Predictive factors of endocrine and exocrine insufficiency after resection of a benign tumour of the pancreas

Neophytou, Hélène; Wangermez, Marc; Gand, Elise; Carretier, Michel; Danion, Jean-Marie; Richer, Jean‐Pierre

doi:10.1016/j.ando.2017.10.003

Cited by 19 publications

(16 citation statements)

References 42 publications

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“…Neuroendocrine and benign serous or mucinous pancreatic tumors variously impair exocrine function similar to PC according to size, localization, ductal involvement, and surgical intervention 18. In advanced well-differentiated pancreatic or extrapancreatic neuroendocrine tumors, moderate EPI may be also observed in 20% of subjects treated with somatostatin analogs therapy due to pancreatic secretion inhibition 19…”

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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“…In those with resectable pancreatic cancer (approximately one in five patients), exocrine insufficiency is found in 40%‐50% on average, but this increases to approximately 75% after surgery 8‐11 . 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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“…Approaches for inferring the cause of diarrhoea: Characteristics of diarrhoea associated with specific causes were described by 14 articles[ 24 , 31 , 38 , 39 , 42 - 45 , 47 , 48 , 50 , 58 - 60 ], and five articles described concomitant symptoms that may be present and may assist in a differential diagnosis ( )[ 6 , 44 , 50 , 60 , 61 ]. Characteristics and symptoms described in the literature were as follows: Diarrhoea due to PEI was described as greasy, foul-smelling, floating stools[ 24 , 42 - 45 , 47 , 59 ], known clinically as steatorrhoea; patients with PEI may also have bloating, weight loss and signs of malabsorption[ 6 , 44 , 60 ]; BAM diarrhoea may be choleretic[ 61 ]; patients with SIBO may experience a change from initially intermittent diarrhoea (caused by CS) to continuous diarrhoea, with associated flatulence, bloating and borborygmic sounds[ 61 ]; characteristics of SBS diarrhoea were not reported, but other symptoms may include significant weight loss, electrolyte disturbance and hydration issues[ 61 ].…”

Section: Resultsmentioning

confidence: 99%

“…Approaches for confirming the cause of diarrhoea: A total of 19 articles reported on 13 unique tests used to investigate diarrhoea for nine specific causes ( )[ 6 , 32 - 34 , 36 - 38 , 40 , 42 - 44 , 46 , 49 , 50 , 60 - 64 ]. Of these, 12 studies had used a test for diagnosis of a condition in a population of patients with NETs[ 6 , 32 - 34 , 36 - 38 , 40 , 46 , 49 , 50 , 60 ], whereas seven articles only described or recommended a test (Table 2 )[ 42 - 44 , 61 - 64 ].…”

Section: Resultsmentioning

confidence: 99%

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Khan

Walter

Buchanan-Hughes

et al. 2020

WJG

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BACKGROUND Approximately 20% of patients with neuroendocrine tumours (NETs) develop carcinoid syndrome (CS), characterised by flushing and diarrhoea. Somatostatin analogues or telotristat can be used to control symptoms of CS through inhibition of serotonin secretion. Although CS is often the cause of diarrhoea among patients with gastroenteropancreatic NETs (GEP-NETs), other causes to consider include pancreatic enzyme insufficiency (PEI), bile acid malabsorption and small intestinal bacterial overgrowth. If other causes of diarrhoea unrelated to serotonin secretion are mistaken for CS diarrhoea, these treatments may be ineffective against the diarrhoea, risking detrimental effects to patient quality of life. AIM To identify and synthesise qualitative and quantitative evidence relating to the differential diagnosis of diarrhoea in patients with GEP-NETs. METHODS Electronic databases (MEDLINE, Embase and the Cochrane Library) were searched from inception to September 12, 2018 using terms for NETs and diarrhoea. Congresses, systematic literature review bibliographies and included articles were also hand-searched. Any study designs and publication types were eligible for inclusion if relevant data on a cause(s) of diarrhoea in patients with GEP-NETs were reported. Studies were screened by two independent reviewers at abstract and full-text stages. Framework synthesis was adapted to synthesise quantitative and qualitative data. The definition of qualitative data was expanded to include all textual data in any section of relevant publications. RESULTS Forty-seven publications (44 studies) were included, comprising a variety of publication types, including observational studies, reviews, guidelines, case reports, interventional studies, and opinion pieces. Most reported on PEI on/after treatment with somatostatin analogs; 9.5%-84% of patients with GEP-NETs had experienced steatorrhoea or confirmed PEI. Where reported, 14.3%–50.7% of patients received pancreatic enzyme replacement therapy. Other causes of diarrhoea reported in patients with GEP-NETs included bile acid malabsorption (80%), small intestinal bacterial overgrowth (23.6%-62%), colitis (20%) and infection (7.1%). Diagnostic approaches included faecal elastase, breath tests, tauroselcholic (selenium-75) acid (SeHCAT) scan and stool culture, although evidence on the effectiveness or diagnostic accuracy of these approaches was limited. Assessment of patient history or diarrhoea characteristics was also reported as initial approaches for investigation. From the identified evidence, if diarrhoea is assumed to be CS diarrhoea, consequences include uncontrolled diarrhoea, malnutrition, and perceived ineffectiveness of CS treatment. Approaches for facilitating differential diagnosis of diarrhoea include improving patient and clinician awareness of non-CS causes and involvement of a multidisciplinary clinical team, including gastroenterologists. CON...

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Predictive factors of endocrine and exocrine insufficiency after resection of a benign tumour of the pancreas

Cited by 19 publications

References 42 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

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

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