The following two studies are related to additional at-risk patient populations for exocrine pancreatic insufficiency. In a single-center cross-sectional study out of Italy, researchers demonstrated that EPI is a feature of type 1 diabetes—compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Notably the study showed correlation between progressive exocrine and endocrine function throughout the natural history of disease. Certainly, further research is needed to clarify the pathogenesis and role of EPI in type 1 diabetes.

Lastly the final selection comes from AIIMS in India, where they assessed endocrine and exocrine function in patients following pancreatic trauma. Notably, of the 20 patients studied with trauma, 11 of them (55%) had evidence of pancreatic exocrine insufficiency by fecal elastase measurement. 4 patients had severe pancreatic insufficiency, 3 of which had partial pancreatectomy (with mean pancreatic volume of 48.65cm3 following surgery). Classic teaching is that EPI develops when exocrine function is impaired by ~90%, however in the resection groups, they have demonstrated severe EPI in patients with roughly 50% retained pancreatic volume.   

The following two studies are related to additional at-risk patient populations for exocrine pancreatic insufficiency. In a single-center cross-sectional study out of Italy, researchers demonstrated that EPI is a feature of type 1 diabetes—compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Notably the study showed correlation between progressive exocrine and endocrine function throughout the natural history of disease. Certainly, further research is needed to clarify the pathogenesis and role of EPI in type 1 diabetes.

Lastly the final selection comes from AIIMS in India, where they assessed endocrine and exocrine function in patients following pancreatic trauma. Notably, of the 20 patients studied with trauma, 11 of them (55%) had evidence of pancreatic exocrine insufficiency by fecal elastase measurement. 4 patients had severe pancreatic insufficiency, 3 of which had partial pancreatectomy (with mean pancreatic volume of 48.65cm3 following surgery). Classic teaching is that EPI develops when exocrine function is impaired by ~90%, however in the resection groups, they have demonstrated severe EPI in patients with roughly 50% retained pancreatic volume.   

The following two studies are related to additional at-risk patient populations for exocrine pancreatic insufficiency. In a single-center cross-sectional study out of Italy, researchers demonstrated that EPI is a feature of type 1 diabetes—compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Notably the study showed correlation between progressive exocrine and endocrine function throughout the natural history of disease. Certainly, further research is needed to clarify the pathogenesis and role of EPI in type 1 diabetes.

Lastly the final selection comes from AIIMS in India, where they assessed endocrine and exocrine function in patients following pancreatic trauma. Notably, of the 20 patients studied with trauma, 11 of them (55%) had evidence of pancreatic exocrine insufficiency by fecal elastase measurement. 4 patients had severe pancreatic insufficiency, 3 of which had partial pancreatectomy (with mean pancreatic volume of 48.65cm3 following surgery). Classic teaching is that EPI develops when exocrine function is impaired by ~90%, however in the resection groups, they have demonstrated severe EPI in patients with roughly 50% retained pancreatic volume.   

Key clinical point: The sphere size is not an essential parameter for selecting effective pancreatin preparations for patients with exocrine pancreatic insufficiency (EPI).

Major finding: One study reported faster emptying of 2 mm pellets than a pancake meal in patients with pancreatic disease. Another study reported parallel emptying of liver pate and 1.5 mm pellets (range, 1.0-1.5 mm). One study reported no clear pattern in stomach emptying for pancreatin pellets of less than 1.2 mm. Emptying of pancreatin preparations with a particle size of up to 7 mm is also documented in the postprandial phase in healthy individuals.

Study details: Meta-analysis of 26 studies that evaluated gastric emptying of indigestible particles of different sizes in healthy volunteers or patients with EPI under fed conditions.

Disclosures: This meta-analysis was supported by Nordmark. The authors received consulting fees outside of this work.

Citation: Peterson K-U. J Gastrointestin Liver Dis. 2021 Mar 12. doi: 10.15403/jgld-2985.

Key clinical point: The sphere size is not an essential parameter for selecting effective pancreatin preparations for patients with exocrine pancreatic insufficiency (EPI).

Major finding: One study reported faster emptying of 2 mm pellets than a pancake meal in patients with pancreatic disease. Another study reported parallel emptying of liver pate and 1.5 mm pellets (range, 1.0-1.5 mm). One study reported no clear pattern in stomach emptying for pancreatin pellets of less than 1.2 mm. Emptying of pancreatin preparations with a particle size of up to 7 mm is also documented in the postprandial phase in healthy individuals.

Study details: Meta-analysis of 26 studies that evaluated gastric emptying of indigestible particles of different sizes in healthy volunteers or patients with EPI under fed conditions.

Disclosures: This meta-analysis was supported by Nordmark. The authors received consulting fees outside of this work.

Citation: Peterson K-U. J Gastrointestin Liver Dis. 2021 Mar 12. doi: 10.15403/jgld-2985.

Key clinical point: The sphere size is not an essential parameter for selecting effective pancreatin preparations for patients with exocrine pancreatic insufficiency (EPI).

