Chronic pancreatitis: Do serum biomarkers provide an association with an inflammageing phenotype?

Rasch, Sebastian; Valantienė, Irena; Mickevičius, Artautas; Beer, Sebastian; Rosendahl, Jonas; Charnley, Richard; Robinson, Stuart

doi:10.1016/j.pan.2016.08.004

Cited by 16 publications

(15 citation statements)

References 60 publications

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“…Chronic pancreatitis has a well‐defined association with increased resting energy expenditure . A recent systematic review demonstrated that chronic pancreatitis is associated with differential expression of 41 serum inflammatory mediators (eg, interleukin [IL]‐10, IL‐6, IL‐4, IL‐12, IL‐8; tumor necrosis factor [TNF]α; transforming growth factor [TGF]‐β; interferon [IFN]‐γ) . Rasch et al hypothesized that there is an integral reciprocal relationship between local pancreatic inflammation and systemic inflammation.…”

Section: Malnutrition Associated With Chronic Pancreatitismentioning

confidence: 99%

“…TNF‐α has a well‐defined role in muscle catabolism and sarcopenia, mediated in part through the mammalian target of rapamycin signaling cascade . These mediators have been associated with the “inflammageing” phenomenon, which is the term coined for inflammation associated with increased biological ageing . However, the role of a number of these mediators in chronic pancreatitis needs further investigation.…”

Section: Malnutrition Associated With Chronic Pancreatitismentioning

confidence: 99%

“…Serial and affordable testing of pancreatic function and response to current therapies are required for patients with chronic pancreatitis to prevent nutrition deterioration. Rasch et al demonstrated that there are blood‐based analytes that are differentially expressed in chronic pancreatitis, but multi‐institutional studies are required for biomarker characterization and validation …”

Section: Future Directionsmentioning

confidence: 99%

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Chronic Pancreatitis and Nutrition Therapy

O’Brien

Omer

2019

Nut in Clin Prac

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Chronic pancreatitis is a complex and irreversible disease of the pancreas and is associated with significant morbidity and mortality. Nutrition deficiencies in chronic pancreatitis are common and can be atypical in nature. As such, the management of these deficiencies can be individualized for patients. The aim of this review is to discuss the components of nutrition deficiencies in chronic pancreatitis, their management, and the current areas of research that are being explored. The clinical guidelines of major national and international societies were analyzed for recommendations on the nutrition management of chronic pancreatitis. The etiology of nutrition deficiencies in chronic pancreatitis is multifactorial and includes aspects of exocrine and/or endocrine dysfunction, significant abdominal pain, often persistent alcohol consumption, and increased metabolic activity. A large number of patients with nutrition deficiencies are underrecognized and undertreated. Although the majority of these patients can be managed by oral and pancreatic enzyme supplementation, some patients may require enteral tube feeding and, in rare cases, parenteral feeding. Current areas of research include the accurate identification of patients at risk for nutrition deficiencies, optimization of feeding regimens, and research into islet cell autotransplantation. (Nutr Clin Pract. 2019;34(suppl 1):S13-S26)

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Section: Malnutrition Associated With Chronic Pancreatitismentioning

confidence: 99%

Section: Malnutrition Associated With Chronic Pancreatitismentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

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Chronic Pancreatitis and Nutrition Therapy

O’Brien

Omer

2019

Nut in Clin Prac

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“…Death is due to a higher occurrence of diseases such as diabetes, cerebrovascular disease, pulmonary disease, ulcer disease and renal disease. Rasch et al described how the phenomenon 'inflamaging' applies to chronic pancreatitis (51) . Inflamaging is characterised by elevated proinflammatory cytokines (IL6, IL4, TNF, T-cell factor-β, IL8) and lower anti-inflammatory cytokines (including IL10).…”

Section: Chronic Systemic Inflammationmentioning

confidence: 99%

Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis

Duggan

2017

Proc. Nutr. Soc.

