Exocrine Pancreatic Insufficiency

Key clinical point: Blood specimens from patients with chronic pancreatitis (CP) yielded a panel of 6 metabolites that showed differential expression with the presence or absence of exocrine pancreatic insufficiency (EPI; fecal elastase < 200 mg/g). Findings highlight the usefulness of metabolic studies to identify novel biomarkers for EPI diagnosis in CP.

Major finding: A 6-metabolite panel including arginine-proline-threonine tripeptide, 1 phosphatidylcholine, pentasine, and 3 phosphatidylserines was effective in discriminating between the presence and absence of EPI in patients with CP (area under the receiver operator characteristic curve, 0.79; 95% CI 0.62-0.92).

Study details: This metabolic study included 53 patients with CP with (60.4%) or without (39.6%) EPI.

Disclosures: This study was funded by grants from the Junta de Andalucia and the Instituto de Salud Carlos III. The authors declared no conflict of interests.

Source: Díaz C et al. Medicina. 2021 Aug 26. doi: 10.3390/medicina57090876.

Key clinical point: Blood specimens from patients with chronic pancreatitis (CP) yielded a panel of 6 metabolites that showed differential expression with the presence or absence of exocrine pancreatic insufficiency (EPI; fecal elastase < 200 mg/g). Findings highlight the usefulness of metabolic studies to identify novel biomarkers for EPI diagnosis in CP.

Major finding: A 6-metabolite panel including arginine-proline-threonine tripeptide, 1 phosphatidylcholine, pentasine, and 3 phosphatidylserines was effective in discriminating between the presence and absence of EPI in patients with CP (area under the receiver operator characteristic curve, 0.79; 95% CI 0.62-0.92).

Study details: This metabolic study included 53 patients with CP with (60.4%) or without (39.6%) EPI.

Disclosures: This study was funded by grants from the Junta de Andalucia and the Instituto de Salud Carlos III. The authors declared no conflict of interests.

Source: Díaz C et al. Medicina. 2021 Aug 26. doi: 10.3390/medicina57090876.

Key clinical point: Blood specimens from patients with chronic pancreatitis (CP) yielded a panel of 6 metabolites that showed differential expression with the presence or absence of exocrine pancreatic insufficiency (EPI; fecal elastase < 200 mg/g). Findings highlight the usefulness of metabolic studies to identify novel biomarkers for EPI diagnosis in CP.

Major finding: A 6-metabolite panel including arginine-proline-threonine tripeptide, 1 phosphatidylcholine, pentasine, and 3 phosphatidylserines was effective in discriminating between the presence and absence of EPI in patients with CP (area under the receiver operator characteristic curve, 0.79; 95% CI 0.62-0.92).

Study details: This metabolic study included 53 patients with CP with (60.4%) or without (39.6%) EPI.

Disclosures: This study was funded by grants from the Junta de Andalucia and the Instituto de Salud Carlos III. The authors declared no conflict of interests.

Source: Díaz C et al. Medicina. 2021 Aug 26. doi: 10.3390/medicina57090876.

Our first study comes out of Sheffield, UK, and Halle, Germany, and looks at the correlation between sarcopenia and EPI (Jalal et al). Notably sarcopenia, or reduction in muscle mass, is a known complication of malnutrition and conditions like EPI. It has traditionally been difficult to diagnose because traditional methods have suffered from low accuracy (i.e., mid-arm circumference). In recent years, commercially available software has been developed to digitally assess skeletal muscle mass on axial CT imaging. Digital imaging allows for granular assessments of metrics such as myosteatosis and sacropenic obesity, both of which remained relatively elusive metrics in prior ways of assessing sarcopenia.

In this study, researchers postulate that, since CT scans are recently performed in the evaluation of those patients with suspected pancreatic pathology, it would be natural to assess for sarcopenia on said CT imaging. Identifying sarcopenia might allow clinicians to identify those patients with or at risk for EPI.

Patients referred to EUS for suspected pancreatic pathology were included in the study (except those found to have pancreatic cancer). This prospective study included 102 patients with suspected or proven benign pancreatic pathology, chronic pancreatitis, or recurrent pancreatic type pain. Fecal elastase testing was used to determine those with EPI, and digital CT analysis was used to recognize patients with sarcopenia.

Overall, EPI was present in 45.1% of patients. The prevalence of sarcopenia (67.4% vs. 37.55%; P < .003), myosteatosis (52.2% vs. 10.7%; P = .046), and sarcopenic obesity (66.7% vs. 24.3%; P = .002) was significantly higher in patients with vs without EPI. Sarcopenia (odds ratio [OR], 4.8; P = .02) was strongly associated with EPI. The authors conclude that digital skeletal mass analysis can be performed on patients already undergoing CT scans for suspected pancreatic pathology for possible further diagnosis, risk assessment and to better inform clinical management.

Another notable study came out of Baylor College of Medicine that looked at the clinical significance of fatty pancreas (FP) (Krill et al). Diffuse echogenicity of the pancreas is a common finding on endoscopic ultrasound (EUS), but of unknown clinical significance. Krill’s group aimed to determine if diffuse fatty infiltration of the pancreas had any clinical implication on pancreatic function. They conducted a retrospective case-control study comparing adult patients with diffuse echogenicity of the pancreas to those without known pancreatic disease with chronic diarrhea. Notably, the incidence of EPI (47% vs. 6%) and chronic pancreatitis (18% vs. 0%) was significantly higher (both P < .001) in the fatty pancreas group vs. the control group. 