Major finding: One study reported faster emptying of 2 mm pellets than a pancake meal in patients with pancreatic disease. Another study reported parallel emptying of liver pate and 1.5 mm pellets (range, 1.0-1.5 mm). One study reported no clear pattern in stomach emptying for pancreatin pellets of less than 1.2 mm. Emptying of pancreatin preparations with a particle size of up to 7 mm is also documented in the postprandial phase in healthy individuals.

Study details: Meta-analysis of 26 studies that evaluated gastric emptying of indigestible particles of different sizes in healthy volunteers or patients with EPI under fed conditions.

Disclosures: This meta-analysis was supported by Nordmark. The authors received consulting fees outside of this work.

Citation: Peterson K-U. J Gastrointestin Liver Dis. 2021 Mar 12. doi: 10.15403/jgld-2985.

Depression might be a disorder of the brain, but its harms aren’t confined to the cranium. Prolonged depression has been linked with a slew of health problems, from impaired immune function to gastrointestinal dysfunction. It’s also been linked with cardiovascular disease (CVD), even increasing the risk for heart attack and a disrupted heart rate. Now, researchers are exploring whether heart function could be a valuable biomarker in informing depression diagnosis and treatment.

Major depressive disorder has proved difficult to diagnose and treat, and biomarkers that indicate a depressive episode or suggest specific interventions would be an attractive solution to its clinically nebulous nature.

Currently, diagnosing depression relies on the patients effectively communicating their symptoms. If the patient does receive a diagnosis, treating it remains a matter of trial and error. It takes weeks to know whether a treatment is working, and in only one-third of cases does the condition go into remission after the patient is initially prescribed an antidepressant. Even after successful treatment, it’s challenging to identify who might be at risk for relapse, and when. Research now shows that cardiac biomarkers may be a way improve this picture. Clinicians could use changes in heart rate to both inform depression diagnosis and gauge a patient’s predicted response to treatment.

Given the increased risk for CVD among people with depression and the link between heart rate changes and CVD risk, these biomarkers could have implications for heart health, too. “We need more than just the current toolkit,” said Amit Shah, MD, a cardiologist and assistant professor of epidemiology at Emory University, Atlanta. “Ultimately, what we’re trying to do is develop interventions not only for depression but also for the associated physical health problems related to depression, in particular, cardiovascular disease,” he said. These overlapping interests – and the prospect of clinically considering both conditions in tandem – mean this research is “really worth its weight in gold,” added Dr. Shah.
 

The data on heart rate biomarkers

Patients with depression are often found to have lower heart rate variability (HRV) and higher heart rates. Scientists don’t know the mechanisms underpinning this relationship but think changes in the autonomic nervous system during depression, as well as stress generally, have a role.

Rébecca Robillard, PhD, is the head scientist of the Clinical Sleep Research Platform at the Royal’s Institute of Mental Health Research, Ottawa, Ont. In a 2019 study published in BMC Psychiatry, Dr. Robillard’s team used electrocardiogram recordings from sleep studies to see whether heart rate abnormalities were associated with depression. Using a profiling algorithm to analyze heart rate and HRV data, the team identified persons with depression with 80% accuracy among 174 people with sleep complaints.

“It’s still early days, but our work certainly suggests that [HRV and heart rate] could serve as potential biomarkers,” Dr. Robillard said.

In another study, Stephan Claes, MD, PhD, psychiatrist and professor of psychiatry at Katholieke Universiteit Leuven, Belgium, and his group tested the biomarker potential of heart rate and HRV data that were continuously recorded over several days. They too used an algorithm to distinguish 16 people with treatment-resistant depression from 16 without depression. Within the depression group, they used the algorithm to distinguish patients who had received ketamine treatment from those who had not.

The algorithm could differentiate between the depressed and nondepressed groups with 90% accuracy. Those with depression had higher overall heart rates, particularly at night, and lower HRV. Dr. Claes noted that, unlike in other studies, “the most reliable parameter that we had for this prediction was the heart rate, not the HRV.” After treatment, heart rates improved, but HRV remained the same.

Although their study has not yet been peer reviewed and more research is needed, Dr. Claes said that increased heart rate, especially during the night, could eventually serve as a warning sign of depression relapse. “That would allow a quicker referral to care and better care because of earlier intervention,” he said.
 

Finding a signal amid the noise

But heart rate and HRV aren’t foolproof biomarkers. Some studies have found that antidepressant use lowers HRV and that HRV changes aren’t unique to depression. There’s the added complication that depression often overlaps with other mental disorders.

“I think we’ve been very disappointed about the success of using particular biomarkers for particular disorders, because the majority of mental disorders are very heterogeneous,” said Andrew Kemp, PhD, psychology professor at Swansea University, Swansea, Wales. “A particular biomarker will, at the end of the day, be just one particular aspect of the overall profile that clinicians will have on particular individuals.”

The clinical utility of a heart rate–depression connection may go both ways.