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Chronic pancreatitis is a chronic inflammatory disease of the pancreas characterised by irreversible morphological change and typically causing pain and/or permanent loss of function. This progressive, irreversible disease results in destruction of healthy pancreatic tissue and the development of fibrous scar tissue. Gradual loss of exocrine and endocrine function follows, along with clinical manifestations such as steatorrhoea, abdominal pain and diabetes. Nutrition in chronic pancreatitis has been described as a problem area and, until recently, there was little research on the topic. It is often asserted that >90 % of the pancreas must be damaged before exocrine insufficiency occurs; however, an exploration of the original studies from the 1970s found that the data do not support this assertion. The management of steatorrhoea with pancreatic enzyme replacement therapy is the mainstay of nutritional management, and early identification and treatment is a key. The presence of steatorrhoea, coupled with poor dietary intake (due to intractable abdominal pain, gastrointestinal side effects and often alcoholism) renders the chronic pancreatitis patients at considerable risk for undernutrition, muscle depletion and fat-soluble vitamin deficiency. Premature osteoporosis/osteopenia afflicts two-thirds of patients as a consequence of poor dietary intake of calcium and vitamin D, low physical activity, low sunlight exposure, heavy smoking, as well as chronic low-grade inflammation. Bone metabolism studies show increased bone formation as well as bone resorption in chronic pancreatitis, indicating that bone turnover is abnormally high. Loss of the pancreatic islet cells occurs later in the disease process as the endocrine cells are diffusely distributed throughout the pancreatic parenchyma. Patients may develop type 3c (pancreatogenic) diabetes, which is complicated by concurrent decreased glucagon secretion, and hence an increased risk of hypoglycaemia. Diabetes control is further complicated by poor diet, malabsorption and (for some) alcoholism, and therefore those with type 3c diabetes have clinical characteristics and therapeutic goals that are different from that of type 1 and type 2 diabetes patients. This review describes emerging research and clinical guidelines for nutrition in chronic pancreatitis.

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“…[ 25 ] In general, elevated infection parameters, such as C-reactive protein and white blood cell count, were not associated with more complications potentially indicating chronic systemic inflammation with accelerated biological ageing in patients with chronic pancreatitis. [ 31 ] Only large pseudocysts located in the pancreatic head are more prone to treatment associated complications like hemorrhage, perforation and formation of fistulae. The complication rate in these large cysts can possibly be further reduced by irrigation via a nasocystic drainage.…”

Section: Discussionmentioning

confidence: 99%

Management of pancreatic pseudocysts—A retrospective analysis

et al. 2017

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BackgroundPancreatic pseudocysts arise mostly in patients with alcohol induced chronic pancreatitis causing various symptoms and complications. However, data on the optimal management are rare. To address this problem, we analysed patients with pancreatic pseudocysts treated at our clinic retrospectively.MethodsWe searched our clinical database for the diagnosis pancreatitis from 2004 till 2014, selected patients with pseudocysts larger than 10 mm and entered all relevant information in a database for statistical analysis.ResultsIn total, 129 patients with pancreatic pseudocysts were treated at our institution during the study period. Most patients suffered from alcohol induced chronic pancreatitis (43.4%; 56/129). Pseudocysts were more frequent in female than in male (2:1) and were mainly located in the pancreatic head (47.3%; 61/129). Local complications like obstructive jaundice were associated with the diameter of the cysts (AUC 0.697 in ROC-curve analysis). However, even cysts up to a diameter of 160 mm can regress spontaneously. Besides a lower re-intervention rate in surgically treated patients, endoscopic, percutaneous and surgical drainage are equally effective. Most treatment related complications occur in large pseudocysts located in the pancreatic head.ConclusionConservative management of large pseudocysts is successful in many patients. Therefore, indication for treatment should be made carefully considering the presence and risk of local complications. Endoscopic and surgical drainage are equally effective.

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Chronic pancreatitis: Do serum biomarkers provide an association with an inflammageing phenotype?

Cited by 16 publications

References 60 publications

Chronic Pancreatitis and Nutrition Therapy

Chronic Pancreatitis and Nutrition Therapy

Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis

Management of pancreatic pseudocysts—A retrospective analysis

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