Endosonographic features in patients with non-alcoholic early chronic pancreatitis improved with treatment at one year follow up

Abstract

Since the prevention of early chronic pancreatitis (ECP) into chronic pancreatitis might be critical for the reduction of pancreatic cancer, we tried to clarify the pathophysiology of ECP patients, focusing on ECP patients without alcoholic chronic pancreatitis. 27 ECP patients without alcoholic chronic pancreatitis and 33 patients with functional dyspepsia with pancreatic enzyme abnormalities (FD-P) were enrolled in this study. Diagnosis of ECP was made when imaging findings showed the presence of more than 2 out of 7 endoscopic ultrasound features. Duodenal degranulated eosinophils and glucagon-like peptide 1 producing cells were estimated by immunostaining. There were no significant differences in characteristics and psychogenic factors between ECP and FD-P patients. Interestingly, endoscopic ultrasound score in ECP patients significantly improved, albeit clinical symptoms in ECP patients showed no improvement at one year follow up. The extent of migration of duodenal degranulated eosinophils in FD-P patients was significantly higher compared to that in ECP patients. The levels of elastase-1 and trypsin in ECP patients with improved endoscopic ultrasound features were significantly reduced by the treatment. Further studies will be needed to clarify whether clinical symptoms and endoscopic ultrasound features in ECP patients without alcoholic chronic pancreatitis were improved in longer follow up study.

State of anxiety may be associated with exocrine pancreatic insufficiency in functional dyspepsia patients with pancreatic enzyme abnormalities

“…We have also reported that the elevation of duodenal inflammatory responses including GLP-1 producing cells expression in FD-P patients and exocrine pancreatic insufficiency has been also reported to be affected by gut hormones such as GLP-1. (4,10,(25)(26)(27) Further studies will be needed to clarify how the exocrine pancreatic insufficiency may associate with the pathophysiology of FD patients including the disturbance of physical quality of life through duodenal inflammatory responses.…”

“…(4,5,8,9) In addition, previous studies and our data have reported that endosonography can reveal abnormalities in pancreas in patients with persistent dyspepsia. (3)(4)(5)10) Therefore, in this study, we compared clinical characteristics and exocrine pancreatic function in FD patients with pancreatic enzyme abnormalities with those in asymptomatic patients with pancreatic enzyme abnormalities. We analyzed the prevalence of exocrine pancreatic insufficiency in FD patients with pancreatic enzyme abnormalities to clarify whether the pathophysiology of FD patients including clinical symptoms and quality of life were associated with exocrine pancreatic insufficiency.…”

Pancreatic Dysfunction and Duodenal Inflammatory Responses Coordinate with Refractory Epigastric Pain Including Functional Dyspepsia: A Narrative Review

“…Considering of Ishikura's study, camostat mesilate may improve pancreatic pain through the inhibition of neuronal activation. In addition, we have reported the treatment including camostat mesilate improved EUS findings in one year-follow up study 26 . Further studies will be needed to clarify why camostat mesilate can improve EUS findings in ECP patients.…”

“…Gut hormones secreted from the duodenal mucosa, including GLP-1, GIP, and PYY have been shown to play critical roles in gastric motility and the absorption of nutrients [23][24][25] . To clarify the differences in duodenal inflammatory responses between functional dyspepsia with pancreatic enzyme abnormalities (FD-P) patients and ECP patients, we compared various phenotypes of duodenal inflammatory cells such as GLP-1positive cells and degranulated eosinophils between FD-P patients and ECP patients 8,26 .…”

“…It is interesting to note that while some populations of alcoholic ECP patients tend to be progressive 41 , most non-alcoholic ECP patients are found to get better at 2 years of follow up or 1 year follow up 8,26 . Masamune et al have reported that four cases of eighty-three ECP advanced into chronic pancreatitis.…”