The authors conclude “Our findings suggest that FP may not merely be a benign sonographic finding, but rather imply underlying parenchymal dysfunction, such as that seen when fat deposition occurs in the liver (i.e., nonalcoholic fatty liver disease).” Additionally the paper states that recent literature has found an association between fatty pancreas and increasing body mass index (BMI), hyperlipidemia, insulin resistance, and metabolic syndrome. Perhaps we will further appreciate the likely prominent and under-appreciated role of metabolic syndrome in the development of acute and chronic pancreatitis.

References:

Jalal M, Rosendahl J, Campbell JA, Vinayagam R, Al-Mukhtar A, Hopper AD. Identification of “digital sarcopenia” can aid the detection of pancreatic exocrine insufficiency and malnutrition assessment in patients with suspected pancreatic pathology. Dig Dis 2021 (Jun 8), (in press).

Krill JT, Szafron D, Elhanafi S, et al. Endoscopic ultrasound finding of diffuse echogenicity in the pancreas, is it relevant? Dig Dis Sci 2021 (Aug 4), (in press).

Our first study comes out of Sheffield, UK, and Halle, Germany, and looks at the correlation between sarcopenia and EPI (Jalal et al). Notably sarcopenia, or reduction in muscle mass, is a known complication of malnutrition and conditions like EPI. It has traditionally been difficult to diagnose because traditional methods have suffered from low accuracy (i.e., mid-arm circumference). In recent years, commercially available software has been developed to digitally assess skeletal muscle mass on axial CT imaging. Digital imaging allows for granular assessments of metrics such as myosteatosis and sacropenic obesity, both of which remained relatively elusive metrics in prior ways of assessing sarcopenia.

In this study, researchers postulate that, since CT scans are recently performed in the evaluation of those patients with suspected pancreatic pathology, it would be natural to assess for sarcopenia on said CT imaging. Identifying sarcopenia might allow clinicians to identify those patients with or at risk for EPI.

Patients referred to EUS for suspected pancreatic pathology were included in the study (except those found to have pancreatic cancer). This prospective study included 102 patients with suspected or proven benign pancreatic pathology, chronic pancreatitis, or recurrent pancreatic type pain. Fecal elastase testing was used to determine those with EPI, and digital CT analysis was used to recognize patients with sarcopenia.

Overall, EPI was present in 45.1% of patients. The prevalence of sarcopenia (67.4% vs. 37.55%; P < .003), myosteatosis (52.2% vs. 10.7%; P = .046), and sarcopenic obesity (66.7% vs. 24.3%; P = .002) was significantly higher in patients with vs without EPI. Sarcopenia (odds ratio [OR], 4.8; P = .02) was strongly associated with EPI. The authors conclude that digital skeletal mass analysis can be performed on patients already undergoing CT scans for suspected pancreatic pathology for possible further diagnosis, risk assessment and to better inform clinical management.

Another notable study came out of Baylor College of Medicine that looked at the clinical significance of fatty pancreas (FP) (Krill et al). Diffuse echogenicity of the pancreas is a common finding on endoscopic ultrasound (EUS), but of unknown clinical significance. Krill’s group aimed to determine if diffuse fatty infiltration of the pancreas had any clinical implication on pancreatic function. They conducted a retrospective case-control study comparing adult patients with diffuse echogenicity of the pancreas to those without known pancreatic disease with chronic diarrhea. Notably, the incidence of EPI (47% vs. 6%) and chronic pancreatitis (18% vs. 0%) was significantly higher (both P < .001) in the fatty pancreas group vs. the control group. 

The authors conclude “Our findings suggest that FP may not merely be a benign sonographic finding, but rather imply underlying parenchymal dysfunction, such as that seen when fat deposition occurs in the liver (i.e., nonalcoholic fatty liver disease).” Additionally the paper states that recent literature has found an association between fatty pancreas and increasing body mass index (BMI), hyperlipidemia, insulin resistance, and metabolic syndrome. Perhaps we will further appreciate the likely prominent and under-appreciated role of metabolic syndrome in the development of acute and chronic pancreatitis.

References:

Jalal M, Rosendahl J, Campbell JA, Vinayagam R, Al-Mukhtar A, Hopper AD. Identification of “digital sarcopenia” can aid the detection of pancreatic exocrine insufficiency and malnutrition assessment in patients with suspected pancreatic pathology. Dig Dis 2021 (Jun 8), (in press).

Krill JT, Szafron D, Elhanafi S, et al. Endoscopic ultrasound finding of diffuse echogenicity in the pancreas, is it relevant? Dig Dis Sci 2021 (Aug 4), (in press).

Our first study comes out of Sheffield, UK, and Halle, Germany, and looks at the correlation between sarcopenia and EPI (Jalal et al). Notably sarcopenia, or reduction in muscle mass, is a known complication of malnutrition and conditions like EPI. It has traditionally been difficult to diagnose because traditional methods have suffered from low accuracy (i.e., mid-arm circumference). In recent years, commercially available software has been developed to digitally assess skeletal muscle mass on axial CT imaging. Digital imaging allows for granular assessments of metrics such as myosteatosis and sacropenic obesity, both of which remained relatively elusive metrics in prior ways of assessing sarcopenia.

In this study, researchers postulate that, since CT scans are recently performed in the evaluation of those patients with suspected pancreatic pathology, it would be natural to assess for sarcopenia on said CT imaging. Identifying sarcopenia might allow clinicians to identify those patients with or at risk for EPI.

Patients referred to EUS for suspected pancreatic pathology were included in the study (except those found to have pancreatic cancer). This prospective study included 102 patients with suspected or proven benign pancreatic pathology, chronic pancreatitis, or recurrent pancreatic type pain. Fecal elastase testing was used to determine those with EPI, and digital CT analysis was used to recognize patients with sarcopenia.

