Pancreatic Insufficiency in Adult Celiac Disease: Do Patients Require Long-Term Enzyme Supplementation?

Evans, K E; Leeds, John S.; Morley, Stephen; Sanders, David S.

doi:10.1007/s10620-010-1261-y

Cited by 37 publications

(23 citation statements)

References 39 publications

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“…Milder cases of pancreatic insufficiency (i.e., insufficient release of pancreatic proteases, assessed by fecal elastase-1 (E1) concentration (< 200 μg/g stool)) are common in gastrointestinal disorders such as celiac disease (Carroccio et al, 1991; Carroccio et al, 1994; Nousia-Arvanitakis et al, 1999; Evans et al, 2010), Crohn’s disease and ulcerative colitis (UC) (Maconi et al, 2008), giardiasis and cow milk-related enteropathy (Walkowiak and Herzig, 2001) and irritable bowel syndrome (Leeds et al, 2010) (Figure 1B). Mucosal damage and villous atrophy, as seen in most of these conditions, can decrease CCK release from I cells in the crypts and villi of the duodenum and jejunum, which results in pancreatic insufficiency.…”

Section: Consumers Differ In Digestive Capacitymentioning

confidence: 99%

Personalizing protein nourishment

Dallas

Sanctuary

et al. 2017

Critical Reviews in Food Science and Nutrition

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Proteins are not equally digestible—their proteolytic susceptibility varies by their source and processing method. Incomplete digestion increases colonic microbial protein fermentation (putrefaction), which produces toxic metabolites that can induce inflammation in vitro and have been associated with inflammation in vivo. Individual humans differ in protein digestive capacity based on phenotypes, particularly disease states. To avoid putrefaction-induced intestinal inflammation, protein sources and processing methods must be tailored to the consumer’s digestive capacity. This review explores how food processing techniques alter protein digestibility and examines how physiological conditions alter digestive capacity. Possible solutions to improving digestive function or matching low digestive capacity with more digestible protein sources are explored. Beyond the ileal digestibility measurements of protein digestibility, less invasive, quicker and cheaper techniques for monitoring the extent of protein digestion and fermentation are needed to personalize protein nourishment. Biomarkers of protein digestive capacity and efficiency can be identified with the toolsets of peptidomics, metabolomics, microbial sequencing and multiplexed protein analysis of fecal and urine samples. By monitoring individual protein digestive function, the protein component of diets can be tailored via protein source and processing selection to match individual needs to minimize colonic putrefaction and, thus, optimize gut health.

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Section: Consumers Differ In Digestive Capacitymentioning

confidence: 99%

Personalizing protein nourishment

Dallas

Sanctuary

et al. 2017

Critical Reviews in Food Science and Nutrition

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“…In this paper, the first longitudinal study to follow-up adult celiac patients with low fecal elastase levels [13], 20 patients with diagnosed celiac disease who remained symptomatic with chronic diarrhea and a low FE-1 despite a gluten-free diet (GFD), were commenced on pancreatic enzyme therapy (PET). Patients were reassessed at 6 and 12 months, and then annual intervals over a period of 4 years.…”

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confidence: 99%

Fecal Elastase: A Useful Test for Pancreatic Insufficiency?

Tod

Fine

2010

Dig Dis Sci

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Section: Extrapancreatic Diseases and Conditionsmentioning

confidence: 99%

“…Celiac disease is frequently associated with PEI,70,71 possibly because of increased immune activity in the intestinal tract. Evans et al70 showed that in a study of 20 patients with celiac disease, diarrhea was improved in 19 patients given PERT at a mean dose of 45,000 lipase units/day. Leeds et al72 also showed that low fecal elastase content is more common in patients with celiac disease and chronic diarrhea, and that PERT in combination with a gluten-free diet reduced stool frequency from four per day to one.…”

Section: Extrapancreatic Diseases and Conditionsmentioning

confidence: 99%

Pancrelipase: an evidence-based review of its use for treating pancreatic exocrine insufficiency

Nakajima

Oshida²,

Muneyuki³

et al. 2012

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Pancreatic exocrine insufficiency (PEI) is often observed in patients with pancreatic diseases, including chronic pancreatitis, cystic fibrosis, and tumors, or after surgical resection. PEI often results in malnutrition, weight loss and steatorrhea, which together increase the risk of morbidity and mortality. Therefore, nutritional interventions, such as low-fat diets and pancreatic enzyme replacement therapy (PERT), are needed to improve the clinical symptoms, and to address the pathophysiology of pancreatic exocrine insufficiency. PERT with delayed-release pancrelipase is now becoming a standard therapy for pancreatic exocrine insufficiency because it significantly improves the coefficients of fat and nitrogen absorption as well as clinical symptoms, without serious treatment-emergent adverse events. The major adverse events were tolerable gastrointestinal tract symptoms, such as stomach pain, nausea, and bloating. Fibrosing colonopathy, a serious complication, is associated with high doses of enzymes. Several pancrelipase products have been approved by the US Food and Drug Administration in recent years. Although many double-blind, placebo-controlled trials of pancrelipase products have been conducted in recent years, these studies have enrolled relatively few patients and have often been less than a few weeks in duration. Moreover, few studies have addressed the issue of pancreatic diabetes, a type of diabetes that is characterized by frequent hypoglycemia, which is difficult to manage. In addition, it is unclear whether PERT improves morbidity and mortality in such settings. Therefore, large, long-term prospective studies are needed to identify the optimal treatment for pancreatic exocrine insufficiency. The studies should also examine the extent to which PERT using pancrelipase improves mortality and morbidity. The etiology and severity of pancreatic exocrine insufficiency often differ among patients with gastrointestinal diseases or diabetes (type 1 and type 2), and among elderly subjects. Finally, although there is currently limited clinical evidence, numerous extrapancreatic diseases and conditions that are highly prevalent in the general population may also be considered potential targets for PERT and related treatments.

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Pancreatic Insufficiency in Adult Celiac Disease: Do Patients Require Long-Term Enzyme Supplementation?

Abstract: Fecal elastase-1 is useful in identifying exocrine pancreatic insufficiency in adult celiac patients with diarrhea. Our longitudinal data suggests that pancreatic enzyme supplementation could be discontinued in a substantial proportion of patients as symptoms improve.

Cited by 37 publications

References 39 publications

Personalizing protein nourishment

Personalizing protein nourishment

Fecal Elastase: A Useful Test for Pancreatic Insufficiency?

Pancrelipase: an evidence-based review of its use for treating pancreatic exocrine insufficiency

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