Exocrine Pancreatic Insufficiency

Key clinical point: Among patients with pancreatic cancer undergoing pancreatectomy, pancreatic fistula (PF) did not affect postoperative pancreatic exocrine function. However, preserved or accelerated exocrine function post-pancreatectomy may cause PF.

Major finding: The levels of ¹³C-trioctanoin absorption (%dose/hour) post- vs. preoperation decreased significantly in the non-PF group (28.5 vs. 36.5; P < .0001) but did not change in the PF group (36.9 vs. 34.5; P = .129). Higher postoperative ¹³C-trioctanoin absorption was independently associated with PF (adjusted odds ratio 1.156; P = .001). Patients with ¹³C-trioctanoin absorption (%dose/hour) of ≥30 vs. <30 had higher postoperative maximum drain amylase levels (2,502 U/L vs. 398 U/L; P = .001).

Study details: This retrospective study included 96 patients with (n = 17) or without (n = 79) PF who underwent ¹³C-trioctanoin breath tests before and approximately 1 month after pancreatectomy.

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

Source: Higashiguchi T et al. Surg Today. 2021 Sep 16. doi: 10.1007/s00595-021-02371-w.

Key clinical point: Among patients with pancreatic cancer undergoing pancreatectomy, pancreatic fistula (PF) did not affect postoperative pancreatic exocrine function. However, preserved or accelerated exocrine function post-pancreatectomy may cause PF.

Major finding: The levels of ¹³C-trioctanoin absorption (%dose/hour) post- vs. preoperation decreased significantly in the non-PF group (28.5 vs. 36.5; P < .0001) but did not change in the PF group (36.9 vs. 34.5; P = .129). Higher postoperative ¹³C-trioctanoin absorption was independently associated with PF (adjusted odds ratio 1.156; P = .001). Patients with ¹³C-trioctanoin absorption (%dose/hour) of ≥30 vs. <30 had higher postoperative maximum drain amylase levels (2,502 U/L vs. 398 U/L; P = .001).

Study details: This retrospective study included 96 patients with (n = 17) or without (n = 79) PF who underwent ¹³C-trioctanoin breath tests before and approximately 1 month after pancreatectomy.

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

Source: Higashiguchi T et al. Surg Today. 2021 Sep 16. doi: 10.1007/s00595-021-02371-w.

Key clinical point: Among patients with pancreatic cancer undergoing pancreatectomy, pancreatic fistula (PF) did not affect postoperative pancreatic exocrine function. However, preserved or accelerated exocrine function post-pancreatectomy may cause PF.

Major finding: The levels of ¹³C-trioctanoin absorption (%dose/hour) post- vs. preoperation decreased significantly in the non-PF group (28.5 vs. 36.5; P < .0001) but did not change in the PF group (36.9 vs. 34.5; P = .129). Higher postoperative ¹³C-trioctanoin absorption was independently associated with PF (adjusted odds ratio 1.156; P = .001). Patients with ¹³C-trioctanoin absorption (%dose/hour) of ≥30 vs. <30 had higher postoperative maximum drain amylase levels (2,502 U/L vs. 398 U/L; P = .001).

Study details: This retrospective study included 96 patients with (n = 17) or without (n = 79) PF who underwent ¹³C-trioctanoin breath tests before and approximately 1 month after pancreatectomy.

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

Source: Higashiguchi T et al. Surg Today. 2021 Sep 16. doi: 10.1007/s00595-021-02371-w.

Key clinical point: Treatment with nonsteroidal anti-inflammatory drugs (NSAID) worsened exocrine pancreatic insufficiency (EPI) in patients with primary osteoarthritis in gastrointestinal comorbidity with EPI. Moreover, the trophologic status of patients also deteriorated, indicating reduced nutrient uptake because of aggravation of EPI.

Major finding: Fecal a-elastase levels decreased, and the CO program score increased significantly after vs. before NSAID treatment, particularly in patients with chronic pancreatitis (all P < .05). Moreover, the levels of trophologic parameters (magnesium, calcium, iron, zinc, selenium, albumin, and vitamins A, E, and K) decreased significantly after NSAID treatment (all P < .05).

Study details: This study included 87 adult patients with primary osteoarthritis along with EPI (chronic pancreatitis, n = 30; chronic nonstone cholecystitis, functional diseases of the gallbladder, and biliary system, n = 28; chronic gastroduodenitis, n = 29) and 30 healthy controls.

Disclosures: This study was funded by the authors’ resources. The authors declared no conflict of interests.

