID: PMC9334300 DOI: 10.1038/s41598-022-17421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
This study aims to evaluate levels of D-dimer and serum lipid in different types of pancreatitis, and the relationship between D-dimer and dyslipidemia, especially triglyceride to HDL-C ratio (TG/HDL-C) in different types of pancreatitis. We analyzed the D-dimer and dyslipidemia levels in acute pancreatitis (AP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). A single-centered retrospective study was conducted on 1013 patients diagnosed with AP, RAP or CP. Only patients hospitalized within 24 h of onset were included, and 204 patients were enrolled in pancreatitis groups. 68 normal persons without pancreatitis, malignant diseases, pregnancy, or organ failure, who had health check-ups, were enrolled in the control group. Blood samples were taken within 24 h of admission. The relevant information on epidemiology and etiology was collected. D-dimer and serum lipid levels in different types of pancreatitis were analyzed. Furthermore, the area under the receiver-operating characteristic curve (AUC) was used to estimate the validity of the predictor and to define optimal cut-off points for prediction. We found that D-dimer and TG/HDL-C ratio could distinguish mild AP (MAP) and non-MAP in AP and RAP patients. The D-dimer level was related to TG/HDL-C ratio and severity of pancreatitis, with the coefficient correlation of 0.379 and 0.427(p < 0.05), respectively. TG/HDL-C was related to D-dimer in different types of pancreatitis. Logistic regression analysis was conducted in the parameters at admission like alcohol abuse, dyslipidemia and coagulation disturbance in distinguishing AP and RAP groups from the control group, and the parameter like diabetes in RAP and CP groups significantly increased compared with that of the control group. The value of D-dimer level and TG/HDL-C ratio in predicting the severity of AP and RAP was confirmed but there was no significant difference between CP group and the control group. The D-dimer level was related to dyslipidemia and TG/HDL-C ratio.
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Affiliation(s)
- Xiaoqing Jia
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Xiaoting Zhang
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Dalong Sun
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Na Yang
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Rong Li
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Zheng Luo
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China.
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Comorbid overweight/obesity and chronic pancreatitis exacerbate the dyslipidemia progression in type 2 diabetic patients. Endocr Regul 2022; 56:168-177. [DOI: 10.2478/enr-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective. The aim of present study was to analyze the serum lipid profile parameters in patients with type 2 diabetes mellitus (T2DM) and comorbidities [overweight/obesity and/or chronic pancreatitis (CP)] to determine the contribution of these pathologic factors to lipid metabolism disorders in T2DM.
Methods. The study involved 579 type 2 diabetic (T2D) patients with comorbid overweight/ obesity and/or CP. The serum lipid panel parameters [total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C)] were determined by commercially available kits on a Cobas 6000 analyzer (Roche Hitachi, Germany). Low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and remnant cholesterol (RC) levels were calculated using formulas. The data were statistically analyzed using STATISTICA 7.0.
Results. It was shown that dyslipidemia in T2D patients is characterized by unidirectional changes regardless the presence/absence of comorbid overweight/obesity or CP. At the same time, the most severe dyslipidemia was detected in T2D patients with a combination of comorbid over-weight/obesity and CP. Both the elevated body mass index (BMI) and CP can aggravate lipid metabolism disorders in T2DM. In our study, however, the BMI increase positively correlated with the number of dyslipidemia patients characterized by exceeding all target lipid levels for diabetic patients. This is in contrast to T2D patients with normal body weight and comorbid CP, in whom only LDL-C and TG exceeded the target lipid levels.
Conclusions. A combination of comorbidities, such as obesity and CP in T2D patients, produced a mutually aggravating course defined particularly by common pathogenic links, insulin resistance, chronic generalized low-intensity inflammation, endothelial dysfunction, and dyslipidemia caused primarily by triglyceridemia.
