Exocrine Pancreatic Insufficiency and Chronic Pancreatitis in Chronic Alcoholic Liver Disease

Rabih, Sami Aoufi; García-Agudo, Rebeca; Huidobro, María Luisa Legaz; Ferrús, Marina Ynfante; Carro, Pedro González; Roldán, Francisco Pérez; Carrillo, Francisco Ruiz; Burillo, José María Tenías

doi:10.1097/mpa.0000000000000085

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…A history of alcohol abuse and smoking may predispose to the gradual development of CP with associated EPI. 57 Smoking is consistent with an increased likelihood of CP, pancreatic cancer and EPI; age may also increase the risk of EPI (≥60 years in a large association study of the general population in Germany). 27 Steady weight loss could be consistent with maldigestion and malabsorption.…”

Section: Patient Historical Factorsmentioning

confidence: 91%

Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician

2018

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SummaryAimsIn exocrine pancreatic insufficiency (EPI), the quantity and/or activity of pancreatic digestive enzymes are below the levels required for normal digestion, leading to maldigestion and malabsorption. Diagnosis of EPI is often challenging because the characteristic signs and symptoms overlap with those of other gastrointestinal conditions. Additionally, there is no single convenient, or specific diagnostic test for EPI. The aim of this review is to provide a framework for differential diagnosis of EPI vs other malabsorptive conditions.MethodsThis is a non‐systematic narrative review summarising information pertaining to the aetiology, diagnosis and management of EPI.ResultsExocrine pancreatic insufficiency may be caused by pancreatic disorders, including chronic pancreatitis, cystic fibrosis, pancreatic resection and pancreatic cancer. EPI may also result from extra‐pancreatic conditions, including coeliac disease, Zollinger‐Ellison syndrome and gastric surgery. Timely and accurate diagnosis of EPI is important, as delays in treatment prolong maldigestion and malabsorption, with potentially serious consequences for malnutrition, overall health and quality of life. Symptoms of EPI are non‐specific; therefore, a high index of clinical suspicion is required to make a correct diagnosis.

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Section: Patient Historical Factorsmentioning

confidence: 91%

Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician

2018

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“…High prevalence of exocrine pancreatic insufficiency (55.2%) and chronic pancreatitis (44%) was observed in subjects with chronic alcoholic liver disease by 13 C mixed-triglycerides breath test. Nonetheless, exocrine pancreatic insufficiency was more common in the early stages of the liver disease (70%) with lower prevalence in patients with cirrhosis (46.2%) (18) . The authors (18) suggested possible explanations for this finding such as, the state of pancreatic hypersecretion (19,23) with less protein and calcium, measured by secretin test in patients with alcoholic liver disease.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, exocrine pancreatic insufficiency was more common in the early stages of the liver disease (70%) with lower prevalence in patients with cirrhosis (46.2%) (18) . The authors (18) suggested possible explanations for this finding such as, the state of pancreatic hypersecretion (19,23) with less protein and calcium, measured by secretin test in patients with alcoholic liver disease. Pancreatic juice with less protein and calcium would protect the pancreas from protein plugs and calcification formation (19) .…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Fecal Elastase 1 for Exocrine Pancreatic Insufficiency Evaluation Between Ex-Alcoholics and Chronic Pancreatitis Patients

Mattar

Lima

Costa

et al. 2014

Arq. Gastroenterol.

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-Context -Fecal elastase is a noninvasive test for pancreatic insufficiency diagnosis. Objective -Evaluate the usefulness of fecal elastase 1 for the indication of exocrine pancreatic insufficiency among former alcohol addicts and patients with chronic pancreatitis. Methods -Forty-three patients with chronic pancreatitis and thirty-three asymptomatic former alcohol addicts entered the study. The levels of fecal elastase 1 were measured using a commercial kit. Pancreatic imaging findings were used to categorize the groups. Results -The levels of fecal elastase 1 were significantly lower in the patients than in the former alcohol addicts and in the group with tissue calcifications, duct alterations, or atrophy. With a cutoff level of 100 µg/g, the sensitivity of fecal elastase 1 in chronic pancreatitis was 46.51% and its specificity was 87.88% with a positive predictive value of 83.33% and a negative predictive value of 55.77%. When patients were stratified according to the severity of their pancreatitis, the sensitivity was 6.25% for mild pancreatitis and 70.37% for marked pancreatitis. Conclusion -Low level of fecal elastase 1 was associated with marked rather than mild chronic pancreatitis; however, it may be useful to indicate pancreatic exocrine insufficiency in asymptomatic former alcohol addicts. HEADINGS -Pancreatic elastase. Chronic pancreatitis. Alcoholics. Exocrine pancreatic insufficiency.

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“…Reduced bile flow in cirrhosis also contributes to fats and fat-soluble vitamins malabsorption. Pancreatic insufficiency in alcoholic related liver disease also contributes to steatorrhoea and fat malabsorption [22].…”

Section: Causes Of Sarcopenia In Cirrhosismentioning

confidence: 99%

Sarcopenia: Ammonia metabolism and hepatic encephalopathy

Jindal

Jagdish

2019

Clin Mol Hepatol

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Sarcopenia includes loss of muscle mass and/or strength leading of physical derangements and frailty. 1,2 Presence of cirrhosis is an important risk factor for the development of sarcopenia as a result of metabolic derangements caused by hepatocyte dysfunction. Sarcopenia is a major complication in cirrhosis and almost 50 to 70% of them develops sarcopenia. 3 The prevalence rates are much higher in males (50-70%) in comparison to female cirrhosis (≤20%). 4 The severity and prevalence of sarcopenia in cirrhosis correlate with Child-Pugh's grade. 5 Sarcopenia when added to model for end-stage liver disease (MELD) score has improved the utility for predicting survival and is particularly useful in low MELD score patients (MELD below15). 6,7 Sarcopenia contributes to fatigue, limits exercise tolerance and may have profound impact on performance status and activities of daily living. 8 Prognostic significance of sarcopenia in decompensated cirrhosis is well reported. 9-11 Major clinical consequences include higher wait-list mortality, poor quality of life (Table 1), 12 higher morbidity and mortality after surgery in cirrhosis; and increased risk of infections 13 and hepatic encephalopathy (HE). 14 Moreover, sarcopenia itself may contribute to liver disease pro

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Exocrine Pancreatic Insufficiency and Chronic Pancreatitis in Chronic Alcoholic Liver Disease

Abstract: Patients with alcoholic liver disease had a high prevalence of EPI and CP; this prevalence was even higher in patients who have not yet developed cirrhosis with liver failure or portal hypertension.

Cited by 12 publications

References 20 publications

Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician

Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician

Comparison of Fecal Elastase 1 for Exocrine Pancreatic Insufficiency Evaluation Between Ex-Alcoholics and Chronic Pancreatitis Patients

Sarcopenia: Ammonia metabolism and hepatic encephalopathy

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