Less common etiologies of exocrine pancreatic insufficiency

Singh, Vikesh K.; Haupt, Mark; Geller, David E.; Hall, Jerry A.; Diez, Pedro M Quintana

doi:10.3748/wjg.v23.i39.7059

Cited by 103 publications

(108 citation statements)

References 174 publications

(248 reference statements)

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“…Iron accumulation may also cause considerable damage to the pancreas, leading to the development of diabetes mellitus and exocrine pancreatic insufficiency . The pathogenesis of diabetes in haemochromatosis is multifactorial but felt to be mediated largely by the predominance of transferrin receptors in pancreatic islets, allowing transferrin‐bound iron to enter pancreatic cells.…”

Section: Assessment Of Organ Damage From Haemochromatosismentioning

confidence: 99%

Diagnosis and management of hereditary haemochromatosis

et al. 2020

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Hereditary haemochromatosis, one of the most common genetic disorders in the United States, can produce systemic iron deposition leading to end-organ failure and death if untreated. The diagnosis of this condition can be challenging as elevated serum ferritin may be seen in a variety of conditions, including acute and chronic liver disease, a range of systemic inflammatory states, and both primary and secondary iron overload syndromes. Appropriate and timely diagnosis of haemochromatosis is paramount as simple interventions, such as phlebotomy, can prevent or reverse organ damage from iron overload. The recognition of other aetiologies of elevated ferritin is also vital to ensure that appropriate intervention is provided and phlebotomy only utilized in patients who require it. In this review, we summarize the existing data on the work up and management of hereditary haemochromatosis and present a practical algorithm for the diagnosis and management of this disease.

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Section: Assessment Of Organ Damage From Haemochromatosismentioning

confidence: 99%

Diagnosis and management of hereditary haemochromatosis

et al. 2020

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“…Pancreatic surgery is also an independent risk factor for exocrine insufficiency, even if not performed for chronic pancreatitis or pancreatic cancer 12 . A number of other conditions may also be associated with exocrine pancreatic insufficiency, 13 including up to 25% of patients after a single episode of acute pancreatitis 14 …”

Section: Introductionmentioning

confidence: 99%

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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Background: Patients with chronic pancreatitis or pancreatic cancer commonly develop exocrine pancreatic insufficiency, and may not be adequately treated with pancreatic enzyme replacement therapy (PERT). Aims:To estimate the frequency of diagnostic testing for exocrine insufficiency, and appropriate use of PERT, in a commercially insured population in the US. Methods:We utilised a nationally representative administrative database representing 48.67 million individuals in over 80 US healthcare plans to assess testing for and treatment of exocrine insufficiency in patients who received a diagnosis of chronic pancreatitis (n = 37 061) or pancreatic cancer (n = 32 461) from 2001 to 2013. We identified the details of any testing for exocrine insufficiency and PERT use. We defined appropriate PERT use as a dosage of ≥120 000 USP units of lipase daily. Multiple logistic regression was used to identify predictors of appropriate use of PERT. Results:In patients with chronic pancreatitis, 6.5% had any testing for exocrine insufficiency, 30.4% filled a prescription for PERT, and 8.5% were prescribed an adequate dose. In those with pancreatic cancer, 1.9% had testing for exocrine insufficiency, 21.9% filled a prescription for PERT, and 5.5% were prescribed an adequate dose.Number of comorbidities, testing for exocrine insufficiency, pancreatic surgery and duration of enrolment were independent predictors for use and appropriate dosing. Conclusions:Testing for exocrine insufficiency, and appropriate dosing of PERT in patients with chronic pancreatitis or pancreatic cancer, is infrequent and inconsistent in an insured US population. Efforts are needed to educate medical providers on the best practices for managing exocrine pancreatic insufficiency in these patients. | 959FORSMARK et Al.

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“…Although there are descriptions of pancreatic dysfunction in elderly patients and those with celiac disease, Crohn's disease and diabetes, there are few objective data on the benefits of pancreatic enzymes for treating such patients . Interest has recently been renewed over the use of enzymes with symptoms consistent with meal‐associated irritable bowel syndrome, especially those with the diarrhea‐predominant irritable bowel syndrome (IBS‐D) …”

Section: Introductionmentioning

confidence: 99%

“…1 Although there are descriptions of pancreatic dysfunction in elderly patients and those with celiac disease, Crohn's disease and diabetes, there are few objective data on the benefits of pancreatic enzymes for treating such patients. 2 Interest has recently been renewed over the use of enzymes with symptoms consistent with meal-associated irritable bowel syndrome, especially those with the diarrhea-predominant irritable bowel syndrome (IBS-D). [3][4][5] Here, we review the three groups of patients who may benefit from enzyme therapy, i.e., those with foregut irritable bowel syndrome-like symptoms, those with meal-associated dyspepsia (e.g., abdominal distension, belching, abdominal pain, abdominal distension and epigastric burning) and those with IBS-D-like symptoms.…”

Section: Introductionmentioning

confidence: 99%

Enzyme therapy for functional bowel disease‐like post‐prandial distress

Graham

Ketwaroo

Money

et al. 2018

J of Digest Diseases

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Post-prandial gastrointestinal symptoms such as diarrhea, abdominal distension, flatulence, bloating and a feeling of fullness are common complaints of often unknown etiology and pathogenesis. There is a long history of trials reporting the successful use of products containing a variety of combinations of digestive enzymes including a number of randomized placebo-controlled trials. We provide a narrative review of studies describing the use of multi-digestive enzymes for symptoms consistent with irritable bowel syndrome. We describe clinical trials reported over the past 60 years including double-blinded randomized, placebo-controlled studies and recent trials that focused on post-prandial diarrhea consistent with diarrhea-predominant irritable bowel syndrome. Disaccharidase deficiencies or deficiencies of other carbohydrate digesting enzymes were excluded. Worldwide studies have generally reported success with multi-enzyme preparations although none used a factorial design to identify subgroups or attempted to link specific symptom responses to specific components of therapy. Although there is a long history of the successful use of multi-enzyme preparations for post-prandial symptoms consistent with irritable bowel syndrome, long-term studies using validated scoring systems and factorial designs are needed to confirm the results for specific symptoms and the components of the combination drugs received.

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Less common etiologies of exocrine pancreatic insufficiency

Cited by 103 publications

References 174 publications

Diagnosis and management of hereditary haemochromatosis

Diagnosis and management of hereditary haemochromatosis

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Enzyme therapy for functional bowel disease‐like post‐prandial distress

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