Overall, EPI was present in 45.1% of patients. The prevalence of sarcopenia (67.4% vs. 37.55%; P < .003), myosteatosis (52.2% vs. 10.7%; P = .046), and sarcopenic obesity (66.7% vs. 24.3%; P = .002) was significantly higher in patients with vs without EPI. Sarcopenia (odds ratio [OR], 4.8; P = .02) was strongly associated with EPI. The authors conclude that digital skeletal mass analysis can be performed on patients already undergoing CT scans for suspected pancreatic pathology for possible further diagnosis, risk assessment and to better inform clinical management.

Another notable study came out of Baylor College of Medicine that looked at the clinical significance of fatty pancreas (FP) (Krill et al). Diffuse echogenicity of the pancreas is a common finding on endoscopic ultrasound (EUS), but of unknown clinical significance. Krill’s group aimed to determine if diffuse fatty infiltration of the pancreas had any clinical implication on pancreatic function. They conducted a retrospective case-control study comparing adult patients with diffuse echogenicity of the pancreas to those without known pancreatic disease with chronic diarrhea. Notably, the incidence of EPI (47% vs. 6%) and chronic pancreatitis (18% vs. 0%) was significantly higher (both P < .001) in the fatty pancreas group vs. the control group. 

The authors conclude “Our findings suggest that FP may not merely be a benign sonographic finding, but rather imply underlying parenchymal dysfunction, such as that seen when fat deposition occurs in the liver (i.e., nonalcoholic fatty liver disease).” Additionally the paper states that recent literature has found an association between fatty pancreas and increasing body mass index (BMI), hyperlipidemia, insulin resistance, and metabolic syndrome. Perhaps we will further appreciate the likely prominent and under-appreciated role of metabolic syndrome in the development of acute and chronic pancreatitis.

References:

Jalal M, Rosendahl J, Campbell JA, Vinayagam R, Al-Mukhtar A, Hopper AD. Identification of “digital sarcopenia” can aid the detection of pancreatic exocrine insufficiency and malnutrition assessment in patients with suspected pancreatic pathology. Dig Dis 2021 (Jun 8), (in press).

Krill JT, Szafron D, Elhanafi S, et al. Endoscopic ultrasound finding of diffuse echogenicity in the pancreas, is it relevant? Dig Dis Sci 2021 (Aug 4), (in press).

Key clinical point: Among patients with unresectable pancreatic cancer undergoing endoscopic retrograde cholangiopancreatography (ERCP), biliopancreatic, but not biliary endoscopic drainage, was associated with improvement and normalization of exocrine pancreatic function.

Major finding: At baseline, 80% of patients had exocrine pancreatic insufficiency (EPI). The median absolute improvement of ¹³C-cumulative recovery rate was significantly higher after biliopancreatic vs biliary drainage (23.75% vs −1.92%; P = .015). Normalization of pancreatic function was observed in all patients after biliopancreatic drainage vs only 1 patient after biliary drainage.

Study details: Findings are from a prospective analysis of 20 adult patients with obstructive jaundice secondary to unresectable pancreatic cancer who underwent ERCP and were randomly assigned to receive either biliary drainage (n=7) or biliopancreatic drainage (n=6).

Disclosures: This study was supported by the Health Research Institute of Santiago de Compostela, Spain. The authors declared no conflict of interests.

Source: Domínguez-Muñoz JE et al. Pancreas. 2021 May 20. doi: 10.1097/MPA.0000000000001817.

Key clinical point: Among patients with unresectable pancreatic cancer undergoing endoscopic retrograde cholangiopancreatography (ERCP), biliopancreatic, but not biliary endoscopic drainage, was associated with improvement and normalization of exocrine pancreatic function.

Major finding: At baseline, 80% of patients had exocrine pancreatic insufficiency (EPI). The median absolute improvement of ¹³C-cumulative recovery rate was significantly higher after biliopancreatic vs biliary drainage (23.75% vs −1.92%; P = .015). Normalization of pancreatic function was observed in all patients after biliopancreatic drainage vs only 1 patient after biliary drainage.

Study details: Findings are from a prospective analysis of 20 adult patients with obstructive jaundice secondary to unresectable pancreatic cancer who underwent ERCP and were randomly assigned to receive either biliary drainage (n=7) or biliopancreatic drainage (n=6).

Disclosures: This study was supported by the Health Research Institute of Santiago de Compostela, Spain. The authors declared no conflict of interests.

Source: Domínguez-Muñoz JE et al. Pancreas. 2021 May 20. doi: 10.1097/MPA.0000000000001817.

Key clinical point: Among patients with unresectable pancreatic cancer undergoing endoscopic retrograde cholangiopancreatography (ERCP), biliopancreatic, but not biliary endoscopic drainage, was associated with improvement and normalization of exocrine pancreatic function.

Major finding: At baseline, 80% of patients had exocrine pancreatic insufficiency (EPI). The median absolute improvement of ¹³C-cumulative recovery rate was significantly higher after biliopancreatic vs biliary drainage (23.75% vs −1.92%; P = .015). Normalization of pancreatic function was observed in all patients after biliopancreatic drainage vs only 1 patient after biliary drainage.

Study details: Findings are from a prospective analysis of 20 adult patients with obstructive jaundice secondary to unresectable pancreatic cancer who underwent ERCP and were randomly assigned to receive either biliary drainage (n=7) or biliopancreatic drainage (n=6).

Disclosures: This study was supported by the Health Research Institute of Santiago de Compostela, Spain. The authors declared no conflict of interests.