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Moutinho-Ribeiro P, Adem B, Batista I, Silva M, Silva S, Ruivo CF, Morais R, Peixoto A, Coelho R, Costa-Moreira P, Lopes S, Vilas-Boas F, Durães C, Lopes J, Barroca H, Carneiro F, Melo SA, Macedo G. Exosomal glypican-1 discriminates pancreatic ductal adenocarcinoma from chronic pancreatitis. Dig Liver Dis 2022; 54:871-877. [PMID: 34840127 DOI: 10.1016/j.dld.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Pancreatic ductal adenocarcinoma (PDAC) diagnosis can be difficult in a chronic pancreatitis (CP) background, especially in its mass forming presentation. We aimed to assess the accuracy of glypican-1-positive circulating exosomes (GPC1+crExos) to distinguish PDAC from CP versus the state-of-the-art CA 19-9 biomarker. METHODS This was a unicentric prospective cohort. Endoscopic ultrasound with fine-needle aspiration or biopsy and blood tests (GPC1+crExos and serum CA 19-9) were performed. RESULTS The cohort comprised 60 PDAC and 29 CP (7 of which mass forming - MF) patients. Median levels of GPC1+crExos were significantly higher in PDAC (99.7%) versus CP (28.4%; p<0.0001) with an AUROC of 0.96 with 98.3% sensitivity and 86.2% specificity for a cut-off of 45.0% (p<0.0001); this outperforms CA 19-9 AUROC of 0.82 with 78.3% sensitivity and 65.5% specificity at a cut-off of 37 U/mL (p<0.0001). The superiority of% GPC1+crExos over CA 19-99 in differentiating PDAC from CP was observed in both early (stage I) and advanced tumors (stages II-IV). CONCLUSION Levels of GPC1+crExos coupled to beads enable differential diagnosis between PDAC and CP including its mass-forming presentation.
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Affiliation(s)
- P Moutinho-Ribeiro
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - B Adem
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - I Batista
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - M Silva
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - S Silva
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro
| | - C F Ruivo
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - R Morais
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - A Peixoto
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - R Coelho
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - P Costa-Moreira
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - S Lopes
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - F Vilas-Boas
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - C Durães
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - J Lopes
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - H Barroca
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - F Carneiro
- Medical Faculty of the University of Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S A Melo
- Medical Faculty of the University of Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - G Macedo
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal.
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Bundred J, Thakkar RG, Pandanaboyana S. Systematic review of sarcopenia in chronic pancreatitis: prevalence, impact on surgical outcomes, and survival. Expert Rev Gastroenterol Hepatol 2022; 16:665-672. [PMID: 35712996 DOI: 10.1080/17474124.2022.2091544] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic pancreatitis (CP) is characterized by progressive inflammatory changes to the pancreas, leading to loss of endocrine and exocrine function. Emerging literature suggests sarcopenia may adversely affect outcomes for chronic pancreatitis patients. This systematic review examines the evidence surrounding the impact of sarcopenia on patients with CP. AREAS COVERED A systematic literature search of MEDLINE (via PUBMED), Cochrane and EMBASE databases was undertaken to identify articles describing body composition assessment in patients with CP. Data collected included definitions of sarcopenia, sarcopenia assessment methodology, baseline demographics, surgical outcomes, and short- and long-term outcomes. EXPERT OPINION In total, nine studies reported on 977 patients with a sarcopenia prevalence of 32.3% (95% CI 22.9-42.6%). CT remains the primary modality to assess for sarcopenia, due to ease of access. None of the studies reporting on post-operative outcomes for patients with chronic pancreatitis found a significant increase in complications among those with sarcopenia. Mortality within 1 year in the outpatient setting from one study of patients with CP was 16% in sarcopenic patients versus 3% (HR: 6.69 (95% CI: 1.79-24.9), p < 0.001) in those with no sarcopenia.Sarcopenia is prevalent in patients with CP occurring in approximately a third of patients. Sarcopenia is associated with an adverse impact on long-term survival.
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Affiliation(s)
- James Bundred
- Leeds Teaching Hospitals NHS Trust, Saint James University Hospital, Leeds, UK
| | - Rohan G Thakkar
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Shetty R, Kumbhar G, Thomas A, Pearlin B, Chowdhury SD, Chandramohan A. How Are Imaging Findings Associated with Exocrine Insufficiency in Idiopathic Chronic Pancreatitis? Indian J Radiol Imaging 2022; 32:182-190. [PMID: 35924133 PMCID: PMC9340190 DOI: 10.1055/s-0042-1744138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim
The aim is to study the association between imaging findings in chronic pancreatitis and fecal elastase 1 (FE1) in patients with idiopathic chronic pancreatitis (ICP).
