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Diagnosis and treatment of autoimmune pancreatitis in Spain
Abstracts / Pancreatology 15 (2015) e1ee17
Introduction: Exocrine pancreatic insufficiency (EPI) is a consequence of multiple diseases, but chronic pancreatitis is its main cause. Recognizing this entity is crucial to prevent malnutrition. Pancreatic enzyme replacement therapy can not be optimized based solely on clinical parameters. The 13C-mixed triglyceride breath test (Pancreo-kit®) is a validated test for obtaining information about exocrine pancreatic activity. Objective: Assess the modifications made in the treatment of patients with suspected EPI depending on the result of the 13C-mixed triglyceride breath test.Material and Methods: Retrospective descriptive study of patients with suspected EPI who underwent the breath test to assess the beginning / removal / increased doses of enzyme replacement therapy. Outpatients attending in the Digestive-Pancreatic examination room from December 2013 to October 2014 were included. Results: The analysis included 30 patients, 22 (73%) men, with an average age of 58 (limits: 2878) years old. The main indications of the test were: chronic pancreatitis, 27 (90%); acute necrotizing pancreatitis, 2 (6%) and resected pancreatic neuroendocrine tumor, 1 (3%). The test was abnormal in 11 patients (36%): in 2 (6%) patients, replacement therapy was initiated; in 7 (23%) patients, dosage was increased and in 2 (6%) patients, treatment was not started because of history of intolerance. Patients with negative test: in 5 (16%) patients, replacement therapy was discontinued; in 12 (40%), treatment was not started and in 2 (6%), treatment was initiated because of symptoms. The results of the test led us to do a change in the treatment in 14 (46%) patients. Conclusions: The implementation of the Pancreo-kit® test in patients with pancreatic diseases could allow enzyme replacement therapy to be adapted to a substantial number of patients. Further prospective studies are needed to find the real implication of the test.
5. Diagnosis and treatment of autoimmune pancreatitis in Spain pez-Serrano 1, J. Crespo 2, S. Salord 3, F. Bolado 4, I. Pascual 5, L. A. Lo pez 9, M. Ilzarbe 6, A.J. del Pozo-García 7, C. Garrido 8, C. Marra-Lo n 12, E. de Madaria 13, M.D. Pleguezuelo 10, P. Almela 11, M. Concepcio n 14, M. Rodríguez 15, C. Alonso 2, L. Secanella 3, M.A. Casi 4, N. Higo García 5, E. Moreno-Osset 1 1 Hospital Universitari Dr. Peset, Universitat de Valencia, Valencia, Spain 2 s de Valdecilla, Santander, Spain Hospital Universitario Marque 3 Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain 4 Complejo Hospitalario de Navarra, Pamplona, Spain 5 Hospital Universitari Clínic, Valencia, Spain 6 Hospital del Mar, Barcelona, Spain 7 Hospital Universitario Doce de Octubre, Madrid, Spain 8 Hospital Son Espases, Palma de Mallorca, Spain 9 Hospital Universitario Araba (Sede Txagorritxu), Vitoria-Gasteiz, Spain 10 rdoba, Spain Hospital Reina Sofía, Co 11 n, Spain Hospital General de Castello 12 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 13 Hospital General Universitario, Alicante, Spain 14 cnic La Fe, Valencia, Spain Hospital Universitari i Polite 15 Hospital Universitario Central de Asturias, Oviedo, Spain
Introduction: Autoimmune pancreatitis (AIP) is a chronic inflammatory disorder described in recent years. Recently, the International Consensus Diagnostic Criteria (ICDC) has been proposed. AIP is classified into 2 subtypes (AIP1 and AIP2). Aim: To analyse the diagnosis and treatment of AIP patients from several tertiary care centres in Spain, according to the ICDC. Methods: Retrospective observational study. Data from patients with a diagnosis of AIP in 15 participating centres through 31 December 2014 were collected. Results: Suspected AIP in 58 patients: misclassification in 27. Fifty patients included: 86.0% AIP1, 10.0% AIP2, and 4.0% non-specific AIP patients. Males: 76%. Mean (SD; range) age: 57.4 (12.7; 24-80) years. Initial
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symptoms: obstructive jaundice 44.0%; and abdominal pain and weight loss, 36.0%, respectively. Thirty-eight extrapancreatic lesions were found in 60.0% of patients: biliary involvement, 44.0%. Serum IgG4 level was increased in 32/48 (66.7%) patients. US, CT, RMI, MRCP, ERCP, USE and 18FFDG-PET/CT were performed in 86.0%, 94.0%, 66.0%, 62.0%, 38.0%, 44.0%, and 6.0% of patients: 44.0% and 38.0% with diffuse and localized pancreatic enlargement, respectively; stenosis of the main pancreatic duct in 33.3%. Extra pancreatic lesions were detected in 60.0%: biliary stricture, 50.0%. Tissue specimens were obtained in 76.0% of patients. Initial treatment: 84.0% steroids and 14.0% surgery. Relapses occurred in 48.8% of AIP1 patients. Prolonged steroid treatment was given in 58.0%. Conclusions: Difficulties in ICDC application were detected. AIP in Spain has clinical profiles similar to other countries. Using ICDC can prevent unnecessary surgery in patients with obstructive jaundice.
