Pancreatic Insufficiency Secondary to Tobacco Exposure

Raphael, Kara L.; Chawla, Saurabh; Kim, Sungjin; Keith, Christopher G.; Propp, David; Chen, Zhengjia N.; Woods, Kevin E.; Keilin, Steven; Cai, Qiang; Willingham, Field F.

doi:10.1097/mpa.0000000000000721

Cited by 21 publications

(10 citation statements)

References 27 publications

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“…Finally, a recent cross-sectional study associated EPI with tobacco exposure in subjects without pancreatic disease, reporting a higher rate of moderate (18%) and severe (10%) fecal elastase reduction in smokers as compared to controls. 42 …”

Section: Introductionmentioning

confidence: 99%

<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

Capurso¹,

Traini²,

Piciucchi³

et al. 2019

CEG

135

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Exocrine pancreatic insufficiency (EPI) is a condition caused by reduced or inappropriate secretion or activity of pancreatic juice and its digestive enzymes, pancreatic lipase in particular. EPI can result in clinical manifestation and biochemical alterations causing reduced quality of life and life-threating complications. EPI is common in pancreatic disorders, where it should be suspected and actively investigated, and in many extrapancreatic conditions. There are various tests available to diagnose EPI, with indirect, noninvasive ones, such as concentration of fecal elastase being more commonly employed. Administration of pancreatic enzymes replacement therapy remains the mainstay of EPI treatment. The present review article will discuss current evidence regarding the prevalence of EPI, the available tests to diagnose it and its treatment.

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Section: Introductionmentioning

confidence: 99%

<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

Capurso¹,

Traini²,

Piciucchi³

et al. 2019

CEG

135

View full text Add to dashboard Cite

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“…The most common cause is chronic pancreatitis, and steatorrhea occurs when more than 90% of pancreatic exocrine capacity is lost 1 . The prevalence of exocrine pancreatic insufficiency ranges from 35% to 75%, with the highest risk in those with chronic pancreatitis due to alcohol (usually with coexistent smoking) and with longer disease duration 2‐6 . Exocrine insufficiency is almost universal in those with chronic pancreatitis due to cystic fibrosis, and is relatively common in many genetic causes of chronic pancreatitis 7 .…”

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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“…-Tumores neuroendocrinos del páncreas 20 % (19) -Tumores pancreáticos 60 %-92 % en cabeza (3) -Cirugía pancreática 85 %-95 % en duodenopancreatectomía cefálica (20) 80 %-90 % con preservación de píloro (20) 20 %-50 % en pancreatectomía distal (21,22) Extrapancreática -Síndrome de Shwachman-Diamond 80 %-90 % (21) -Enfermedad celíaca 5 %-80 % (21) -Enfermedad inflamatoria intestinal 10 % colitis ulcerosa (21) 4 % enfermedad de Crohn (21) -Cirugía gastrointestinal 40 %-80 % gastrectomía subtotal/total (21) 31 % cirugía bariátrica (bypass gástrico, Y de Roux) (23) -Virus de inmunodeficiencia humana 10 %-50 % (24) -Tabaquismo 10 %-18 % (25) Fuente: elaboración propia 17 estudios, que incluyeron a 3662 sujetos con DM, se informó IPE en el 39 % de los pacientes con DM tipo 1 y en el 28 % de los pacientes con DM tipo 2. La DM tipo 3C también se ha asociado con el desarrollo de disfunción exocrina (18) .…”

Section: Etiología Prevalenciaunclassified

“…La prevalencia de IPE fue entre 10 %-50 % (24) . En un estudio se asoció IPE con TBQ, con una prevalencia de 10 %-18 % en sujetos sin enfermedad pancreática (25) .…”

Section: Causas Extrapancreáticasunclassified

Actualización en el manejo nutricional de la insuficiencia pancreática exocrina: revisión de la literatura

Canicoba

Nobili²,

Villagra³

2021

Rev. Nutr. Clin. Metab.

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La insuficiencia pancreática exocrina (IPE) produce mala digestión y malabsorción de nutrientes, lo que impacta negativamente en el estado nutricional. Si no se trata adecuadamente, esta conduce a una pérdida de peso progresiva y posibles deficiencias nutricionales, lo que aumenta la morbimortalidad de los pacientes, las reinternaciones y los costos sanitarios. La detección y el tratamiento oportuno de la IPE afectan positivamente el pronóstico de la enfermedad. El cuidado nutricional, el cual consta de un proceso continuo, tiene que formar parte de la atención integral del paciente, por tanto, debe ser un componente inherente a su cuidado. La detección temprana de pacientes en riesgo de desnutrición, o desnutridos, permite una intervención nutricional precoz, con el propósito de atenuar el impacto nutricio¬nal de la IPE. El objetivo de esta revisión es proporcionar evidencia científica acerca de la IPE y brindar un enfoque práctico para el manejo nutricional y el tratamiento clínico de la misma, importante por su impacto en la morbimortalidad y la calidad de vida. Palabras clave: insuficiencia pancreática exocrina, evaluación nutricional, terapia de reemplazo enzimático pancreático, terapia nutricional.

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Pancreatic Insufficiency Secondary to Tobacco Exposure

Abstract: This study suggests that tobacco exposure is independently associated with pancreatic exocrine insufficiency in patients without a prior diagnosis of pancreatic disease. Tobacco exposure seems to have greater detrimental effects on pancreatic function than alcohol in this population.

Cited by 21 publications

References 27 publications

<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

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

Actualización en el manejo nutricional de la insuficiencia pancreática exocrina: revisión de la literatura

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