Methods
In this retrospective study on a prospectively maintained database of patients with ICP, a radiologist blinded to clinical and laboratory findings reviewed CT and/or MRI. Findings were documented according to recommendations of the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer, October 2018. Low FE1 (<100 μg elastase/g) was considered diagnostic of pancreatic exocrine insufficiency (PEI). Association between imaging findings and FE1 was studied.
Results
In total, 70 patients (M: F = 37:33) with ICP with mean age of 24.2 (SD 6.5) years, range 10 to 37 years and mean disease duration of 5.6 (SD 4.6) years, range 0 to 20 years were included. Mean FE level was 82.5 (SD 120.1), range 5 to 501 μg elastase/g. Mean main pancreatic duct (MPD) caliber was 7 (SD 4) mm, range 3 to 21 mm and mean pancreatic parenchymal thickness (PPT) was 13.7 (SD 5.5) mm, range 5 to 27 mm. There was a significant association between FE1 and MPD size, PPT, type of pancreatic calcification; presence of intraductal stones, side branch dilatation on magnetic resonance cholangiopancreatography and extent of pancreatic involvement (
p
<0.05). In total, 79%, 86%, and 78% with moderate to severe MPD dilatation, pancreatic atrophy, and side branch dilatation had low FE1, respectively. But nearly half of those with no or mild structural abnormality on imaging had low FE1.
Conclusion
Significant association between FE1 and specific imaging findings demonstrates its potential as a marker of exocrine insufficiency and disease severity in chronic pancreatitis. But imaging and FE1 are complementary rather than supplementary.
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Affiliation(s)
- Ranjan Shetty
- Department of Radiology, Christian Medical College, Vellore, India
| | - Gauri Kumbhar
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Ajith Thomas
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
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Chen W, Chen Q, Parker RA, Zhou Y, Lustigova E, Wu BU. Risk Prediction of Pancreatic Cancer in Patients With Abnormal Morphologic Findings Related to Chronic Pancreatitis: A Machine Learning Approach. GASTRO HEP ADVANCES 2022; 1:1014-1026. [PMID: 36467394 PMCID: PMC9718544 DOI: 10.1016/j.gastha.2022.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS A significant factor contributing to poor survival in pancreatic cancer is the often late stage at diagnosis. We sought to develop and validate a risk prediction model to facilitate the distinction between chronic pancreatitis-related vs potential early pancreatic ductal adenocarcinoma (PDAC)-associated changes on pancreatic imaging. METHODS In this retrospective cohort study, patients aged 18-84 years whose abdominal computed tomography/magnetic resonance imaging reports indicated duct dilatation, atrophy, calcification, cyst, or pseudocyst between January 2008 and November 2019 were identified. The outcome of interest is PDAC in 3 years. More than 100 potential predictors were extracted. Random survival forests approach was used to develop and validate risk models. Multivariable Cox proportional hazard model was applied to estimate the effect of the covariates on the risk of PDAC. RESULTS The cohort consisted of 46,041 (mean age 66.4 years). The 3-year incidence rate was 4.0 (95% confidence interval CI 3.6-4.4)/1000 person-years of follow-up. The final models containing age, weight change, duct dilatation, and either alkaline phosphatase or total bilirubin had good discrimination and calibration (c-indices 0.81). Patients with pancreas duct dilatation and at least another morphological feature in the absence of calcification had the highest risk (adjusted hazard ratio [aHR] = 14.15, 95% CI 8.7-22.6), followed by patients with calcification and duct dilatation (aHR = 7.28, 95% CI 4.09-12.96), and patients with duct dilation only (aHR = 6.22, 95% CI 3.86-10.03), compared with patients with calcifications alone as the reference group. CONCLUSION The study characterized the risk of pancreatic cancer among patients with 5 abnormal morphologic findings based on radiology reports and demonstrated the ability of prediction algorithms to provide improved risk stratification of pancreatic cancer in these patients.