Source: Halabitska IM et al. Fam Med Prim Care Rev. 2021;23(4), Oct 5. doi: 10.5114/fmpcr.2021.108207.

Key clinical point: Treatment with nonsteroidal anti-inflammatory drugs (NSAID) worsened exocrine pancreatic insufficiency (EPI) in patients with primary osteoarthritis in gastrointestinal comorbidity with EPI. Moreover, the trophologic status of patients also deteriorated, indicating reduced nutrient uptake because of aggravation of EPI.

Major finding: Fecal a-elastase levels decreased, and the CO program score increased significantly after vs. before NSAID treatment, particularly in patients with chronic pancreatitis (all P < .05). Moreover, the levels of trophologic parameters (magnesium, calcium, iron, zinc, selenium, albumin, and vitamins A, E, and K) decreased significantly after NSAID treatment (all P < .05).

Study details: This study included 87 adult patients with primary osteoarthritis along with EPI (chronic pancreatitis, n = 30; chronic nonstone cholecystitis, functional diseases of the gallbladder, and biliary system, n = 28; chronic gastroduodenitis, n = 29) and 30 healthy controls.

Disclosures: This study was funded by the authors’ resources. The authors declared no conflict of interests.

Source: Halabitska IM et al. Fam Med Prim Care Rev. 2021;23(4), Oct 5. doi: 10.5114/fmpcr.2021.108207.

Key clinical point: Treatment with nonsteroidal anti-inflammatory drugs (NSAID) worsened exocrine pancreatic insufficiency (EPI) in patients with primary osteoarthritis in gastrointestinal comorbidity with EPI. Moreover, the trophologic status of patients also deteriorated, indicating reduced nutrient uptake because of aggravation of EPI.

Major finding: Fecal a-elastase levels decreased, and the CO program score increased significantly after vs. before NSAID treatment, particularly in patients with chronic pancreatitis (all P < .05). Moreover, the levels of trophologic parameters (magnesium, calcium, iron, zinc, selenium, albumin, and vitamins A, E, and K) decreased significantly after NSAID treatment (all P < .05).

Study details: This study included 87 adult patients with primary osteoarthritis along with EPI (chronic pancreatitis, n = 30; chronic nonstone cholecystitis, functional diseases of the gallbladder, and biliary system, n = 28; chronic gastroduodenitis, n = 29) and 30 healthy controls.

Disclosures: This study was funded by the authors’ resources. The authors declared no conflict of interests.

Source: Halabitska IM et al. Fam Med Prim Care Rev. 2021;23(4), Oct 5. doi: 10.5114/fmpcr.2021.108207.

Key clinical point: Timing of pancreatic enzyme replacement therapy (PERT) did not influence abdominal pain among children and adolescents with cystic fibrosis (CF) and pancreatic insufficiency (PI).

Major finding: No significant change was observed in the occurrence, intensity, and duration of abdominal pain with the change of PERT timing from before to after meals and vice versa (all P > .05).

Study details: This randomized, cross-over trial included 30 Danish patients (age 0-17 years) with CF and PI. Patients were randomly assigned to take their usual PERT dose before meals for 4 weeks, followed by after meals for 4 weeks, and vice versa.

Disclosures: This study was funded by grants from the Danish Ronald McDonald Children’s Fund and the Danish Cystic Fibrosis Foundation to M Skov, AMT Raun, and G Brekke. The authors declared no conflict of interests.

Source: Raun AMT et al. Acta Paediatr. 2021 Oct 8. doi: 10.1111/apa.16143.

Key clinical point: Timing of pancreatic enzyme replacement therapy (PERT) did not influence abdominal pain among children and adolescents with cystic fibrosis (CF) and pancreatic insufficiency (PI).

Major finding: No significant change was observed in the occurrence, intensity, and duration of abdominal pain with the change of PERT timing from before to after meals and vice versa (all P > .05).

Study details: This randomized, cross-over trial included 30 Danish patients (age 0-17 years) with CF and PI. Patients were randomly assigned to take their usual PERT dose before meals for 4 weeks, followed by after meals for 4 weeks, and vice versa.

Disclosures: This study was funded by grants from the Danish Ronald McDonald Children’s Fund and the Danish Cystic Fibrosis Foundation to M Skov, AMT Raun, and G Brekke. The authors declared no conflict of interests.

Source: Raun AMT et al. Acta Paediatr. 2021 Oct 8. doi: 10.1111/apa.16143.

Key clinical point: Timing of pancreatic enzyme replacement therapy (PERT) did not influence abdominal pain among children and adolescents with cystic fibrosis (CF) and pancreatic insufficiency (PI).