Source: Domínguez-Muñoz JE et al. Pancreas. 2021 May 20. doi: 10.1097/MPA.0000000000001817.

Key clinical point: Investigation of pancreatic elasticity and exocrine pancreatic insufficiency (EPI) using point shear wave elastography (pSWE) may provide a simple, inexpensive, and noninvasive tool for early detection of EPI, thereby influencing long-term outcomes in young patients with cystic fibrosis (CF).

Major finding: The mean pSWE was significantly lower in children with CF vs healthy children (0.97±0.16 vs 1.12±0.16; P < .001). Higher disease duration was independently associated with low pSWE (R²=0.634; P < .001).

Study details: Findings are from a prospective assessment of 55 pediatric patients with CF and 60 healthy children without any chronic diseases.

Disclosures: No source of funding was identified. The authors declared no conflict of interests.

Source: Yılmaz K et al. Pediatr Int. 2021 Aug 13. doi: 10.1111/ped.14951.

Key clinical point: Investigation of pancreatic elasticity and exocrine pancreatic insufficiency (EPI) using point shear wave elastography (pSWE) may provide a simple, inexpensive, and noninvasive tool for early detection of EPI, thereby influencing long-term outcomes in young patients with cystic fibrosis (CF).

Major finding: The mean pSWE was significantly lower in children with CF vs healthy children (0.97±0.16 vs 1.12±0.16; P < .001). Higher disease duration was independently associated with low pSWE (R²=0.634; P < .001).

Study details: Findings are from a prospective assessment of 55 pediatric patients with CF and 60 healthy children without any chronic diseases.

Disclosures: No source of funding was identified. The authors declared no conflict of interests.

Source: Yılmaz K et al. Pediatr Int. 2021 Aug 13. doi: 10.1111/ped.14951.

Key clinical point: Investigation of pancreatic elasticity and exocrine pancreatic insufficiency (EPI) using point shear wave elastography (pSWE) may provide a simple, inexpensive, and noninvasive tool for early detection of EPI, thereby influencing long-term outcomes in young patients with cystic fibrosis (CF).

Major finding: The mean pSWE was significantly lower in children with CF vs healthy children (0.97±0.16 vs 1.12±0.16; P < .001). Higher disease duration was independently associated with low pSWE (R²=0.634; P < .001).

Study details: Findings are from a prospective assessment of 55 pediatric patients with CF and 60 healthy children without any chronic diseases.

Disclosures: No source of funding was identified. The authors declared no conflict of interests.

Source: Yılmaz K et al. Pediatr Int. 2021 Aug 13. doi: 10.1111/ped.14951.

Key clinical point: The prevalence of exocrine pancreatic insufficiency (EPI) was higher in patients with diffuse echogenicity of the pancreas on endoscopic ultrasound (EUS; fatty pancreas group) vs patients with chronic diarrhea without known pancreatic disease (control group). This indicates that the EUS finding of diffuse echogenicity of the pancreas may have clinical implications on pancreatic function.

Major finding: The incidence of EPI (47% vs 6%) and chronic pancreatitis (18% vs 0%) was significantly higher (both P less than .001) in the fatty pancreas group vs control group. EPI was significantly associated with smoking (odds ratio [OR], 2.26; P = .018) and nonalcoholic fatty liver disease (OR, 4.00; P = .036) but not with chronic pancreatitis (OR, 0.70; P = .60).

Study details: Findings are from a retrospective analysis of 166 adult patients (fatty pancreas, n=89; control, n=77).

Disclosures: No source of funding was identified. MO Othman and I Raijman reported ties with various pharmaceutical companies. Other authors declared no conflict of interests.

Source: Krill JT et al. Dig Dis Sci. 2021 Aug 4. doi: 10.1007/s10620-021-07181-1

Key clinical point: The prevalence of exocrine pancreatic insufficiency (EPI) was higher in patients with diffuse echogenicity of the pancreas on endoscopic ultrasound (EUS; fatty pancreas group) vs patients with chronic diarrhea without known pancreatic disease (control group). This indicates that the EUS finding of diffuse echogenicity of the pancreas may have clinical implications on pancreatic function.

Major finding: The incidence of EPI (47% vs 6%) and chronic pancreatitis (18% vs 0%) was significantly higher (both P less than .001) in the fatty pancreas group vs control group. EPI was significantly associated with smoking (odds ratio [OR], 2.26; P = .018) and nonalcoholic fatty liver disease (OR, 4.00; P = .036) but not with chronic pancreatitis (OR, 0.70; P = .60).

Study details: Findings are from a retrospective analysis of 166 adult patients (fatty pancreas, n=89; control, n=77).

Disclosures: No source of funding was identified. MO Othman and I Raijman reported ties with various pharmaceutical companies. Other authors declared no conflict of interests.

Source: Krill JT et al. Dig Dis Sci. 2021 Aug 4. doi: 10.1007/s10620-021-07181-1

Key clinical point: The prevalence of exocrine pancreatic insufficiency (EPI) was higher in patients with diffuse echogenicity of the pancreas on endoscopic ultrasound (EUS; fatty pancreas group) vs patients with chronic diarrhea without known pancreatic disease (control group). This indicates that the EUS finding of diffuse echogenicity of the pancreas may have clinical implications on pancreatic function.

Major finding: The incidence of EPI (47% vs 6%) and chronic pancreatitis (18% vs 0%) was significantly higher (both P less than .001) in the fatty pancreas group vs control group. EPI was significantly associated with smoking (odds ratio [OR], 2.26; P = .018) and nonalcoholic fatty liver disease (OR, 4.00; P = .036) but not with chronic pancreatitis (OR, 0.70; P = .60).