For instance, depression could serve as a warning sign for atrial fibrillation, according to research from Parveen K. Garg, MD, associate professor of clinical medicine at the University of Southern California, Los Angeles. In a study involving more than 6,000 people, Dr. Garg showed that higher scores on depression scales correlated with a higher risk for the occurrence of atrial fibrillation over a follow-up period of about 13 years.

Depression is associated with other heart conditions as well. “A lot of data seem to suggest that just the presence of depression can increase risk for a whole range of cardiovascular problems,” said Dr. Garg. Epidemiologic studies have found associations between depression and the development of coronary heart disease and a modest increased risk for stroke.

“Things going on in your brain also have effects on the rest of your body,” said Dr. Garg. “Just recognizing this link, that maybe mental illness has an effect on other illnesses or diseases that can affect other parts of your body – I think that’s something we can share now.”

A version of this article first appeared on Medscape.com.

Depression might be a disorder of the brain, but its harms aren’t confined to the cranium. Prolonged depression has been linked with a slew of health problems, from impaired immune function to gastrointestinal dysfunction. It’s also been linked with cardiovascular disease (CVD), even increasing the risk for heart attack and a disrupted heart rate. Now, researchers are exploring whether heart function could be a valuable biomarker in informing depression diagnosis and treatment.

Major depressive disorder has proved difficult to diagnose and treat, and biomarkers that indicate a depressive episode or suggest specific interventions would be an attractive solution to its clinically nebulous nature.

Currently, diagnosing depression relies on the patients effectively communicating their symptoms. If the patient does receive a diagnosis, treating it remains a matter of trial and error. It takes weeks to know whether a treatment is working, and in only one-third of cases does the condition go into remission after the patient is initially prescribed an antidepressant. Even after successful treatment, it’s challenging to identify who might be at risk for relapse, and when. Research now shows that cardiac biomarkers may be a way improve this picture. Clinicians could use changes in heart rate to both inform depression diagnosis and gauge a patient’s predicted response to treatment.

Given the increased risk for CVD among people with depression and the link between heart rate changes and CVD risk, these biomarkers could have implications for heart health, too. “We need more than just the current toolkit,” said Amit Shah, MD, a cardiologist and assistant professor of epidemiology at Emory University, Atlanta. “Ultimately, what we’re trying to do is develop interventions not only for depression but also for the associated physical health problems related to depression, in particular, cardiovascular disease,” he said. These overlapping interests – and the prospect of clinically considering both conditions in tandem – mean this research is “really worth its weight in gold,” added Dr. Shah.
 

The data on heart rate biomarkers

Patients with depression are often found to have lower heart rate variability (HRV) and higher heart rates. Scientists don’t know the mechanisms underpinning this relationship but think changes in the autonomic nervous system during depression, as well as stress generally, have a role.

Rébecca Robillard, PhD, is the head scientist of the Clinical Sleep Research Platform at the Royal’s Institute of Mental Health Research, Ottawa, Ont. In a 2019 study published in BMC Psychiatry, Dr. Robillard’s team used electrocardiogram recordings from sleep studies to see whether heart rate abnormalities were associated with depression. Using a profiling algorithm to analyze heart rate and HRV data, the team identified persons with depression with 80% accuracy among 174 people with sleep complaints.

“It’s still early days, but our work certainly suggests that [HRV and heart rate] could serve as potential biomarkers,” Dr. Robillard said.

In another study, Stephan Claes, MD, PhD, psychiatrist and professor of psychiatry at Katholieke Universiteit Leuven, Belgium, and his group tested the biomarker potential of heart rate and HRV data that were continuously recorded over several days. They too used an algorithm to distinguish 16 people with treatment-resistant depression from 16 without depression. Within the depression group, they used the algorithm to distinguish patients who had received ketamine treatment from those who had not.

The algorithm could differentiate between the depressed and nondepressed groups with 90% accuracy. Those with depression had higher overall heart rates, particularly at night, and lower HRV. Dr. Claes noted that, unlike in other studies, “the most reliable parameter that we had for this prediction was the heart rate, not the HRV.” After treatment, heart rates improved, but HRV remained the same.

Although their study has not yet been peer reviewed and more research is needed, Dr. Claes said that increased heart rate, especially during the night, could eventually serve as a warning sign of depression relapse. “That would allow a quicker referral to care and better care because of earlier intervention,” he said.
 

Finding a signal amid the noise

But heart rate and HRV aren’t foolproof biomarkers. Some studies have found that antidepressant use lowers HRV and that HRV changes aren’t unique to depression. There’s the added complication that depression often overlaps with other mental disorders.

“I think we’ve been very disappointed about the success of using particular biomarkers for particular disorders, because the majority of mental disorders are very heterogeneous,” said Andrew Kemp, PhD, psychology professor at Swansea University, Swansea, Wales. “A particular biomarker will, at the end of the day, be just one particular aspect of the overall profile that clinicians will have on particular individuals.”