Major finding: No significant change was observed in the occurrence, intensity, and duration of abdominal pain with the change of PERT timing from before to after meals and vice versa (all P > .05).

Study details: This randomized, cross-over trial included 30 Danish patients (age 0-17 years) with CF and PI. Patients were randomly assigned to take their usual PERT dose before meals for 4 weeks, followed by after meals for 4 weeks, and vice versa.

Disclosures: This study was funded by grants from the Danish Ronald McDonald Children’s Fund and the Danish Cystic Fibrosis Foundation to M Skov, AMT Raun, and G Brekke. The authors declared no conflict of interests.

Source: Raun AMT et al. Acta Paediatr. 2021 Oct 8. doi: 10.1111/apa.16143.

Key clinical point: Exocrine pancreatic insufficiency (EPI) developed early during carbon ion radiotherapy among patients with pancreatic cancer, suggesting pancreatic sensitivity to carbon-ion beams.

Major finding: Overall, 57.6% of patients developed EPI, defined as both amylase and lipase deficiencies, within 13.6 months during and after carbon-ion radiotherapy. Pancreatic volume that received < 5 Gy at the cutoff value of 4.57 cm³ was the most effective prognostic factor for EPI development (area under the receiver operating characteristic curve 0.74; P = .02).

Study details: Findings are from a retrospective analysis of 33 patients with pancreatic cancer and normal serum pancreatic amylase and lipase levels who underwent carbon-ion radiotherapy.

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

Source: Shiba S et al. Clin Tranl Radiat Oncol. 2021;31:80-85. doi: 10.1016/j.ctro.2021.09.007.

Key clinical point: Exocrine pancreatic insufficiency (EPI) developed early during carbon ion radiotherapy among patients with pancreatic cancer, suggesting pancreatic sensitivity to carbon-ion beams.

Major finding: Overall, 57.6% of patients developed EPI, defined as both amylase and lipase deficiencies, within 13.6 months during and after carbon-ion radiotherapy. Pancreatic volume that received < 5 Gy at the cutoff value of 4.57 cm³ was the most effective prognostic factor for EPI development (area under the receiver operating characteristic curve 0.74; P = .02).

Study details: Findings are from a retrospective analysis of 33 patients with pancreatic cancer and normal serum pancreatic amylase and lipase levels who underwent carbon-ion radiotherapy.

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

Source: Shiba S et al. Clin Tranl Radiat Oncol. 2021;31:80-85. doi: 10.1016/j.ctro.2021.09.007.

Key clinical point: Exocrine pancreatic insufficiency (EPI) developed early during carbon ion radiotherapy among patients with pancreatic cancer, suggesting pancreatic sensitivity to carbon-ion beams.

Major finding: Overall, 57.6% of patients developed EPI, defined as both amylase and lipase deficiencies, within 13.6 months during and after carbon-ion radiotherapy. Pancreatic volume that received < 5 Gy at the cutoff value of 4.57 cm³ was the most effective prognostic factor for EPI development (area under the receiver operating characteristic curve 0.74; P = .02).

Study details: Findings are from a retrospective analysis of 33 patients with pancreatic cancer and normal serum pancreatic amylase and lipase levels who underwent carbon-ion radiotherapy.

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

Source: Shiba S et al. Clin Tranl Radiat Oncol. 2021;31:80-85. doi: 10.1016/j.ctro.2021.09.007.

This month’s journal scan of articles in exocrine pancreatic insufficiency explores the connection between the two functions of the pancreas, both exocrine and endocrine–and demonstrates somewhat differing findings which are worth exploration.

The first paper is from Uysal and Argun out of Istanbul, Turkey which explores the connection between insulin resistance and the development of exocrine pancreatic insufficiency (EPI). Researchers enrolled 65 patients with obesity and ages 16-69. The homeostasis model of assessment (HOMA) was used for the diagnosis of insulin resistance, and EPI was diagnosed with a fecal elastase-1 (FE-1) < 200 µg/g (via enzyme-linked immunosorbent assay). The study looked at both mean FE-1 levels as well as the distribution of EPI amongst patients with and without insulin resistance.

The study reported FE-1 levels (430.27 ± 207.63 vs. 508.64 ± 188.77 µg/g; P = .119) and the rate of EPI (FE-1 < 200 µg/g; 25.7% vs. 10.0%; P = .104) were not significantly different in patients with or without insulin resistance. The authors note that prior studies have suggested a link between EPI and diabetes mellitus (DM); however this study shows the correlation may not be strong in the pre-diabetic insulin resistance, or pre-DM period.

