Reduced exocrine pancreatic function has been observed in a high percentage of patients with type 1 diabetes in the past. There are only few data for type 2 diabetes available and they are contradictory. In this study we investigated exocrine pancreatic function in 105 controls and 114 patients with type 1 or type 2 diabetes mellitus by means of an indirect test (faecal elastase-1 concentration). This test has good sensitivity and specificity for moderate and severe pancreatic insufficiency as compared to the gold standard. Reduced faecal elastase-1 concentrations were found in 56.7% of type 1 patients, 35% of type 2 patients and 18.1% of the controls. Elastase-1 concentrations did not correlate with alcohol consumption, diabetes duration or diabetes therapy. The data found for type 1 patients correspond to those reported in earlier studies. The results for type 2 diabetics show that exocrine pancreatic function is also impaired in a high percentage in this group of patients. Pathogenetic concepts to explain these findings as consequences of diabetes complications or insulin deficiency are still under debate. Observations from autopsies and the data of the controls in this study suggest that chronic pancreatitis might be a common problem. In consequence, diabetes secondary to exocrine disease could be much more frequent than believed so far.

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Endoscopic retrograde cholangio-pancreatography is a combination of endoscopy and fluoroscopy used for radiographic imaging of the biliary and pancreatic ducts. In order to assess its feasibility and to describe abnormal findings in dogs, this technique was performed in 30 dogs with nonspecific chronic gastrointestinal disturbances. Using an 11-mm side-view endoscope, retrograde cholangiography was successful in 20/30 dogs (67%) and pancreatography in 21/30 (70%). Success was affected by intraduodenal food, mucus or blood, problems in papillary cannulation, stomach overdistention, body size, and changes in duodenal mucosa. It was impossible to perform the procedure in dogs weighing < 10 kg with the available material. Endoscopic retrograde cholangiography revealed findings that differed from previous reports in healthy beagles in 5/20 dogs. Findings included enlarged common bile duct (n = 2), intraductal filling defects (n = 2), and deviated course of common bile duct (n = 1), and major papilla stenosis (n = 1). In the dog with major papilla stenosis and intraductal filling defects, endoscopic guided sphincterotomy was performed. Endoscopic retrograde pancreatography revealed an abnormal course of the accessory pancreatic duct in 2/21 dogs. In both dogs with proven end-stage pancreatic acinar atrophy, the left duct branch did not run distal the stomach to the left but went parallel to the right duct branch and the duodenum. Repeated clinical and laboratory examinations revealed no signs of complications after endoscopic retrograde cholangio-pancreatography. It was concluded that this imaging technique is promising for the diagnosis of biliary and pancreatic diseases in dogs. It also offers the chance for new treatment options such as endoscopic guided sphincterotomy in dogs.

Fecal elastase 1 measurements appear to be valuable for characterizing patients at high risk for chronic pancreatitis, even if their sensitivity is lower than that of direct tests.

Background: Patients with highly increased plasma triglyceride levels are at risk of developing serious complications such as pancreatitis, coronary heart disease and stroke. Therefore it is important to rapidly decrease plasma triglyceride levels. A sufficient control of triglyceride levels with drugs like fibrates, statins or nicotinic acid can usually only be attained after a couple of weeks. Plasma exchange appears to be a fast but expensive method to reduce triglyceride levels. In this study we describe the use of a new ω–3 fatty acid and medium-chain triglyceride-rich formula diet as a therapeutic concept to reduce plasma triglyceride levels fast and effectively. Methods: Thirty-two patients with severe hypertriglyceridemia were treated with the especially composed formula diet for a period of 7 days. Results: Within this period of time, plasma triglycerides decreased from 1,601 (402–4,555) to 554 (142–2,382) mg/dl (p < 0.05). Total cholesterol levels were reduced from 417 (211–841) to 287 (165–457) mg/dl (p < 0.001). Fasting glucose and uric acid levels also slightly decreased (–8%; –12%). The formula diet as a 1-week treatment was well tolerated and accepted by the patients. Conclusion: This diet was successfully used as an acute treatment in severe hypertriglyceridemia and showed effectiveness in rapidly and safely lowering plasma triglyceride levels.