Study details: Findings are from a retrospective analysis of 166 adult patients (fatty pancreas, n=89; control, n=77).

Disclosures: No source of funding was identified. MO Othman and I Raijman reported ties with various pharmaceutical companies. Other authors declared no conflict of interests.

Source: Krill JT et al. Dig Dis Sci. 2021 Aug 4. doi: 10.1007/s10620-021-07181-1

Key clinical point: Among patients undergoing endoscopic ultrasound for suspected pancreatic pathology, the presence of sarcopenia, assessed by digital skeletal muscle mass analysis, was associated with exocrine pancreatic insufficiency (EPI). Findings indicate that digital skeletal muscle analysis may aid as a nutritional assessment tool in this patient population.

Major finding: Overall, EPI was present in 45.1% of patients. The prevalence of sarcopenia (67.4% vs 37.55%; P less than .003), myosteatosis (52.2% vs 10.7%; P = .046), and sarcopenic obesity (66.7% vs 24.3%; P = .002) was significantly higher in patients with vs without EPI. Sarcopenia (odds ratio [OR], 4.8; P = .02) was strongly associated with EPI.

Study details: This prospective study included 102 patients with suspected or proven benign pancreatic pathology, chronic pancreatitis, or recurrent pancreatic type pain.

Disclosures: This study did not receive any specific funding. The authors declared no conflict of interests.

Source: Jalal M et al. Dig Dis. 2021 Jun 8. doi: 10.1159/000517554.

Key clinical point: Among patients undergoing endoscopic ultrasound for suspected pancreatic pathology, the presence of sarcopenia, assessed by digital skeletal muscle mass analysis, was associated with exocrine pancreatic insufficiency (EPI). Findings indicate that digital skeletal muscle analysis may aid as a nutritional assessment tool in this patient population.

Major finding: Overall, EPI was present in 45.1% of patients. The prevalence of sarcopenia (67.4% vs 37.55%; P less than .003), myosteatosis (52.2% vs 10.7%; P = .046), and sarcopenic obesity (66.7% vs 24.3%; P = .002) was significantly higher in patients with vs without EPI. Sarcopenia (odds ratio [OR], 4.8; P = .02) was strongly associated with EPI.

Study details: This prospective study included 102 patients with suspected or proven benign pancreatic pathology, chronic pancreatitis, or recurrent pancreatic type pain.

Disclosures: This study did not receive any specific funding. The authors declared no conflict of interests.

Source: Jalal M et al. Dig Dis. 2021 Jun 8. doi: 10.1159/000517554.

Key clinical point: Among patients undergoing endoscopic ultrasound for suspected pancreatic pathology, the presence of sarcopenia, assessed by digital skeletal muscle mass analysis, was associated with exocrine pancreatic insufficiency (EPI). Findings indicate that digital skeletal muscle analysis may aid as a nutritional assessment tool in this patient population.

Major finding: Overall, EPI was present in 45.1% of patients. The prevalence of sarcopenia (67.4% vs 37.55%; P less than .003), myosteatosis (52.2% vs 10.7%; P = .046), and sarcopenic obesity (66.7% vs 24.3%; P = .002) was significantly higher in patients with vs without EPI. Sarcopenia (odds ratio [OR], 4.8; P = .02) was strongly associated with EPI.

Study details: This prospective study included 102 patients with suspected or proven benign pancreatic pathology, chronic pancreatitis, or recurrent pancreatic type pain.

Disclosures: This study did not receive any specific funding. The authors declared no conflict of interests.

Source: Jalal M et al. Dig Dis. 2021 Jun 8. doi: 10.1159/000517554.

Key clinical point: Treatment with both long-acting (liraglutide) and short-acting (lixisenatide) glucagon-like peptide-1 receptor agonists (GLP-1RAs) significantly improved exocrine pancreatic function in patients with type 2 diabetes (T2D).

Major finding: Fecal elastase levels increased with lixisenatide (+46.6±17.7 mg/g; P = .015) and liraglutide (+30.3±14.3 mg/g; P = .045) treatment. b-carotene levels increased with lixisenatide (+0.05±0.02 mmol/L; P = .022) but not with liraglutide (−0.00±0.02 mmol/L; P = .96) treatment. Levels of lipase and amylase increased with liraglutide (P = .0001 and P = .013, respectively) but not with lixisenatide (P = .46 and P = .93, respectively).

Study details: This study included 50 patients with T2D randomly assigned to receive a 10-week treatment of either lixisenatide (n=24) or liraglutide (n=26).

Disclosures: This study was sponsored by Novo Nordisk. Some investigators reported ties with various pharmaceutical companies including Novo Nordisk.

Source: Quast DR et al. Diabetes Obes Metab. 2021 Jun 29. doi: 10.1111/dom.14477.

Key clinical point: Treatment with both long-acting (liraglutide) and short-acting (lixisenatide) glucagon-like peptide-1 receptor agonists (GLP-1RAs) significantly improved exocrine pancreatic function in patients with type 2 diabetes (T2D).

Major finding: Fecal elastase levels increased with lixisenatide (+46.6±17.7 mg/g; P = .015) and liraglutide (+30.3±14.3 mg/g; P = .045) treatment. b-carotene levels increased with lixisenatide (+0.05±0.02 mmol/L; P = .022) but not with liraglutide (−0.00±0.02 mmol/L; P = .96) treatment. Levels of lipase and amylase increased with liraglutide (P = .0001 and P = .013, respectively) but not with lixisenatide (P = .46 and P = .93, respectively).