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Affiliation(s)
- Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California
| | - Qiaoling Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California
| | - Rex A. Parker
- Department of Radiology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, California
| | - Yichen Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California
| | - Eva Lustigova
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California
| | - Bechien U. Wu
- Department of Gastroenterology, Center for Pancreatic Care, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, California
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Screening for gastrointestinal and pancreatic diseases. Adv Clin Chem 2022; 108:129-153. [PMID: 35659059 DOI: 10.1016/bs.acc.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosis of chronic gastrointestinal and pancreatic diseases is challenging because patients generally present with nonspecific symptoms, such as abdominal pain and chronic diarrhea, some of which can last for many years. Although stool assays are more sensitive than serum assays, the former has unique limitations that healthcare providers should be aware of. One algorithm to screen for chronic gastrointestinal and pancreatic issues is to perform stool testing to assess inflammatory, watery (osmotic) and malabsorptive conditions. This chapter will discuss several stool-based screening tests, the major disorders they screen for and clinical performance. Sections on assay and sample limitations are also included. Stool testing can provide valuable diagnostic, prognostic and treatment response information if both the laboratory and clinician understand the benefits and limitations of these assays.
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Comparison of fecal calprotectin and pancreatic elastase assays based on proficiency testing results. Clin Biochem 2022; 107:19-23. [DOI: 10.1016/j.clinbiochem.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/26/2022] [Accepted: 05/11/2022] [Indexed: 12/14/2022]
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Histopathologic correlation of pancreatic fibrosis with pancreatic magnetic resonance imaging quantitative metrics and Cambridge classification. Abdom Radiol (NY) 2022; 47:2371-2380. [PMID: 35486166 DOI: 10.1007/s00261-022-03532-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the correlation of the T1-weighted signal intensity ratio (T1 SIR, or T1 Score) and arterial-to-delayed venous enhancement ratio (ADV ratio) of the pancreas with pancreatic fibrosis on histopathology. METHODS Sixty consecutive adult CP patients who had an MRI/MRCP study prior to pancreatic surgery were analyzed. Three blinded observers measured T1 SIR of pancreas to spleen (T1 SIR p/s), pancreas-to-paraspinal muscle (T1 SIR p/m), ADV ratio, and Cambridge grade. Histopathologic grades were given by a gastrointestinal pathologist using Ammann's fibrosis score. Statistical analysis included Spearman's correlation coefficient of the T1 SIR, ADV ratio, Cambridge grade with the fibrosis score, and weighted kappa for interobserver agreement. RESULTS The study population included 31 female and 29 male patients, with an average age of 52.1 (26-78 years). Correlations between fibrosis score and T1 SIR p/s, T1 SIR p/m, and ADV ratio were ρ = - 0.54 (p = 0.0001), ρ = - 0.19 (p = 0.19), and ρ = - 0.39 (p = 0.003), respectively. The correlation of Cambridge grade with fibrosis score was ρ = 0.26 (p = 0.07). There was substantial interobserver agreement (weighted kappa) for T1 SIR p/s (0.78), T1 SIR p/m (0.71), and ADV ratio (0.64). T1 SIR p/s of ≤ 1.20 provided a sensitivity of 74% and specificity of 50% (AUC: 0.74), while ADV ratio of ≤ 1.10 provided a sensitivity of 75% and specificity of 55% (AUC: 0.68) to detect a fibrosis score of ≥ 6. CONCLUSION There is a moderate negative correlation between the T1 Score (SIR p/s) and ADV ratio with pancreatic fibrosis and a substantial interobserver agreement. These parenchymal metrics show a higher correlation than the Cambridge grade.
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Abstract
The basic pancreatic lesions include location, size, shape, number, capsule, calcification/calculi, hemorrhage, cystic degeneration, fibrosis, pancreatic duct alterations, and microvessel. One or more basic lesions form a kind of pancreatic disease. As recognizing the characteristic imaging features of pancreatic basic lesions and their relationships with pathology aids in differentiating the variety of pancreatic diseases. The purpose of this study is to review the pathological and imaging features of the basic pancreatic lesions.