Further along the diabetes spectrum, researchers in China aimed to assess the prevalence of EPI amongst the type 2 DM (T2DM) Chinese population, and to further identify factors associated with the development of EPI. This study was a cross-sectional analysis of 85 adult inpatients with T2DM without known exocrine pancreatic disorders or digestive system diseases. Fecal samples were used to measure FE-1 levels, and blood samples were collected to investigate pancreatic endocrine function and metabolic biomarkers in all participants. Multiple logistic regression analysis was used to evaluate the influencing factors of pancreatic exocrine insufficiency in patients with T2DM.

Ultimately, the prevalence of EPI (FE-1 < 200 µg/g) amongst this patient population was 18.8%. There was a highly significant positive association between FE-1 levels and fasting C-peptide (FCP) levels (correlation coefficient 0.451; P < .001). Logistic regression analysis demonstrated that FCP was independently associated with EPI (odds ratio 0.204; P = .024), and receiver operating characteristic (ROC) analysis demonstrated good predictive value for EPI as well.

In summary, the authors infer a mechanistic conclusion that likely merits further investigation, “the reduced quantity and quality of β-cell lead to insufficient insulin secretion and subsequently results in hyperglycemia and DM. Further, as the trophic function from β-cells on pancreatic acinar cells weaken, the development into exocrine dysfunction in patients with DM is likely.”

Bibliography

1. Uysal BB, Argun D. Assessment of the impact of insulin resistance on pancreatic exocrine functions in obese patients. Med-Science. 2021;10(3):998-1001.
2. Lv Y, Wei Q, Yuan X, et al. Two sides of the pancreas: Exocrine insufficiency is correlated with endocrine dysfunction in type 2 diabetes. Clin Chim Acta. 2021(Sep 14);523:81-86. doi: 10.1016/j.cca.2021.09.008.

This month’s journal scan of articles in exocrine pancreatic insufficiency explores the connection between the two functions of the pancreas, both exocrine and endocrine–and demonstrates somewhat differing findings which are worth exploration.

The first paper is from Uysal and Argun out of Istanbul, Turkey which explores the connection between insulin resistance and the development of exocrine pancreatic insufficiency (EPI). Researchers enrolled 65 patients with obesity and ages 16-69. The homeostasis model of assessment (HOMA) was used for the diagnosis of insulin resistance, and EPI was diagnosed with a fecal elastase-1 (FE-1) < 200 µg/g (via enzyme-linked immunosorbent assay). The study looked at both mean FE-1 levels as well as the distribution of EPI amongst patients with and without insulin resistance.

The study reported FE-1 levels (430.27 ± 207.63 vs. 508.64 ± 188.77 µg/g; P = .119) and the rate of EPI (FE-1 < 200 µg/g; 25.7% vs. 10.0%; P = .104) were not significantly different in patients with or without insulin resistance. The authors note that prior studies have suggested a link between EPI and diabetes mellitus (DM); however this study shows the correlation may not be strong in the pre-diabetic insulin resistance, or pre-DM period.

Further along the diabetes spectrum, researchers in China aimed to assess the prevalence of EPI amongst the type 2 DM (T2DM) Chinese population, and to further identify factors associated with the development of EPI. This study was a cross-sectional analysis of 85 adult inpatients with T2DM without known exocrine pancreatic disorders or digestive system diseases. Fecal samples were used to measure FE-1 levels, and blood samples were collected to investigate pancreatic endocrine function and metabolic biomarkers in all participants. Multiple logistic regression analysis was used to evaluate the influencing factors of pancreatic exocrine insufficiency in patients with T2DM.

Ultimately, the prevalence of EPI (FE-1 < 200 µg/g) amongst this patient population was 18.8%. There was a highly significant positive association between FE-1 levels and fasting C-peptide (FCP) levels (correlation coefficient 0.451; P < .001). Logistic regression analysis demonstrated that FCP was independently associated with EPI (odds ratio 0.204; P = .024), and receiver operating characteristic (ROC) analysis demonstrated good predictive value for EPI as well.

In summary, the authors infer a mechanistic conclusion that likely merits further investigation, “the reduced quantity and quality of β-cell lead to insufficient insulin secretion and subsequently results in hyperglycemia and DM. Further, as the trophic function from β-cells on pancreatic acinar cells weaken, the development into exocrine dysfunction in patients with DM is likely.”

Bibliography

1. Uysal BB, Argun D. Assessment of the impact of insulin resistance on pancreatic exocrine functions in obese patients. Med-Science. 2021;10(3):998-1001.
2. Lv Y, Wei Q, Yuan X, et al. Two sides of the pancreas: Exocrine insufficiency is correlated with endocrine dysfunction in type 2 diabetes. Clin Chim Acta. 2021(Sep 14);523:81-86. doi: 10.1016/j.cca.2021.09.008.

