Epigastric pain syndrome accompanying pancreatic enzyme abnormalities was overlapped with early chronic pancreatitis using endosonography

Abstract

There was not available data about the overlap between functional dyspepsia (FD) and pancreatic diseases. We aimed to determine whether epigastric pain syndrome (EPS) accompanying with pancreatic enzyme abnormalities were associated with early chronic pancreatitis proposed by Japan Pancreas Society (JPS) using endosonography. We enrolled 99 consecutive patients presenting with typical symptoms of FD, including patients with postprandial distress syndrome (PDS) (n = 59), EPS with pancreatic enzyme abnormalities (n = 41) and EPS without pancreatic enzyme abnormalities (n = 42) based on Rome III criteria. Gastric motility was evaluated using the 13C-acetate breath test. Early chronic pancreatitis was detected by endosonography and graded from 0 to 7. The ratio of female patients among EPS patients (34/41) with pancreatic enzyme abnormalities was significantly (p = 0.0018) higher than the ratio of female EPS patients (20/42) without it. Postprandial abdominal distention and physical component summary (PCS) scores in EPS patients with pancreatic enzyme abnormalities were significantly disturbed compared to those in EPS patients without it. Interestingly, AUC5 and AUC15 values (24.85 ± 1.31 and 56.11 ± 2.51, respectively) in EPS patients with pancreatic enzyme abnormalities were also significantly (p = 0.002 and p = 0.001, respectively) increased compared to those (19.75 ± 1.01 and 47.02 ± 1.99, respectively) in EPS patients without it. Overall, 64% of EPS patients with pancreatic enzyme abnormalities were diagnosed by endosonography as having concomitant early chronic pancreatitis proposed by JPS. Further studies are warranted to clarify how EPS patients with pancreatic enzyme abnormalities were associated with early chronic pancreatitis proposed by JPS.

New classification Rome IV functional dyspepsia and subtypes

“…Then, the reason why certain populations of EPS are resistant for the treatment using anti-acid therapy or prokinetics are considered as the involvement with several other overlapped diseases. We have also reported that almost 40% of FD patients with abnormalities of pancreatic enzyme was determined as early chronic pancreatitis (ECP) using endosonography (19). Our results suggest that the measurement of early phase of gastric emptying may be a useful tool to distinguish ECP patients from FD patients.…”

Camostat Mesilate, Pancrelipase, and Rabeprazole Combination Therapy Improves Epigastric Pain in Early Chronic Pancreatitis and Functional Dyspepsia with Pancreatic Enzyme Abnormalities

“…In 2015, in Japan, new guidelines for FD were approved and also described that 24% of FD patients involved had chronic pancreatitis [15,18]. We have reported that 41% of FD patients with abnormalities of pancreatic enzyme were determined as ECP using EUS [19,20]. Ashizawa et al [21] have also reported that anti-acid-therapy-resistant FD involves FD patients concomitant with chronic pancreatitis.…”

Comparison of Duodenal Mucosal Chromogranin-A Expression in Non-Alcoholic Fatty Pancreas Dyspeptic Patients with and without Endosonography-Diagnosed Early Chronic Pancreatitis: A Case Series Study

“…The second approach concerns symptoms and events of acute pancreatitis. Dyspepsia is a common manifestation of pancreatic exocrine dysfunction and can be classified as epigastric pain or postprandial distress syndrome [16, 17, 18]. The confirmation of acute pancreatitis needs clinical, laboratory, and image data, but patients do not always undergo complete examinations.…”