The clinical utility of a heart rate–depression connection may go both ways.

For instance, depression could serve as a warning sign for atrial fibrillation, according to research from Parveen K. Garg, MD, associate professor of clinical medicine at the University of Southern California, Los Angeles. In a study involving more than 6,000 people, Dr. Garg showed that higher scores on depression scales correlated with a higher risk for the occurrence of atrial fibrillation over a follow-up period of about 13 years.

Depression is associated with other heart conditions as well. “A lot of data seem to suggest that just the presence of depression can increase risk for a whole range of cardiovascular problems,” said Dr. Garg. Epidemiologic studies have found associations between depression and the development of coronary heart disease and a modest increased risk for stroke.

“Things going on in your brain also have effects on the rest of your body,” said Dr. Garg. “Just recognizing this link, that maybe mental illness has an effect on other illnesses or diseases that can affect other parts of your body – I think that’s something we can share now.”

A version of this article first appeared on Medscape.com.

Depression might be a disorder of the brain, but its harms aren’t confined to the cranium. Prolonged depression has been linked with a slew of health problems, from impaired immune function to gastrointestinal dysfunction. It’s also been linked with cardiovascular disease (CVD), even increasing the risk for heart attack and a disrupted heart rate. Now, researchers are exploring whether heart function could be a valuable biomarker in informing depression diagnosis and treatment.

Major depressive disorder has proved difficult to diagnose and treat, and biomarkers that indicate a depressive episode or suggest specific interventions would be an attractive solution to its clinically nebulous nature.

Currently, diagnosing depression relies on the patients effectively communicating their symptoms. If the patient does receive a diagnosis, treating it remains a matter of trial and error. It takes weeks to know whether a treatment is working, and in only one-third of cases does the condition go into remission after the patient is initially prescribed an antidepressant. Even after successful treatment, it’s challenging to identify who might be at risk for relapse, and when. Research now shows that cardiac biomarkers may be a way improve this picture. Clinicians could use changes in heart rate to both inform depression diagnosis and gauge a patient’s predicted response to treatment.

Given the increased risk for CVD among people with depression and the link between heart rate changes and CVD risk, these biomarkers could have implications for heart health, too. “We need more than just the current toolkit,” said Amit Shah, MD, a cardiologist and assistant professor of epidemiology at Emory University, Atlanta. “Ultimately, what we’re trying to do is develop interventions not only for depression but also for the associated physical health problems related to depression, in particular, cardiovascular disease,” he said. These overlapping interests – and the prospect of clinically considering both conditions in tandem – mean this research is “really worth its weight in gold,” added Dr. Shah.
 

The data on heart rate biomarkers

Patients with depression are often found to have lower heart rate variability (HRV) and higher heart rates. Scientists don’t know the mechanisms underpinning this relationship but think changes in the autonomic nervous system during depression, as well as stress generally, have a role.

Rébecca Robillard, PhD, is the head scientist of the Clinical Sleep Research Platform at the Royal’s Institute of Mental Health Research, Ottawa, Ont. In a 2019 study published in BMC Psychiatry, Dr. Robillard’s team used electrocardiogram recordings from sleep studies to see whether heart rate abnormalities were associated with depression. Using a profiling algorithm to analyze heart rate and HRV data, the team identified persons with depression with 80% accuracy among 174 people with sleep complaints.

“It’s still early days, but our work certainly suggests that [HRV and heart rate] could serve as potential biomarkers,” Dr. Robillard said.

In another study, Stephan Claes, MD, PhD, psychiatrist and professor of psychiatry at Katholieke Universiteit Leuven, Belgium, and his group tested the biomarker potential of heart rate and HRV data that were continuously recorded over several days. They too used an algorithm to distinguish 16 people with treatment-resistant depression from 16 without depression. Within the depression group, they used the algorithm to distinguish patients who had received ketamine treatment from those who had not.

The algorithm could differentiate between the depressed and nondepressed groups with 90% accuracy. Those with depression had higher overall heart rates, particularly at night, and lower HRV. Dr. Claes noted that, unlike in other studies, “the most reliable parameter that we had for this prediction was the heart rate, not the HRV.” After treatment, heart rates improved, but HRV remained the same.

Although their study has not yet been peer reviewed and more research is needed, Dr. Claes said that increased heart rate, especially during the night, could eventually serve as a warning sign of depression relapse. “That would allow a quicker referral to care and better care because of earlier intervention,” he said.
 

Finding a signal amid the noise

But heart rate and HRV aren’t foolproof biomarkers. Some studies have found that antidepressant use lowers HRV and that HRV changes aren’t unique to depression. There’s the added complication that depression often overlaps with other mental disorders.

“I think we’ve been very disappointed about the success of using particular biomarkers for particular disorders, because the majority of mental disorders are very heterogeneous,” said Andrew Kemp, PhD, psychology professor at Swansea University, Swansea, Wales. “A particular biomarker will, at the end of the day, be just one particular aspect of the overall profile that clinicians will have on particular individuals.”