This month’s journal scan of articles in exocrine pancreatic insufficiency explores the connection between the two functions of the pancreas, both exocrine and endocrine–and demonstrates somewhat differing findings which are worth exploration.

The first paper is from Uysal and Argun out of Istanbul, Turkey which explores the connection between insulin resistance and the development of exocrine pancreatic insufficiency (EPI). Researchers enrolled 65 patients with obesity and ages 16-69. The homeostasis model of assessment (HOMA) was used for the diagnosis of insulin resistance, and EPI was diagnosed with a fecal elastase-1 (FE-1) < 200 µg/g (via enzyme-linked immunosorbent assay). The study looked at both mean FE-1 levels as well as the distribution of EPI amongst patients with and without insulin resistance.

The study reported FE-1 levels (430.27 ± 207.63 vs. 508.64 ± 188.77 µg/g; P = .119) and the rate of EPI (FE-1 < 200 µg/g; 25.7% vs. 10.0%; P = .104) were not significantly different in patients with or without insulin resistance. The authors note that prior studies have suggested a link between EPI and diabetes mellitus (DM); however this study shows the correlation may not be strong in the pre-diabetic insulin resistance, or pre-DM period.

Further along the diabetes spectrum, researchers in China aimed to assess the prevalence of EPI amongst the type 2 DM (T2DM) Chinese population, and to further identify factors associated with the development of EPI. This study was a cross-sectional analysis of 85 adult inpatients with T2DM without known exocrine pancreatic disorders or digestive system diseases. Fecal samples were used to measure FE-1 levels, and blood samples were collected to investigate pancreatic endocrine function and metabolic biomarkers in all participants. Multiple logistic regression analysis was used to evaluate the influencing factors of pancreatic exocrine insufficiency in patients with T2DM.

Ultimately, the prevalence of EPI (FE-1 < 200 µg/g) amongst this patient population was 18.8%. There was a highly significant positive association between FE-1 levels and fasting C-peptide (FCP) levels (correlation coefficient 0.451; P < .001). Logistic regression analysis demonstrated that FCP was independently associated with EPI (odds ratio 0.204; P = .024), and receiver operating characteristic (ROC) analysis demonstrated good predictive value for EPI as well.

In summary, the authors infer a mechanistic conclusion that likely merits further investigation, “the reduced quantity and quality of β-cell lead to insufficient insulin secretion and subsequently results in hyperglycemia and DM. Further, as the trophic function from β-cells on pancreatic acinar cells weaken, the development into exocrine dysfunction in patients with DM is likely.”

Bibliography

1. Uysal BB, Argun D. Assessment of the impact of insulin resistance on pancreatic exocrine functions in obese patients. Med-Science. 2021;10(3):998-1001.
2. Lv Y, Wei Q, Yuan X, et al. Two sides of the pancreas: Exocrine insufficiency is correlated with endocrine dysfunction in type 2 diabetes. Clin Chim Acta. 2021(Sep 14);523:81-86. doi: 10.1016/j.cca.2021.09.008.

Key clinical point: Fasting C-peptide (FCP) was positively associated with fecal elastase (FE)-1 levels with an independent predictive value for exocrine pancreatic insufficiency (EPI) in patients with type 2 diabetes mellitus (T2DM).

Major finding: Overall, the prevalence of EPI (FE-1 < 200 mg/g) was 18.8%. FE-1 levels were positively associated with FCP levels (correlation coefficient 0.451; P < .001). FCP level was an independent factor (odds ratio 0.204; P = .024) with a good predictive value (area under the receiver operating curve 0.793; sensitivity 0.710; specificity 0.812; P < .001) for EPI.

Study details: Findings are from a cross-sectional analysis of 85 adult inpatients with T2DM without known exocrine pancreatic disorders or digestive system diseases.

Disclosures: This study was supported by the National Natural Science Foundation of China, the Key Research & Development Program of Jiangsu Province, and the Joint Key Project funded by the Southeast University and Nanjing Medical University. The authors declared no conflict of interests.

Source: Lv Y et al. Clin Chim Acta. 2021 Sep 14. doi: 10.1016/j.cca.2021.09.008.

Key clinical point: Fasting C-peptide (FCP) was positively associated with fecal elastase (FE)-1 levels with an independent predictive value for exocrine pancreatic insufficiency (EPI) in patients with type 2 diabetes mellitus (T2DM).