6. Is an early diagnosis of pancreatic cancer possible? K. De Jesús, A. P erez, A. Germade, R. Castillo, B. Moreira, S. Maestro, J. Barcenilla, F. Igea, R. Madrigal, C. Ordieres, E. Saracibar, J. Martin, G. de la lama Complejo Asistencial Universitario de Palencia, Palencia, Spain Introduction and Aim: Worldwide, pancreatic cancer is the eighth leading cause of cancer death in men and the ninth in women. Its early diagnosis is not easy. The prognosis of pancreatic cancer is poor even in those with potentially resectable disease. Endoscopic ultrasound (EUS) is a very effective technique in detected pancreatic lesions and may allow early diagnoses in patients with average-risk. It is clear that patients considered at high risk of developing pancreatic cancer should be screened. Patients with diabetes mellitus (DM) have a significantly increased likelihood of association with pancreatic cancer, numerous epidemiologic studies describe an association between diabetes mellitus and pancreatic cancer. We need to select the subgroup of diabetic patients who have more chance of association with pancreatic cancer. Methods: We made a protocol with Endocrine and Internal Medicine Units for performing EUS in asymptomatic diabetic patients with: Patients over 50 years with recent onset diabetes and BMI < 22. Diabetic patients over 50 years with good glycemic control that have significant and abrupt deterioration of their diabetes (sudden needed for insulin in patients with oral antidiabetes or significant increase in insulin dose associated with weight loss). During 2013-2014, 15 EUS were performed, 8 with new onset diabetes, and 7 with deterioration of glycemic profile. The range of age was between 50-87 years. Results: We detected two adenocarcinomas (13.3%) one of 20 mm in 54-years-old male with postoperative diagnosis of T2N0 and other of 8 mm in 73 years old women with T1N0, and 1 patient with neuroendocrine tumor (6.6%) with postoperative diagnosis G1 (pT1NoMx). All belonged to the group of decompensation of their diabetes. Conclusions: EUS is an excellent technique for early diagnosis of pancreatic cancer. In selected cases of diabetic patients, an early diagnosis of pancreatic cancer may be possible. It is not proven that involves increased survival but it is possible.
7. Spectrum of use and effectiveness of endoscopic pancreatic sphincteroplasty B. Gonzalez de la Higuera, D. Ruiz-Clavijo, F. Bolado, J. Urman, M.A. Casi, C. Prieto, J.J. Vila Complejo Hospitalario de Navarra, Pamplona, Spain
Introduction: Exocrine pancreatic insufficiency (EPI) is a consequence of multiple diseases, but chronic pancreatitis is its main cause. Recognizing this entity is crucial to prevent malnutrition. Pancreatic enzyme replacement therapy can not be optimized based solely on clinical parameters. The 13C-mixed triglyceride breath test (Pancreo-kit®) is a validated test for obtaining information about exocrine pancreatic activity. Objective: Assess the modifications made in the treatment of patients with suspected EPI depending on the result of the 13C-mixed triglyceride breath test.Material and Methods: Retrospective descriptive study of patients with suspected EPI who underwent the breath test to assess the beginning / removal / increased doses of enzyme replacement therapy. Outpatients attending in the Digestive-Pancreatic examination room from December 2013 to October 2014 were included. Results: The analysis included 30 patients, 22 (73%) men, with an average age of 58 (limits: 2878) years old. The main indications of the test were: chronic pancreatitis, 27 (90%); acute necrotizing pancreatitis, 2 (6%) and resected pancreatic neuroendocrine tumor, 1 (3%). The test was abnormal in 11 patients (36%): in 2 (6%) patients, replacement therapy was initiated; in 7 (23%) patients, dosage was increased and in 2 (6%) patients, treatment was not started because of history of intolerance. Patients with negative test: in 5 (16%) patients, replacement therapy was discontinued; in 12 (40%), treatment was not started and in 2 (6%), treatment was initiated because of symptoms. The results of the test led us to do a change in the treatment in 14 (46%) patients. Conclusions: The implementation of the Pancreo-kit® test in patients with pancreatic diseases could allow enzyme replacement therapy to be adapted to a substantial number of patients. Further prospective studies are needed to find the real implication of the test.