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D'Aversa F, Ainora ME, Mignini I, Liguori A, Garcovich M, Pagliari D, Attili F, Larghi A, Rizzatti G, Riccardi L, Verme LZD, Pompili M, Gasbarrini A, Zocco MA. The Gemelli Ultrasound Chronic Pancreatitis Score: A Non-invasive Tool for the Diagnosis of Chronic Pancreatitis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:685-693. [PMID: 35090781 DOI: 10.1016/j.ultrasmedbio.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
A dedicated ultrasound (US) score, the Gemelli Ultrasound Chronic Pancreatitis (USCP) score, could be useful in the follow-up of patients with chronic pancreatitis (CP). However, its role in the diagnosis of CP has not been investigated. We aimed to evaluate the role of the Gemelli USCP score in the diagnosis of CP and the agreement with standard imaging techniques. Ninety-three patients clinically suspected of having CP and referred to the pancreatic outpatient clinic of A. Gemelli Hospital for endoscopic ultrasound (EUS) were prospectively enrolled. All patients underwent pancreatic US to calculate the Gemelli USCP score. A receiver operating characteristic curve analysis was also performed to assess the performance of the US score in CP diagnosis. The Gemelli USCP score was inversely related to the Rosemont score for both total value (p < 0.0001) and each parameter evaluated (p < 0.0001). This score was significantly higher in patients with CP with an excellent area under the receiver operating characteristic curve (0.946) and the optimal cutoff of 5. Moreover, we found a significant correlation between the Gemelli USCP score and laboratory parameters related to pancreatic exocrine insufficiency (p < 0.0001). The development of a dedicated ultrasound score could be useful as a non-invasive tool in the diagnosis of CP.
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Affiliation(s)
- Francesca D'Aversa
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Maria Elena Ainora
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Irene Mignini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Antonio Liguori
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Matteo Garcovich
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Danilo Pagliari
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Fabia Attili
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Alberto Larghi
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Gianenrico Rizzatti
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Laura Riccardi
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Lorenzo Zileri Dal Verme
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Maurizio Pompili
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Antonio Gasbarrini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy
| | - Maria Assunta Zocco
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, Rome, Italy.
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Clinical and Analytical Characterization of the DiaSorin and ScheBo Fecal Pancreatic Elastase 1 Assays. Pancreas 2022; 51:243-249. [PMID: 35584381 DOI: 10.1097/mpa.0000000000002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Fecal pancreatic elastase (PE) assays are screening tests for exocrine pancreatic insufficiency (EPI). We analytically evaluated a new PE assay and retrospectively analyzed data from an academic hospital and reference laboratory to understand the clinical utility. METHODS Forty stool samples with different PE concentrations were tested on the ScheBo enzyme-linked immunosorbent assay (ELISA) versus DiaSorin LIAISON immunoassay; a simple-to-use extraction device was assessed. The cross-reactivity of porcine enzymes was investigated in the immunoassay. Charts of 207 patients with PE results less than 250 μg/g at an academic hospital were reviewed, and data were analyzed for 5136 patients with repeat PE results from a reference laboratory. RESULTS The LIAISON immunoassay gave comparable results to the ScheBo ELISA, with 87.5% agreement of PE results in classifying as sufficient, mild/moderate insufficiency, or severe insufficiency. The extraction device worked well compared with manual weighing, and no cross reactivity with porcine enzymes was observed. In agreement with prior studies, our clinical data suggested that PE assays were most useful in detecting severe EPI. CONCLUSIONS The new DiaSorin LIAISON immunoassay preforms similarly to the well-known ScheBo ELISA. Pancreatic elastase assays can help identify patients with severe EPI but are not as useful in classifying mild/moderate EPI.
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Insulin receptor substrate 1 gene variations and lipid profile characteristics in the type 2 diabetic patients with comorbid obesity and chronic pancreatitis. Endocr Regul 2022; 56:1-9. [PMID: 35180824 DOI: 10.2478/enr-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective. Type 2 diabetes mellitus (T2DM) is one of diseases that develops in a setting of polymorbid processes or more often promotes their development, forming in this spectrum the phenomenon of comorbidity. The aim of this study was to evaluate changes in the lipid panel data in T2DM patients with comorbid obesity and chronic pancreatitis (CP) taking into account the C/A polymorphism of the insulin receptor substrate 1 (IRS1) gene (rs2943640). Methods. The study involved 34 T2DM patients and 10 healthy individuals. The rs2943640 IRS1 gene polymorphism was genotyped using the TaqMan real-time polymerase chain reaction (PCR) method. Blood serum lipid panel data were determined with commercially available kits on a Cobas 6000 analyzer. Results. In patients with only T2DM and T2DM + comorbid obesity, an association between IRS1 gene polymorphism (rs2943640) and lipid profile abnormalities with maximum changes of the lipid characteristics recorded in C/C genotype carriers was found. Within the C/C genotype of the IRS1 gene (rs2943640) in type 2 diabetic patients with comorbid obesity and CP, significantly lower high-density lipoprotein cholesterol (HDL-C) levels and significantly higher levels of triglycerides (TG), non-HDL-C and remnant cholesterol (RC) in relation to type 2 diabetic patients with comorbid obesity were found. At the same time, within the C/A genotype of the IRS1 gene (rs2943640), significant changes of lipid panel data were found in type 2 diabetic patients with comorbid obesity relative to the control group (p<0.001). Conclusions. Our data indicate that the presence of the C allele of IRS1 gene (rs2943640) in both homozygous and heterozygous states may indicate increased risk of dyslipidemia in type 2 diabetic patients with comorbidities.