Major finding: Overall, the prevalence of EPI (FE-1 < 200 mg/g) was 18.8%. FE-1 levels were positively associated with FCP levels (correlation coefficient 0.451; P < .001). FCP level was an independent factor (odds ratio 0.204; P = .024) with a good predictive value (area under the receiver operating curve 0.793; sensitivity 0.710; specificity 0.812; P < .001) for EPI.

Study details: Findings are from a cross-sectional analysis of 85 adult inpatients with T2DM without known exocrine pancreatic disorders or digestive system diseases.

Disclosures: This study was supported by the National Natural Science Foundation of China, the Key Research & Development Program of Jiangsu Province, and the Joint Key Project funded by the Southeast University and Nanjing Medical University. The authors declared no conflict of interests.

Source: Lv Y et al. Clin Chim Acta. 2021 Sep 14. doi: 10.1016/j.cca.2021.09.008.

Key clinical point: Fasting C-peptide (FCP) was positively associated with fecal elastase (FE)-1 levels with an independent predictive value for exocrine pancreatic insufficiency (EPI) in patients with type 2 diabetes mellitus (T2DM).

Major finding: Overall, the prevalence of EPI (FE-1 < 200 mg/g) was 18.8%. FE-1 levels were positively associated with FCP levels (correlation coefficient 0.451; P < .001). FCP level was an independent factor (odds ratio 0.204; P = .024) with a good predictive value (area under the receiver operating curve 0.793; sensitivity 0.710; specificity 0.812; P < .001) for EPI.

Study details: Findings are from a cross-sectional analysis of 85 adult inpatients with T2DM without known exocrine pancreatic disorders or digestive system diseases.

Disclosures: This study was supported by the National Natural Science Foundation of China, the Key Research & Development Program of Jiangsu Province, and the Joint Key Project funded by the Southeast University and Nanjing Medical University. The authors declared no conflict of interests.

Source: Lv Y et al. Clin Chim Acta. 2021 Sep 14. doi: 10.1016/j.cca.2021.09.008.

Key clinical point: The prevalence of exocrine pancreatic insufficiency (EPI) was higher in patients with functional dyspepsia (FD) with pancreatic enzyme abnormalities (PEA) compared to asymptomatic patients (AP) with PEA and was associated with physical function but not with the state of anxiety.

Major finding: The prevalence of EPI was higher in patients with FD-PEA vs. AP-PEA (N-benzoyl-L-tyrosyl-p-aminobenzoic acid test scores, 61.67% ± 5.55% vs. 95.38% ± 2.36%; P = .01). Physical component scale was significantly lower in FD-PEA vs. AP-PEA group (44.60 ± 2.40 vs. 53.56 ± 1.31; P = .002). No difference was observed in State-Trait Anxiety Inventory (STAI)-state (P = .089) and STAI-trait (P = .483) scores between groups.

Study details: This study included 49 patients with PEA with (n=20) or without (n=29) symptoms of FD.

Disclosures: This study was funded by the Ministry of Education, Culture, and Science and the Ministry of Health, Japan. The authors declared no conflict of interests.

Source: Agawa S et al. J Clin Biochem Nutr. 2021 Sep 3. doi: 10.3164/jcbn.21-67.

Key clinical point: The prevalence of exocrine pancreatic insufficiency (EPI) was higher in patients with functional dyspepsia (FD) with pancreatic enzyme abnormalities (PEA) compared to asymptomatic patients (AP) with PEA and was associated with physical function but not with the state of anxiety.

Major finding: The prevalence of EPI was higher in patients with FD-PEA vs. AP-PEA (N-benzoyl-L-tyrosyl-p-aminobenzoic acid test scores, 61.67% ± 5.55% vs. 95.38% ± 2.36%; P = .01). Physical component scale was significantly lower in FD-PEA vs. AP-PEA group (44.60 ± 2.40 vs. 53.56 ± 1.31; P = .002). No difference was observed in State-Trait Anxiety Inventory (STAI)-state (P = .089) and STAI-trait (P = .483) scores between groups.

Study details: This study included 49 patients with PEA with (n=20) or without (n=29) symptoms of FD.

Disclosures: This study was funded by the Ministry of Education, Culture, and Science and the Ministry of Health, Japan. The authors declared no conflict of interests.

Source: Agawa S et al. J Clin Biochem Nutr. 2021 Sep 3. doi: 10.3164/jcbn.21-67.

Key clinical point: The prevalence of exocrine pancreatic insufficiency (EPI) was higher in patients with functional dyspepsia (FD) with pancreatic enzyme abnormalities (PEA) compared to asymptomatic patients (AP) with PEA and was associated with physical function but not with the state of anxiety.