5. Diagnosis and treatment of autoimmune pancreatitis in Spain pez-Serrano 1, J. Crespo 2, S. Salord 3, F. Bolado 4, I. Pascual 5, L. A. Lo pez 9, M. Ilzarbe 6, A.J. del Pozo-García 7, C. Garrido 8, C. Marra-Lo n 12, E. de Madaria 13, M.D. Pleguezuelo 10, P. Almela 11, M. Concepcio n 14, M. Rodríguez 15, C. Alonso 2, L. Secanella 3, M.A. Casi 4, N. Higo García 5, E. Moreno-Osset 1 1 Hospital Universitari Dr. Peset, Universitat de Valencia, Valencia, Spain 2 s de Valdecilla, Santander, Spain Hospital Universitario Marque 3 Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain 4 Complejo Hospitalario de Navarra, Pamplona, Spain 5 Hospital Universitari Clínic, Valencia, Spain 6 Hospital del Mar, Barcelona, Spain 7 Hospital Universitario Doce de Octubre, Madrid, Spain 8 Hospital Son Espases, Palma de Mallorca, Spain 9 Hospital Universitario Araba (Sede Txagorritxu), Vitoria-Gasteiz, Spain 10 rdoba, Spain Hospital Reina Sofía, Co 11 n, Spain Hospital General de Castello 12 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 13 Hospital General Universitario, Alicante, Spain 14 cnic La Fe, Valencia, Spain Hospital Universitari i Polite 15 Hospital Universitario Central de Asturias, Oviedo, Spain
Introduction: Autoimmune pancreatitis (AIP) is a chronic inflammatory disorder described in recent years. Recently, the International Consensus Diagnostic Criteria (ICDC) has been proposed. AIP is classified into 2 subtypes (AIP1 and AIP2). Aim: To analyse the diagnosis and treatment of AIP patients from several tertiary care centres in Spain, according to the ICDC. Methods: Retrospective observational study. Data from patients with a diagnosis of AIP in 15 participating centres through 31 December 2014 were collected. Results: Suspected AIP in 58 patients: misclassification in 27. Fifty patients included: 86.0% AIP1, 10.0% AIP2, and 4.0% non-specific AIP patients. Males: 76%. Mean (SD; range) age: 57.4 (12.7; 24-80) years. Initial
e3
symptoms: obstructive jaundice 44.0%; and abdominal pain and weight loss, 36.0%, respectively. Thirty-eight extrapancreatic lesions were found in 60.0% of patients: biliary involvement, 44.0%. Serum IgG4 level was increased in 32/48 (66.7%) patients. US, CT, RMI, MRCP, ERCP, USE and 18FFDG-PET/CT were performed in 86.0%, 94.0%, 66.0%, 62.0%, 38.0%, 44.0%, and 6.0% of patients: 44.0% and 38.0% with diffuse and localized pancreatic enlargement, respectively; stenosis of the main pancreatic duct in 33.3%. Extra pancreatic lesions were detected in 60.0%: biliary stricture, 50.0%. Tissue specimens were obtained in 76.0% of patients. Initial treatment: 84.0% steroids and 14.0% surgery. Relapses occurred in 48.8% of AIP1 patients. Prolonged steroid treatment was given in 58.0%. Conclusions: Difficulties in ICDC application were detected. AIP in Spain has clinical profiles similar to other countries. Using ICDC can prevent unnecessary surgery in patients with obstructive jaundice.
6. Is an early diagnosis of pancreatic cancer possible? K. De Jesús, A. P erez, A. Germade, R. Castillo, B. Moreira, S. Maestro, J. Barcenilla, F. Igea, R. Madrigal, C. Ordieres, E. Saracibar, J. Martin, G. de la lama Complejo Asistencial Universitario de Palencia, Palencia, Spain Introduction and Aim: Worldwide, pancreatic cancer is the eighth leading cause of cancer death in men and the ninth in women. Its early diagnosis is not easy. The prognosis of pancreatic cancer is poor even in those with potentially resectable disease. Endoscopic ultrasound (EUS) is a very effective technique in detected pancreatic lesions and may allow early diagnoses in patients with average-risk. It is clear that patients considered at high risk of developing pancreatic cancer should be screened. Patients with diabetes mellitus (DM) have a significantly increased likelihood of association with pancreatic cancer, numerous epidemiologic studies describe an association between diabetes mellitus and pancreatic cancer. We need to select the subgroup of diabetic patients who have more chance of association with pancreatic cancer. Methods: We made a protocol with Endocrine and Internal Medicine Units for performing EUS in asymptomatic diabetic patients with: Patients over 50 years with recent onset diabetes and BMI < 22. Diabetic patients over 50 years with good glycemic control that have significant and abrupt deterioration of their diabetes (sudden needed for insulin in patients with oral antidiabetes or significant increase in insulin dose associated with weight loss). During 2013-2014, 15 EUS were performed, 8 with new onset diabetes, and 7 with deterioration of glycemic profile. The range of age was between 50-87 years. Results: We detected two adenocarcinomas (13.3%) one of 20 mm in 54-years-old male with postoperative diagnosis of T2N0 and other of 8 mm in 73 years old women with T1N0, and 1 patient with neuroendocrine tumor (6.6%) with postoperative diagnosis G1 (pT1NoMx). All belonged to the group of decompensation of their diabetes. Conclusions: EUS is an excellent technique for early diagnosis of pancreatic cancer. In selected cases of diabetic patients, an early diagnosis of pancreatic cancer may be possible. It is not proven that involves increased survival but it is possible.
7. Spectrum of use and effectiveness of endoscopic pancreatic sphincteroplasty B. Gonzalez de la Higuera, D. Ruiz-Clavijo, F. Bolado, J. Urman, M.A. Casi, C. Prieto, J.J. Vila Complejo Hospitalario de Navarra, Pamplona, Spain