Comparison of clinical symptoms, gastric motility and fat intake in the early chronic pancreatitis patients with anti-acid therapy-resistant functional dyspepsia patients

Abstract

BackgroundThere was no available data concerning the clinical differentiation between the updated definition of early chronic pancreatitis (ECP) and anti-acid therapy-resistant functional dyspepsia (RFD).AimsWe aimed to determine whether clinical symptoms, gastric motility, psychogenic factors and fat intake can help distinguish early chronic pancreatitis (ECP) from anti-acid therapy-resistant functional dyspepsia patients with pancreatic enzyme abnormalities (RFD-P) and anti-acid therapy-resistant functional dyspepsia (RFD) patients using endosonography.MethodsWe enrolled 102 consecutive patients presenting with typical symptoms of RFD patients (n = 52), ECP patients (n = 25) and RFD-P patients (n = 25). ECP patients were diagnosed based on the criteria recommended by the Japan Pancreatic Association. Gastric motility was evaluated by 13C-acetate breath tests. Severity of duodenal inflammation was examined.Results24.5% of RFD patients were determined as ECP using endosonography. Abdominal pain score in Gastrointestinal Symptom Rating Scale (GSRS) in the patients with ECP was significantly lower compared to that in the patients with RFD-P. There were no significant differences in State-Trait Inventory (STAI)-state/-trait scores, Self-Rating Questionnaire for Depression (SRQ-D) scores and clinical symptoms for fat intake among three groups. The early phase of gastric emptying (AUC5; AUC15) in ECP and RFD-P patients were significantly disturbed compared to those in RFD patients.ConclusionsEvaluation of severity of abdominal pain and measurement of the early phase of gastric emptying will be useful tools to distinguish ECP patients from RFD patients. Accurate diagnosis of ECP patients may contribute to the prevention from advancing of chronic pancreatitis.

Pancreatic Fibrosis (Early Chronic Pancreatitis) as Emerging Diagnosis in Structural Causes of Dyspepsia: Evidence from Endoscopic Ultrasonography and Shear Wave Elastography

“…On average, functional dyspepsia accounts for 80% of dyspepsia [ 1 , 28 ]. Early chronic pancreatitis theoretically accounts for at least 19.6% of the whole dyspeptic population, because the study performed in Japan showed that approximately 24.5% of functional dyspepsia is early chronic pancreatitis [ 27 ]. Another study performed in Spain showed that the percentage of early-stage chronic pancreatitis, with three or four criteria of EUS for chronic pancreatitis, was 15.9% of the whole dyspeptic population, as seen in Figure 1 of that article (34/213 cases) [ 26 ].…”

“…Among the chronic pancreatitis group, 60% of patients had early-stage chronic pancreatitis [ 26 ]. The other study enrolled 100 consecutive patients with functional dyspepsia and showed that approximately 24% were attributable to EUS-diagnosed early chronic pancreatitis [ 27 ]. However, these two studies lacked data on the overlap between Helicobacter pylori and early chronic pancreatitis.…”

Recent Advances in the Definition and Management of Functional Dyspepsia

“…Recently Wakabayashi et al reported that nearly half of patients with proton pump inhibitor (PPI)-resistant FD had abnormalities in their pancreatic enzymes. 58 Interestingly, half of these FD patients had pancreatic enzyme abnormalities compatible with a diagnosis of ECP, suggesting that PPI-resistant FD cannot be differentiated from ECP on the basis of clinical symptoms alone: endosonography must be used to identify the unique EUS characteristics of these diseases. Interestingly, Yamawaki et al reported that EUS scores tended to be low in patients with refractory FD.…”

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

“…( 2 ) ECP is considered to be early stage of chronic pancreatitis and exhibits symptoms similar to FD in Japan. ( 2 , 3 ) Since epigastric pain in ECP patients was improved by the treatment for chronic pancreatitis and aggravated by therapeutics targeting of FD, a precise diagnosis of ECP is critical to control clinical symptoms in ECP patients and to prevent this disease from advancing into chronic pancreatitis. ( 4 ) There were no available data about the differences between ECP and functional dyspepsia with pancreatic enzyme abnormalities (FD-P) patients.…”