Major finding: The prevalence of EPI was higher in patients with FD-PEA vs. AP-PEA (N-benzoyl-L-tyrosyl-p-aminobenzoic acid test scores, 61.67% ± 5.55% vs. 95.38% ± 2.36%; P = .01). Physical component scale was significantly lower in FD-PEA vs. AP-PEA group (44.60 ± 2.40 vs. 53.56 ± 1.31; P = .002). No difference was observed in State-Trait Anxiety Inventory (STAI)-state (P = .089) and STAI-trait (P = .483) scores between groups.

Study details: This study included 49 patients with PEA with (n=20) or without (n=29) symptoms of FD.

Disclosures: This study was funded by the Ministry of Education, Culture, and Science and the Ministry of Health, Japan. The authors declared no conflict of interests.

Source: Agawa S et al. J Clin Biochem Nutr. 2021 Sep 3. doi: 10.3164/jcbn.21-67.

Key clinical point: Patients with diabetes and exocrine pancreatic insufficiency (EPI) had reduced autonomic function compared with those with diabetes without EPI.

Major finding: Overall, the prevalence of EPI (fecal elastase [FE] < 200 mg/g) was 20%. Patients with or without EPI had reduced baroreflex sensitivity (all P < .05) and heart rate variability (P < .05), but not increased frequency of orthostatic hypotension (P = .92).

Study details: This study included 59 patients with type 1 or type 2 diabetes. Patients with diabetes were stratified into EPI (n=8) and control (n=13) groups based on FE levels.

Disclosures: This study was funded by Haukeland University Hospital. The authors declared no conflict of interests.

Source: Sangnes DA et al. Scand J Gastroenterol. 2021 Sep 7. doi: 10.1080/00365521.2021.1957496.

Key clinical point: Patients with diabetes and exocrine pancreatic insufficiency (EPI) had reduced autonomic function compared with those with diabetes without EPI.

Major finding: Overall, the prevalence of EPI (fecal elastase [FE] < 200 mg/g) was 20%. Patients with or without EPI had reduced baroreflex sensitivity (all P < .05) and heart rate variability (P < .05), but not increased frequency of orthostatic hypotension (P = .92).

Study details: This study included 59 patients with type 1 or type 2 diabetes. Patients with diabetes were stratified into EPI (n=8) and control (n=13) groups based on FE levels.

Disclosures: This study was funded by Haukeland University Hospital. The authors declared no conflict of interests.

Source: Sangnes DA et al. Scand J Gastroenterol. 2021 Sep 7. doi: 10.1080/00365521.2021.1957496.

Key clinical point: Patients with diabetes and exocrine pancreatic insufficiency (EPI) had reduced autonomic function compared with those with diabetes without EPI.

Major finding: Overall, the prevalence of EPI (fecal elastase [FE] < 200 mg/g) was 20%. Patients with or without EPI had reduced baroreflex sensitivity (all P < .05) and heart rate variability (P < .05), but not increased frequency of orthostatic hypotension (P = .92).

Study details: This study included 59 patients with type 1 or type 2 diabetes. Patients with diabetes were stratified into EPI (n=8) and control (n=13) groups based on FE levels.

Disclosures: This study was funded by Haukeland University Hospital. The authors declared no conflict of interests.

Source: Sangnes DA et al. Scand J Gastroenterol. 2021 Sep 7. doi: 10.1080/00365521.2021.1957496.

Key clinical point: High prevalence of exocrine pancreatic insufficiency (EPI)-related fat malabsorption was observed in Asian Indian patients with type 2 diabetes mellitus (T2DM), which was significantly associated with autonomic dysfunction.

Major finding: EPI-related fat malabsorption (72 hours fecal fat > 18 g) was present in 44.9% and 6.1% of patients with and without T2DM, respectively (P < .05). Among patients with T2DM, those with or without EPI-related fat malabsorption had significantly higher proportion of parasympathetic nervous system (PNS) dysfunction (86.7% vs. 61.5%), sympathetic nervous system (SNS) dysfunction (92.4% vs. 72.3%), and PNS+SNS dysfunction (83.1 vs. 66.0%; all P < .05).

Study details: Findings are from a cross-sectional analysis of 118 patients with T2DM and 82 normoglycemic individuals.

Disclosures: This study was supported by the FLUID research grant of CMC, Vellore, India. The authors declared no conflict of interests.

Source: Anoop S et al. Diab Metab Syndr Clin Res Rev. 2021 Sep 4. doi: 10.1016/j.dsx.2021.102273.