The clinical utility of a heart rate–depression connection may go both ways.

For instance, depression could serve as a warning sign for atrial fibrillation, according to research from Parveen K. Garg, MD, associate professor of clinical medicine at the University of Southern California, Los Angeles. In a study involving more than 6,000 people, Dr. Garg showed that higher scores on depression scales correlated with a higher risk for the occurrence of atrial fibrillation over a follow-up period of about 13 years.

Depression is associated with other heart conditions as well. “A lot of data seem to suggest that just the presence of depression can increase risk for a whole range of cardiovascular problems,” said Dr. Garg. Epidemiologic studies have found associations between depression and the development of coronary heart disease and a modest increased risk for stroke.

“Things going on in your brain also have effects on the rest of your body,” said Dr. Garg. “Just recognizing this link, that maybe mental illness has an effect on other illnesses or diseases that can affect other parts of your body – I think that’s something we can share now.”

A version of this article first appeared on Medscape.com.

Key clinical point: In patients with advanced pancreatic cancer, pancreatic enzyme replacement therapy (PERT) for exocrine pancreatic insufficiency (EPI) does not affect survival.

Major finding: There was no significant difference in the overall survival in patients who received PERT vs. those who did not (weighted estimate, 9.5 months vs. 8.1 months; P = .464). No PERT-related adverse events were reported.

Study details: A meta-analysis of 4 randomized controlled trials including 194 patients with pancreatic cancer. The patients with EPI received PERT.

Disclosures: No specific sponsor was identified. One reviewer received personal fees from Abbott Pharmaceuticals and Mylan.

Citation: Ammar K. Expert Rev Gastroenterol Hepatol. 2021 Feb 15. doi: 10.1080/17474124.2021.1884544.

Key clinical point: In patients with advanced pancreatic cancer, pancreatic enzyme replacement therapy (PERT) for exocrine pancreatic insufficiency (EPI) does not affect survival.

Major finding: There was no significant difference in the overall survival in patients who received PERT vs. those who did not (weighted estimate, 9.5 months vs. 8.1 months; P = .464). No PERT-related adverse events were reported.

Study details: A meta-analysis of 4 randomized controlled trials including 194 patients with pancreatic cancer. The patients with EPI received PERT.

Disclosures: No specific sponsor was identified. One reviewer received personal fees from Abbott Pharmaceuticals and Mylan.

Citation: Ammar K. Expert Rev Gastroenterol Hepatol. 2021 Feb 15. doi: 10.1080/17474124.2021.1884544.

Key clinical point: In patients with advanced pancreatic cancer, pancreatic enzyme replacement therapy (PERT) for exocrine pancreatic insufficiency (EPI) does not affect survival.

Major finding: There was no significant difference in the overall survival in patients who received PERT vs. those who did not (weighted estimate, 9.5 months vs. 8.1 months; P = .464). No PERT-related adverse events were reported.

Study details: A meta-analysis of 4 randomized controlled trials including 194 patients with pancreatic cancer. The patients with EPI received PERT.

Disclosures: No specific sponsor was identified. One reviewer received personal fees from Abbott Pharmaceuticals and Mylan.

Citation: Ammar K. Expert Rev Gastroenterol Hepatol. 2021 Feb 15. doi: 10.1080/17474124.2021.1884544.

Key clinical point: Presence of exocrine pancreatic insufficiency (EPI) in patients with cystic fibrosis is associated with lower levels of phytosterol and cholesterol. Pancreatic enzyme supplement improves cholesterol levels in these patients.

Major finding: Total fat and cholesterol intake were higher in patients with cystic fibrosis. Total cholesterol, low-density lipoprotein cholesterol, campesterol, and β-sitosterol levels were significantly lower in cystic fibrosis patients with EPI vs. those without (all P less than .05). The rate of hypocholesterolemia was lower in patients with EPI receiving a supplementation dose of greater than 2500 U of lipase/g of fat (P = .0026).

Study details: The study included 55 patients with cystic fibrosis and 45 healthy adults. Forty-eight patients with cystic fibrosis had EPI (fecal elastase-1 concentrations less than 100 µg/g) and received pancreatic enzymes.

Disclosures: The study was supported by the Polish National Science Centre. The authors declared no conflicts of interest.

Citation: Drzymała-Czyż S et al. Biomolecules. 2021 Feb 19. doi: 10.3390/biom11020313.

Key clinical point: Presence of exocrine pancreatic insufficiency (EPI) in patients with cystic fibrosis is associated with lower levels of phytosterol and cholesterol. Pancreatic enzyme supplement improves cholesterol levels in these patients.

Major finding: Total fat and cholesterol intake were higher in patients with cystic fibrosis. Total cholesterol, low-density lipoprotein cholesterol, campesterol, and β-sitosterol levels were significantly lower in cystic fibrosis patients with EPI vs. those without (all P less than .05). The rate of hypocholesterolemia was lower in patients with EPI receiving a supplementation dose of greater than 2500 U of lipase/g of fat (P = .0026).