Study details: This study included 50 patients with T2D randomly assigned to receive a 10-week treatment of either lixisenatide (n=24) or liraglutide (n=26).

Disclosures: This study was sponsored by Novo Nordisk. Some investigators reported ties with various pharmaceutical companies including Novo Nordisk.

Source: Quast DR et al. Diabetes Obes Metab. 2021 Jun 29. doi: 10.1111/dom.14477.

Key clinical point: Treatment with both long-acting (liraglutide) and short-acting (lixisenatide) glucagon-like peptide-1 receptor agonists (GLP-1RAs) significantly improved exocrine pancreatic function in patients with type 2 diabetes (T2D).

Major finding: Fecal elastase levels increased with lixisenatide (+46.6±17.7 mg/g; P = .015) and liraglutide (+30.3±14.3 mg/g; P = .045) treatment. b-carotene levels increased with lixisenatide (+0.05±0.02 mmol/L; P = .022) but not with liraglutide (−0.00±0.02 mmol/L; P = .96) treatment. Levels of lipase and amylase increased with liraglutide (P = .0001 and P = .013, respectively) but not with lixisenatide (P = .46 and P = .93, respectively).

Study details: This study included 50 patients with T2D randomly assigned to receive a 10-week treatment of either lixisenatide (n=24) or liraglutide (n=26).

Disclosures: This study was sponsored by Novo Nordisk. Some investigators reported ties with various pharmaceutical companies including Novo Nordisk.

Source: Quast DR et al. Diabetes Obes Metab. 2021 Jun 29. doi: 10.1111/dom.14477.

Key clinical point: The development of exocrine pancreatic insufficiency (EPI) varied with the type of restrictive or malabsorptive bariatric surgery, i.e., sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD/DS).

Major finding: Six-hour ¹³C-cumulative recovery rate was significantly reduced (all P less than .001) in patients who underwent BPD/DS (25.6±13.5%) vs those who underwent RYGB (44.0±9.6%) or SG (47.6±9.3%) and the control group of patients who did not undergo bariatric surgery (45.0±6.1%). EPI was present in 78.8% of patients after BPD/DS, 8.3% of patients after RYGB, and 4.3% of patients after SG (P < .01).

Study details: This was a prospective study that assessed pancreatic function using a ¹³C-mixed triglyceride breath test in 95 adult patients who underwent bariatric surgery (RYGB, n=36; BPD/DS, n=36; SG, n=23) and 10 patients with obesity who formed the control group.

Disclosures: No source of funding was identified. JE Dominguez-Munoz received personal fees from Abbott Pharmaceuticals, AbbVie, and Viatris. Other authors declared no conflict of interests.

Source: Uribarri-Gonzalez L et al. Surg Obes Relat Dis. 2021 Jul 6. doi: 10.1016/j.soard.2021.06.019.

Key clinical point: The development of exocrine pancreatic insufficiency (EPI) varied with the type of restrictive or malabsorptive bariatric surgery, i.e., sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD/DS).

Major finding: Six-hour ¹³C-cumulative recovery rate was significantly reduced (all P less than .001) in patients who underwent BPD/DS (25.6±13.5%) vs those who underwent RYGB (44.0±9.6%) or SG (47.6±9.3%) and the control group of patients who did not undergo bariatric surgery (45.0±6.1%). EPI was present in 78.8% of patients after BPD/DS, 8.3% of patients after RYGB, and 4.3% of patients after SG (P < .01).

Study details: This was a prospective study that assessed pancreatic function using a ¹³C-mixed triglyceride breath test in 95 adult patients who underwent bariatric surgery (RYGB, n=36; BPD/DS, n=36; SG, n=23) and 10 patients with obesity who formed the control group.

Disclosures: No source of funding was identified. JE Dominguez-Munoz received personal fees from Abbott Pharmaceuticals, AbbVie, and Viatris. Other authors declared no conflict of interests.

Source: Uribarri-Gonzalez L et al. Surg Obes Relat Dis. 2021 Jul 6. doi: 10.1016/j.soard.2021.06.019.

Key clinical point: The development of exocrine pancreatic insufficiency (EPI) varied with the type of restrictive or malabsorptive bariatric surgery, i.e., sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD/DS).

Major finding: Six-hour ¹³C-cumulative recovery rate was significantly reduced (all P less than .001) in patients who underwent BPD/DS (25.6±13.5%) vs those who underwent RYGB (44.0±9.6%) or SG (47.6±9.3%) and the control group of patients who did not undergo bariatric surgery (45.0±6.1%). EPI was present in 78.8% of patients after BPD/DS, 8.3% of patients after RYGB, and 4.3% of patients after SG (P < .01).

Study details: This was a prospective study that assessed pancreatic function using a ¹³C-mixed triglyceride breath test in 95 adult patients who underwent bariatric surgery (RYGB, n=36; BPD/DS, n=36; SG, n=23) and 10 patients with obesity who formed the control group.

Disclosures: No source of funding was identified. JE Dominguez-Munoz received personal fees from Abbott Pharmaceuticals, AbbVie, and Viatris. Other authors declared no conflict of interests.

Source: Uribarri-Gonzalez L et al. Surg Obes Relat Dis. 2021 Jul 6. doi: 10.1016/j.soard.2021.06.019.