Key clinical point: High prevalence of exocrine pancreatic insufficiency (EPI)-related fat malabsorption was observed in Asian Indian patients with type 2 diabetes mellitus (T2DM), which was significantly associated with autonomic dysfunction.

Major finding: EPI-related fat malabsorption (72 hours fecal fat > 18 g) was present in 44.9% and 6.1% of patients with and without T2DM, respectively (P < .05). Among patients with T2DM, those with or without EPI-related fat malabsorption had significantly higher proportion of parasympathetic nervous system (PNS) dysfunction (86.7% vs. 61.5%), sympathetic nervous system (SNS) dysfunction (92.4% vs. 72.3%), and PNS+SNS dysfunction (83.1 vs. 66.0%; all P < .05).

Study details: Findings are from a cross-sectional analysis of 118 patients with T2DM and 82 normoglycemic individuals.

Disclosures: This study was supported by the FLUID research grant of CMC, Vellore, India. The authors declared no conflict of interests.

Source: Anoop S et al. Diab Metab Syndr Clin Res Rev. 2021 Sep 4. doi: 10.1016/j.dsx.2021.102273.

Key clinical point: High prevalence of exocrine pancreatic insufficiency (EPI)-related fat malabsorption was observed in Asian Indian patients with type 2 diabetes mellitus (T2DM), which was significantly associated with autonomic dysfunction.

Major finding: EPI-related fat malabsorption (72 hours fecal fat > 18 g) was present in 44.9% and 6.1% of patients with and without T2DM, respectively (P < .05). Among patients with T2DM, those with or without EPI-related fat malabsorption had significantly higher proportion of parasympathetic nervous system (PNS) dysfunction (86.7% vs. 61.5%), sympathetic nervous system (SNS) dysfunction (92.4% vs. 72.3%), and PNS+SNS dysfunction (83.1 vs. 66.0%; all P < .05).

Study details: Findings are from a cross-sectional analysis of 118 patients with T2DM and 82 normoglycemic individuals.

Disclosures: This study was supported by the FLUID research grant of CMC, Vellore, India. The authors declared no conflict of interests.

Source: Anoop S et al. Diab Metab Syndr Clin Res Rev. 2021 Sep 4. doi: 10.1016/j.dsx.2021.102273.

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;

Key clinical point: Presence of insulin resistance did not change the fecal elastase-1 (FE-1) levels or the rate of exocrine pancreatic insufficiency (EPI) in patients with obesity.

Major finding: Mean FE-1 levels (430.27 ± 207.63 vs. 508.64 ± 188.77; P = .119) and the rate of EPI (FE-1 < 200 mg/g; 25.7% vs. 10.0%; P = .104) were not significantly different in patients with or without insulin resistance.

Study details: Findings are from a retrospective analysis of 65 patients with obesity (body mass index, >30 kg/m²) with (n=35) or without (n=30) insulin resistance.

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

Source: Uysal BB et al. Med Sci. 2021 Aug 23. doi: 10.5455/medscience.2021.05.164.

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;

Key clinical point: Presence of insulin resistance did not change the fecal elastase-1 (FE-1) levels or the rate of exocrine pancreatic insufficiency (EPI) in patients with obesity.

Major finding: Mean FE-1 levels (430.27 ± 207.63 vs. 508.64 ± 188.77; P = .119) and the rate of EPI (FE-1 < 200 mg/g; 25.7% vs. 10.0%; P = .104) were not significantly different in patients with or without insulin resistance.

Study details: Findings are from a retrospective analysis of 65 patients with obesity (body mass index, >30 kg/m²) with (n=35) or without (n=30) insulin resistance.

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

Source: Uysal BB et al. Med Sci. 2021 Aug 23. doi: 10.5455/medscience.2021.05.164.

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;

Key clinical point: Presence of insulin resistance did not change the fecal elastase-1 (FE-1) levels or the rate of exocrine pancreatic insufficiency (EPI) in patients with obesity.

Major finding: Mean FE-1 levels (430.27 ± 207.63 vs. 508.64 ± 188.77; P = .119) and the rate of EPI (FE-1 < 200 mg/g; 25.7% vs. 10.0%; P = .104) were not significantly different in patients with or without insulin resistance.

Study details: Findings are from a retrospective analysis of 65 patients with obesity (body mass index, >30 kg/m²) with (n=35) or without (n=30) insulin resistance.

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

Source: Uysal BB et al. Med Sci. 2021 Aug 23. doi: 10.5455/medscience.2021.05.164.