Study details: The study included 55 patients with cystic fibrosis and 45 healthy adults. Forty-eight patients with cystic fibrosis had EPI (fecal elastase-1 concentrations less than 100 µg/g) and received pancreatic enzymes.

Disclosures: The study was supported by the Polish National Science Centre. The authors declared no conflicts of interest.

Citation: Drzymała-Czyż S et al. Biomolecules. 2021 Feb 19. doi: 10.3390/biom11020313.

Key clinical point: Presence of exocrine pancreatic insufficiency (EPI) in patients with cystic fibrosis is associated with lower levels of phytosterol and cholesterol. Pancreatic enzyme supplement improves cholesterol levels in these patients.

Major finding: Total fat and cholesterol intake were higher in patients with cystic fibrosis. Total cholesterol, low-density lipoprotein cholesterol, campesterol, and β-sitosterol levels were significantly lower in cystic fibrosis patients with EPI vs. those without (all P less than .05). The rate of hypocholesterolemia was lower in patients with EPI receiving a supplementation dose of greater than 2500 U of lipase/g of fat (P = .0026).

Study details: The study included 55 patients with cystic fibrosis and 45 healthy adults. Forty-eight patients with cystic fibrosis had EPI (fecal elastase-1 concentrations less than 100 µg/g) and received pancreatic enzymes.

Disclosures: The study was supported by the Polish National Science Centre. The authors declared no conflicts of interest.

Citation: Drzymała-Czyż S et al. Biomolecules. 2021 Feb 19. doi: 10.3390/biom11020313.

Key clinical point: Impaired exocrine pancreatic function is reported in a subgroup of patients undergoing esophagectomy, and pancreatic enzyme replacement therapy can improve symptoms and body weight in these patients.

Major finding: Fecal elastase-1 levels of less than 200 µg/g were reported in 16%-18% of patients at 4-6 months following esophagectomy. Pancreatic enzyme replacement therapy (25,000-50,000 units lipase per meal) improved gastrointestinal symptoms, body weight, and normalized stool in patients with steatorrhea.

Study details: Systematic review of 3 prospective cohort studies reporting exocrine pancreatic insufficiency (EPI) in 107 patients undergoing esophagectomy.

Disclosures: No sponsor was identified for this review.

Citation: Blonk L et al. Dis Esophagus. 2021 Feb 9. doi: 10.1093/dote/doab003.

Key clinical point: Impaired exocrine pancreatic function is reported in a subgroup of patients undergoing esophagectomy, and pancreatic enzyme replacement therapy can improve symptoms and body weight in these patients.

Major finding: Fecal elastase-1 levels of less than 200 µg/g were reported in 16%-18% of patients at 4-6 months following esophagectomy. Pancreatic enzyme replacement therapy (25,000-50,000 units lipase per meal) improved gastrointestinal symptoms, body weight, and normalized stool in patients with steatorrhea.

Study details: Systematic review of 3 prospective cohort studies reporting exocrine pancreatic insufficiency (EPI) in 107 patients undergoing esophagectomy.

Disclosures: No sponsor was identified for this review.

Citation: Blonk L et al. Dis Esophagus. 2021 Feb 9. doi: 10.1093/dote/doab003.

Key clinical point: Impaired exocrine pancreatic function is reported in a subgroup of patients undergoing esophagectomy, and pancreatic enzyme replacement therapy can improve symptoms and body weight in these patients.

Major finding: Fecal elastase-1 levels of less than 200 µg/g were reported in 16%-18% of patients at 4-6 months following esophagectomy. Pancreatic enzyme replacement therapy (25,000-50,000 units lipase per meal) improved gastrointestinal symptoms, body weight, and normalized stool in patients with steatorrhea.

Study details: Systematic review of 3 prospective cohort studies reporting exocrine pancreatic insufficiency (EPI) in 107 patients undergoing esophagectomy.

Disclosures: No sponsor was identified for this review.

Citation: Blonk L et al. Dis Esophagus. 2021 Feb 9. doi: 10.1093/dote/doab003.

Key clinical point: Asymptomatic patients with pancreatic trauma may have exocrine insufficiency when evaluated with specific investigations.

Major finding: Patients who underwent pancreatic resection had a lower fecal elastase value vs. those who did not, but the difference was not statistically significant (113 vs. 162.5 μg/g; P = .7). One patient in the resection group reported steatorrhea. Three patients in the pancreatic resection and 1 in the nonresection group had severe pancreatic exocrine insufficiency (P = .7). No patient required pancreatic enzyme supplements.

Study details: A study of 20 patients (mean age, 25 years) with pancreatic trauma between June 2016 and December 2017. Partial pancreatic resection was performed in 12 patients. Exocrine functions were evaluated with the fecal elastase test at 6 months.

Disclosures: No study sponsor was identified.

Citation: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Asymptomatic patients with pancreatic trauma may have exocrine insufficiency when evaluated with specific investigations.