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Nissinen SI, Venäläinen M, Kumpulainen P, Roine A, Häkkinen MR, Vepsäläinen J, Oksala N, Rantanen T. Discrimination between Pancreatic Cancer, Pancreatitis and Healthy Controls Using Urinary Polyamine Panel. Cancer Control 2022; 28:10732748211039762. [PMID: 35135363 PMCID: PMC8832577 DOI: 10.1177/10732748211039762] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKROUND Polyamines play an important role in cellular proliferation, and the change in polyamine metabolism is reported in various cancers. We searched for urinary polyamine signature for distinguishing between pancreatic cancer, premalignant lesions of the pancreas (PLP), acute and chronic pancreatitis, and controls. METHODS Patients and controls were prospectively recruited in three Finnish hospitals between October 2013 and June 2016. The patients provided a urine sample at the time of the diagnosis. The panel of 14 polyamines was obtained in a single run with mass spectrometry. The polyamine concentrations were analysed with quadratic discriminant analysis and cross-validated with leave-one-out cross-validation. RESULTS Sixty-eight patients with pancreatic cancer, 36 with acute pancreatitis, 18 with chronic pancreatitis and 7 with PLP were recruited, as were 53 controls. The combination of 4 polyamines - acetylputrescine, diacetylspermidine, N8-acetylspermidine and diacetylputrescine - distinguished pancreatic cancer and PLP from controls (sensitivity = 94%, specificity = 68% and AUC = 0.88). The combination of diacetylspermidine, N8-acetylspermidine and diacetylspermine distinguished acute pancreatitis from controls (sensitivity = 94%, specificity = 92%, AUC = 0.98). The combination of acetylputrescine, diacetylspermidine and diacetylputrescine distinguished chronic pancreatitis from controls (sensitivity = 98%, specificity = 71%, AUC = 0.93). CONCLUSIONS Optimally selected urinary polyamine panels discriminate between pancreatic cancer and controls, as well as between acute and chronic pancreatitis and controls.
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Affiliation(s)
- Samuli I Nissinen
- Department of Internal Medicine, School of Medicine, 205537University of Eastern Finland, Kuopio, Finland.,Department of Internal Medicine, 3701Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Markus Venäläinen
- Department of Internal Medicine, School of Medicine, 205537University of Eastern Finland, Kuopio, Finland
| | | | - Antti Roine
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere, Finland
| | - Merja R Häkkinen
- School of Pharmacy, Biocenter Kuopio, 205537University of Eastern Finland, Kuopio, Finland
| | - Jouko Vepsäläinen
- School of Pharmacy, Biocenter Kuopio, 205537University of Eastern Finland, Kuopio, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere, Finland.,Centre for Vascular Surgery and Interventional Radiology, 60670Tampere University Hospital, Tampere, Finland
| | - Tuomo Rantanen
- Department of Surgery, School of Medicine, 205537University of Eastern Finland, Kuopio, Finland
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48
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Martínez-Bosch N, Cristóbal H, Iglesias M, Gironella M, Barranco L, Visa L, Calafato D, Jiménez-Parrado S, Earl J, Carrato A, Manero-Rupérez N, Moreno M, Morales A, Guerra C, Navarro P, García de Frutos P. Soluble AXL is a novel blood marker for early detection of pancreatic ductal adenocarcinoma and differential diagnosis from chronic pancreatitis. EBioMedicine 2022; 75:103797. [PMID: 34973624 PMCID: PMC8724936 DOI: 10.1016/j.ebiom.2021.103797] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023] Open
Abstract