In the study, 60 patients were classified as having EPI based on the gold standard test of PABA excretion, then the FBHC of the two groups were compared. According to the study findings FBHC levels were higher in the EPI group 15.70 (1.4 to 77.0) ppm than in the non-PEI group 2.80 (0.7 to 28.2) ppm (P < 0.0001).  The cutoff value for FBHC of 10.7 ppm (95% CI: 0.678–0.913; P < 0.001) showed a sensitivity of 73.3% and a specificity of 83.3% for PEI diagnosis. Interestingly, to prove biologic plausibility, the researchers also looked at microbiome analysis and found that there was a significant increase of relative abundance of phylum Firmicutes (P < 0.05) and the genus Clostridium (P < 0.05) in the EPI group. The researchers suggested that the flow of undigested food in EPI may select for Clorstridia species, which are the main hydrogen producing bacteria in the intestine. 

In AZN Journal of Surgery, Chan-Min Choi, et al looked at management of palliative stage pancreatic ductal adenocarcinomas (PDAC)  in 67 patients with locally advanced or metastatic pancreatic cancer at Western Health in Melbourne.² Weight loss and steatorrhea were present in 83.6% and 13.4% of patients, respectively, and median body mass index decreased by 13.3% from pre-illness to cancer diagnosis. Yet, despite high rates of referral to dieticians (79.1%), only 24 patients were prescribed pancreatic enzyme replacement therapy. The researchers concluded that the "study shows a lack of clear guideline for diagnosis and management of EPI for palliative PDAC.”

Finally a study by Johnston et al. in Gastroenterology looked at predictors of exocrine pancreatic insufficiency in 68 patients who underwent pancreatectomy (distal, n=23; pancreaticoduodenectomy, n=45).³ EPI, requiring pancreatic enzyme replacement therapy, developed in 50% of patients at 1-year postpancreatectomy. The researchers looked at predictors of EPI including variables such as preoperative A1c, smoking status, neoadjuvant chemo and radio therapy, and age, among others. In the final multivariate analysis, the only factor associated with EPI development was postoperative remnant pancreas volume (odds ratio, 0.93; 95% CI, 0.88-0.98; P < 0.01). While these studies may not immediately change practice, they offer further steps in the direction towards better diagnostics and more appropriate management of EPI.  

References 

1. Uetsuki K, Kawashima H, Ohno E, et al. Measurement of fasting breath hydrogen concentration as a simple diagnostic method for pancreatic exocrine insufficiency. BMC Gastroenterol 2021;21(1):211.

2. Choi CC-M, Choi J, Houli N, et al. Evaluation of palliative treatments in unresectable pancreatic cancer. ANZ J Surg 2021;

3. Johnston ME, Wahab SA, Turner K, et al. 298 post-pancreatectomy volumetric analysis: a missing variable in the development of post-operative endocrine and exocrine dysfunction. Gastroenterology 2021;160(6):S-878.

In the study, 60 patients were classified as having EPI based on the gold standard test of PABA excretion, then the FBHC of the two groups were compared. According to the study findings FBHC levels were higher in the EPI group 15.70 (1.4 to 77.0) ppm than in the non-PEI group 2.80 (0.7 to 28.2) ppm (P < 0.0001).  The cutoff value for FBHC of 10.7 ppm (95% CI: 0.678–0.913; P < 0.001) showed a sensitivity of 73.3% and a specificity of 83.3% for PEI diagnosis. Interestingly, to prove biologic plausibility, the researchers also looked at microbiome analysis and found that there was a significant increase of relative abundance of phylum Firmicutes (P < 0.05) and the genus Clostridium (P < 0.05) in the EPI group. The researchers suggested that the flow of undigested food in EPI may select for Clorstridia species, which are the main hydrogen producing bacteria in the intestine. 

In AZN Journal of Surgery, Chan-Min Choi, et al looked at management of palliative stage pancreatic ductal adenocarcinomas (PDAC)  in 67 patients with locally advanced or metastatic pancreatic cancer at Western Health in Melbourne.² Weight loss and steatorrhea were present in 83.6% and 13.4% of patients, respectively, and median body mass index decreased by 13.3% from pre-illness to cancer diagnosis. Yet, despite high rates of referral to dieticians (79.1%), only 24 patients were prescribed pancreatic enzyme replacement therapy. The researchers concluded that the "study shows a lack of clear guideline for diagnosis and management of EPI for palliative PDAC.”

Finally a study by Johnston et al. in Gastroenterology looked at predictors of exocrine pancreatic insufficiency in 68 patients who underwent pancreatectomy (distal, n=23; pancreaticoduodenectomy, n=45).³ EPI, requiring pancreatic enzyme replacement therapy, developed in 50% of patients at 1-year postpancreatectomy. The researchers looked at predictors of EPI including variables such as preoperative A1c, smoking status, neoadjuvant chemo and radio therapy, and age, among others. In the final multivariate analysis, the only factor associated with EPI development was postoperative remnant pancreas volume (odds ratio, 0.93; 95% CI, 0.88-0.98; P < 0.01). While these studies may not immediately change practice, they offer further steps in the direction towards better diagnostics and more appropriate management of EPI.  

References 

1. Uetsuki K, Kawashima H, Ohno E, et al. Measurement of fasting breath hydrogen concentration as a simple diagnostic method for pancreatic exocrine insufficiency. BMC Gastroenterol 2021;21(1):211.

2. Choi CC-M, Choi J, Houli N, et al. Evaluation of palliative treatments in unresectable pancreatic cancer. ANZ J Surg 2021;

3. Johnston ME, Wahab SA, Turner K, et al. 298 post-pancreatectomy volumetric analysis: a missing variable in the development of post-operative endocrine and exocrine dysfunction. Gastroenterology 2021;160(6):S-878.