Major finding: Patients who underwent pancreatic resection had a lower fecal elastase value vs. those who did not, but the difference was not statistically significant (113 vs. 162.5 μg/g; P = .7). One patient in the resection group reported steatorrhea. Three patients in the pancreatic resection and 1 in the nonresection group had severe pancreatic exocrine insufficiency (P = .7). No patient required pancreatic enzyme supplements.

Study details: A study of 20 patients (mean age, 25 years) with pancreatic trauma between June 2016 and December 2017. Partial pancreatic resection was performed in 12 patients. Exocrine functions were evaluated with the fecal elastase test at 6 months.

Disclosures: No study sponsor was identified.

Citation: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Asymptomatic patients with pancreatic trauma may have exocrine insufficiency when evaluated with specific investigations.

Major finding: Patients who underwent pancreatic resection had a lower fecal elastase value vs. those who did not, but the difference was not statistically significant (113 vs. 162.5 μg/g; P = .7). One patient in the resection group reported steatorrhea. Three patients in the pancreatic resection and 1 in the nonresection group had severe pancreatic exocrine insufficiency (P = .7). No patient required pancreatic enzyme supplements.

Study details: A study of 20 patients (mean age, 25 years) with pancreatic trauma between June 2016 and December 2017. Partial pancreatic resection was performed in 12 patients. Exocrine functions were evaluated with the fecal elastase test at 6 months.

Disclosures: No study sponsor was identified.

Citation: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Patients who experience malabsorption with sorafenib treatment may develop exocrine pancreatic insufficiency (EPI); supplementation with pancreatic enzymes may benefit these patients.

Major finding: Two patients had moderate and 6 patients had severe pancreatic insufficiency. Six patients who developed EPI received pancreatic enzymes and recovered from the malabsorption symptoms within 1 month. The fecal elastase values recovered in 5 of 6 patients who received pancreatic enzymes.

Study details: A prospective study of 21 patients with hepatocellular carcinoma treated with sorafenib who developed malabsorption.

Disclosures: No study sponsor was identified. The authors received speaker fees and grants outside the study work.

Citation: Díaz-González A et al. J Clin Gastroenterol. 2021 Mar 1. doi: 10.1097/MCG.0000000000001366.

Key clinical point: Patients who experience malabsorption with sorafenib treatment may develop exocrine pancreatic insufficiency (EPI); supplementation with pancreatic enzymes may benefit these patients.

Major finding: Two patients had moderate and 6 patients had severe pancreatic insufficiency. Six patients who developed EPI received pancreatic enzymes and recovered from the malabsorption symptoms within 1 month. The fecal elastase values recovered in 5 of 6 patients who received pancreatic enzymes.

Study details: A prospective study of 21 patients with hepatocellular carcinoma treated with sorafenib who developed malabsorption.

Disclosures: No study sponsor was identified. The authors received speaker fees and grants outside the study work.

Citation: Díaz-González A et al. J Clin Gastroenterol. 2021 Mar 1. doi: 10.1097/MCG.0000000000001366.

Key clinical point: Patients who experience malabsorption with sorafenib treatment may develop exocrine pancreatic insufficiency (EPI); supplementation with pancreatic enzymes may benefit these patients.

Major finding: Two patients had moderate and 6 patients had severe pancreatic insufficiency. Six patients who developed EPI received pancreatic enzymes and recovered from the malabsorption symptoms within 1 month. The fecal elastase values recovered in 5 of 6 patients who received pancreatic enzymes.

Study details: A prospective study of 21 patients with hepatocellular carcinoma treated with sorafenib who developed malabsorption.

Disclosures: No study sponsor was identified. The authors received speaker fees and grants outside the study work.

Citation: Díaz-González A et al. J Clin Gastroenterol. 2021 Mar 1. doi: 10.1097/MCG.0000000000001366.

Key clinical point: Exocrine pancreatic insufficiency is a feature of type 1 diabetes (T1D). Lower levels of fecal elastase-1 and amylase are reported in patients with T1D vs. healthy individuals.

Major finding: Compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Pancreatic amylase levels were significantly lower in patients with long-standing T1D vs. healthy individuals (P = .0001). The markers of impaired exocrine function tests (fecal elastase-1, serum pancreatic amylase, and lipase) correlated with the reduction of fasting and urinary C-peptide (all P less than .001).

Study details: A single-center, cross-sectional study of pancreatic exocrine function in adult patients with new-onset T1D (n = 12) or long-standing T1D (n = 19) and healthy individuals (n = 25).

Disclosures: This study was supported by a grant received by Battaglia M from the Italian Diabetes Society (SID) Research Foundation SID.

Citation: Dozio N et al. BMJ Open Diab Res Care. 2021 Feb. doi: 10.1136/bmjdrc-2019-001158.

Key clinical point: Exocrine pancreatic insufficiency is a feature of type 1 diabetes (T1D). Lower levels of fecal elastase-1 and amylase are reported in patients with T1D vs. healthy individuals.