Background Early diagnosis is crucial for patients with pancreatic ductal adenocarcinoma (PDAC). The AXL receptor tyrosine kinase is proteolytically processed releasing a soluble form (sAXL) into the blood stream. Here we explore the use of sAXL as a biomarker for PDAC. Methods AXL was analysed by immunohistochemistry in human pancreatic tissue samples. RNA expression analysis was performed using TCGA/GTEx databases. The plasma concentrations of sAXL, its ligand GAS6, and CA19-9 were studied in two independent cohorts, the HMar cohort (n = 59) and the HClinic cohort (n = 142), including healthy controls, chronic pancreatitis (CP) or PDAC patients, and in a familial PDAC cohort (n = 68). AXL expression and sAXL release were studied in PDAC cell lines and murine models. Findings AXL is increased in PDAC and precursor lesions as compared to CP or controls. sAXL determined in plasma from two independent cohorts was significantly increased in the PDAC group as compared to healthy controls or CP patients. Patients with high levels of AXL have a lower overall survival. ROC analysis of the plasma levels of sAXL, GAS6, or CA19-9 in our cohorts revealed that sAXL outperformed CA19-9 for discriminating between CP and PDAC. Using both sAXL and CA19-9 increased the diagnostic value. These results were validated in murine models, showing increased sAXL specifically in animals developing PDAC but not those with precursor lesions or acinar tumours. Interpretation sAXL appears as a biomarker for early detection of PDAC and PDAC–CP discrimination that could accelerate treatment and improve its dismal prognosis. Funding This work was supported by grants PI20/00625 (PN), RTI2018-095672-B-I00 (AM and PGF), PI20/01696 (MG) and PI18/01034 (AC) from MICINN-FEDER and grant 2017/SGR/225 (PN) from Generalitat de Catalunya.
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Affiliation(s)
- Neus Martínez-Bosch
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain
| | - Helena Cristóbal
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB)-CSIC and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Mar Iglesias
- Department of Pathology, Autonomous University of Barcelona, Hospital del Mar, Centro de Investigación Biomédica en Red de Oncología (CIBERONC), Barcelona, Spain
| | - Meritxell Gironella
- Gastrointestinal & Pancreatic Oncology Group, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Hospital Clínic of Barcelona and IDIBAPS; Barcelona, Spain
| | - Luis Barranco
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain; Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Domenico Calafato
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB)-CSIC and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Silvia Jiménez-Parrado
- Molecular Oncology Program, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Julie Earl
- Molecular Epidemiology and Predictive Tumour Markers Group, Medical Oncology Research Laboratory, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain. CIBERONC
| | - Alfredo Carrato
- Molecular Epidemiology and Predictive Tumour Markers Group, Medical Oncology Research Laboratory, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain. CIBERONC
| | - Noemí Manero-Rupérez
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain
| | - Mireia Moreno
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain
| | - Albert Morales
- Department of Cell Death and Proliferation, IIBB-CSIC, Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic, CIBEREHD and IDIBAPS, Barcelona, Spain
| | - Carmen Guerra
- Molecular Oncology Program, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Pilar Navarro
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain; Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB)-CSIC and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
| | - Pablo García de Frutos
- Department of Cell Death and Proliferation, IIBB-CSIC, Unidad Asociada IMIM/IIBB-CSIC; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and IDIBAPS, Barcelona, Spain.
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49
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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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50
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Goodman MT, Lo SK, Yadav D, Wu BU, Jamil LH, Kwok KK, Papachristou GI, Afghani E, Choi-Kuaea Y, Waldron RT, Lombardi C, Jeon CY, Helenowski IB, Richmond E, Benante K, Habtezion A, Schering T, Khan SA, Rodriguez LM, Pandol SJ. A Randomized, Double-Blinded, Placebo-Controlled Trial of Simvastatin to Prevent Recurrent Pancreatitis. Pancreas 2022; 51:e10-e12. [PMID: 35195610 PMCID: PMC8887796 DOI: 10.1097/mpa.0000000000001955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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