In the study, 60 patients were classified as having EPI based on the gold standard test of PABA excretion, then the FBHC of the two groups were compared. According to the study findings FBHC levels were higher in the EPI group 15.70 (1.4 to 77.0) ppm than in the non-PEI group 2.80 (0.7 to 28.2) ppm (P < 0.0001).  The cutoff value for FBHC of 10.7 ppm (95% CI: 0.678–0.913; P < 0.001) showed a sensitivity of 73.3% and a specificity of 83.3% for PEI diagnosis. Interestingly, to prove biologic plausibility, the researchers also looked at microbiome analysis and found that there was a significant increase of relative abundance of phylum Firmicutes (P < 0.05) and the genus Clostridium (P < 0.05) in the EPI group. The researchers suggested that the flow of undigested food in EPI may select for Clorstridia species, which are the main hydrogen producing bacteria in the intestine. 

In AZN Journal of Surgery, Chan-Min Choi, et al looked at management of palliative stage pancreatic ductal adenocarcinomas (PDAC)  in 67 patients with locally advanced or metastatic pancreatic cancer at Western Health in Melbourne.² Weight loss and steatorrhea were present in 83.6% and 13.4% of patients, respectively, and median body mass index decreased by 13.3% from pre-illness to cancer diagnosis. Yet, despite high rates of referral to dieticians (79.1%), only 24 patients were prescribed pancreatic enzyme replacement therapy. The researchers concluded that the "study shows a lack of clear guideline for diagnosis and management of EPI for palliative PDAC.”

Finally a study by Johnston et al. in Gastroenterology looked at predictors of exocrine pancreatic insufficiency in 68 patients who underwent pancreatectomy (distal, n=23; pancreaticoduodenectomy, n=45).³ EPI, requiring pancreatic enzyme replacement therapy, developed in 50% of patients at 1-year postpancreatectomy. The researchers looked at predictors of EPI including variables such as preoperative A1c, smoking status, neoadjuvant chemo and radio therapy, and age, among others. In the final multivariate analysis, the only factor associated with EPI development was postoperative remnant pancreas volume (odds ratio, 0.93; 95% CI, 0.88-0.98; P < 0.01). While these studies may not immediately change practice, they offer further steps in the direction towards better diagnostics and more appropriate management of EPI.  

References 

1. Uetsuki K, Kawashima H, Ohno E, et al. Measurement of fasting breath hydrogen concentration as a simple diagnostic method for pancreatic exocrine insufficiency. BMC Gastroenterol 2021;21(1):211.

2. Choi CC-M, Choi J, Houli N, et al. Evaluation of palliative treatments in unresectable pancreatic cancer. ANZ J Surg 2021;

3. Johnston ME, Wahab SA, Turner K, et al. 298 post-pancreatectomy volumetric analysis: a missing variable in the development of post-operative endocrine and exocrine dysfunction. Gastroenterology 2021;160(6):S-878.

Key clinical point: Patients with chronic pancreatitis, pancreatic cancer, and pancreatic resection, followed-up by a gastroenterologist had higher rates of screening for exocrine pancreatic insufficiency (EPI) and appropriate prescription of pancreatic enzyme replacement therapy (PERT).

Major finding: EPI screening by measurement of pancreatic elastase (odds ratio [OR], 5.94; P less than .001), PERT prescription (OR, 2.02; P less than .001), and prescription for a minimally effective dosage (OR, 1.5; P = .008) was higher in patients followed-up by gastroenterologist (n=470) vs. those who were not (n=994).

Study details: This retrospective study assessed 1,464 patients with either EPI, chronic pancreatitis, pancreatic cancer, or pancreatic resection at the University of Florida between February 2018 and February 2020.

Disclosures: No source of funding was identified.

Source: Ladna M et al. Gastroenterology. 2021 May 10. doi: 10.1016/S0016-5085(21)01015-5.

Key clinical point: Patients with chronic pancreatitis, pancreatic cancer, and pancreatic resection, followed-up by a gastroenterologist had higher rates of screening for exocrine pancreatic insufficiency (EPI) and appropriate prescription of pancreatic enzyme replacement therapy (PERT).

Major finding: EPI screening by measurement of pancreatic elastase (odds ratio [OR], 5.94; P less than .001), PERT prescription (OR, 2.02; P less than .001), and prescription for a minimally effective dosage (OR, 1.5; P = .008) was higher in patients followed-up by gastroenterologist (n=470) vs. those who were not (n=994).

Study details: This retrospective study assessed 1,464 patients with either EPI, chronic pancreatitis, pancreatic cancer, or pancreatic resection at the University of Florida between February 2018 and February 2020.

Disclosures: No source of funding was identified.

Source: Ladna M et al. Gastroenterology. 2021 May 10. doi: 10.1016/S0016-5085(21)01015-5.

Key clinical point: Patients with chronic pancreatitis, pancreatic cancer, and pancreatic resection, followed-up by a gastroenterologist had higher rates of screening for exocrine pancreatic insufficiency (EPI) and appropriate prescription of pancreatic enzyme replacement therapy (PERT).

Major finding: EPI screening by measurement of pancreatic elastase (odds ratio [OR], 5.94; P less than .001), PERT prescription (OR, 2.02; P less than .001), and prescription for a minimally effective dosage (OR, 1.5; P = .008) was higher in patients followed-up by gastroenterologist (n=470) vs. those who were not (n=994).

Study details: This retrospective study assessed 1,464 patients with either EPI, chronic pancreatitis, pancreatic cancer, or pancreatic resection at the University of Florida between February 2018 and February 2020.

Disclosures: No source of funding was identified.

Source: Ladna M et al. Gastroenterology. 2021 May 10. doi: 10.1016/S0016-5085(21)01015-5.