Major finding: Compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Pancreatic amylase levels were significantly lower in patients with long-standing T1D vs. healthy individuals (P = .0001). The markers of impaired exocrine function tests (fecal elastase-1, serum pancreatic amylase, and lipase) correlated with the reduction of fasting and urinary C-peptide (all P less than .001).

Study details: A single-center, cross-sectional study of pancreatic exocrine function in adult patients with new-onset T1D (n = 12) or long-standing T1D (n = 19) and healthy individuals (n = 25).

Disclosures: This study was supported by a grant received by Battaglia M from the Italian Diabetes Society (SID) Research Foundation SID.

Citation: Dozio N et al. BMJ Open Diab Res Care. 2021 Feb. doi: 10.1136/bmjdrc-2019-001158.

Key clinical point: Exocrine pancreatic insufficiency is a feature of type 1 diabetes (T1D). Lower levels of fecal elastase-1 and amylase are reported in patients with T1D vs. healthy individuals.

Major finding: Compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Pancreatic amylase levels were significantly lower in patients with long-standing T1D vs. healthy individuals (P = .0001). The markers of impaired exocrine function tests (fecal elastase-1, serum pancreatic amylase, and lipase) correlated with the reduction of fasting and urinary C-peptide (all P less than .001).

Study details: A single-center, cross-sectional study of pancreatic exocrine function in adult patients with new-onset T1D (n = 12) or long-standing T1D (n = 19) and healthy individuals (n = 25).

Disclosures: This study was supported by a grant received by Battaglia M from the Italian Diabetes Society (SID) Research Foundation SID.

Citation: Dozio N et al. BMJ Open Diab Res Care. 2021 Feb. doi: 10.1136/bmjdrc-2019-001158.

Key clinical point: Exocrine pancreatic insufficiency (EPI) is common in patients with gastroenteropancreatic neuroendocrine neoplasia (NEN) receiving somatostatin analogs. Pancreatic enzyme replacement therapy (PERT) is justified in patients experiencing EPI symptoms.

Major findings: Studies have reported an EPI prevalence of 20% to 38% in patients with NEN receiving somatostatin analogs. Its symptoms overlap with clinical features of tumor and common side effects of somatostatin analogs. EPI can be diagnosed with noninvasive fecal elastase-1 test and is easy to treat using PERT. However, there is a general lack of awareness about EPI and PERT. A multidisciplinary team of gastroenterologists and nutritionists can increase the odds of providing the best care.

Study details: An editorial on EPI in patients with NEN receiving somatostatin analogs.

Disclosures: No specific funding was identified for this editorial. Panzuto F received speaker honoraria from Mylan Italia.

Source: Panzuto F et al. Expert Opin Drug Saf. 2021 Feb 2. doi: 10.1080/14740338.2021.1881478.

Key clinical point: Exocrine pancreatic insufficiency (EPI) is common in patients with gastroenteropancreatic neuroendocrine neoplasia (NEN) receiving somatostatin analogs. Pancreatic enzyme replacement therapy (PERT) is justified in patients experiencing EPI symptoms.

Major findings: Studies have reported an EPI prevalence of 20% to 38% in patients with NEN receiving somatostatin analogs. Its symptoms overlap with clinical features of tumor and common side effects of somatostatin analogs. EPI can be diagnosed with noninvasive fecal elastase-1 test and is easy to treat using PERT. However, there is a general lack of awareness about EPI and PERT. A multidisciplinary team of gastroenterologists and nutritionists can increase the odds of providing the best care.

Study details: An editorial on EPI in patients with NEN receiving somatostatin analogs.

Disclosures: No specific funding was identified for this editorial. Panzuto F received speaker honoraria from Mylan Italia.

Source: Panzuto F et al. Expert Opin Drug Saf. 2021 Feb 2. doi: 10.1080/14740338.2021.1881478.

Key clinical point: Exocrine pancreatic insufficiency (EPI) is common in patients with gastroenteropancreatic neuroendocrine neoplasia (NEN) receiving somatostatin analogs. Pancreatic enzyme replacement therapy (PERT) is justified in patients experiencing EPI symptoms.

Major findings: Studies have reported an EPI prevalence of 20% to 38% in patients with NEN receiving somatostatin analogs. Its symptoms overlap with clinical features of tumor and common side effects of somatostatin analogs. EPI can be diagnosed with noninvasive fecal elastase-1 test and is easy to treat using PERT. However, there is a general lack of awareness about EPI and PERT. A multidisciplinary team of gastroenterologists and nutritionists can increase the odds of providing the best care.

Study details: An editorial on EPI in patients with NEN receiving somatostatin analogs.

Disclosures: No specific funding was identified for this editorial. Panzuto F received speaker honoraria from Mylan Italia.

Source: Panzuto F et al. Expert Opin Drug Saf. 2021 Feb 2. doi: 10.1080/14740338.2021.1881478.