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Pancreatic enzyme replacement therapy in exocrine pancreatic insufficiency: Evaluation of dosage and adjust dosage effect
Abstracts / Pancreatology 13 (2013) e1–e19
Alterations in intracellular calcium levels and amylase secretion were suggested as responsible for the inflammatory process associated to chronic pancreatitis (CP). The effect of tobacco in this context is unclear. Hypothesis: Tobacco promotes CP development in vitro across the modification of intracellular calcium levels and enzyme secretion. Aim: To evaluate the role of tobacco compared with alcohol, in the intracellular calcium levels and amylase secretion in pancreatic acinar cells (PAC). Methods: PAC were isolated from pancreas from Swiss mice and stimulated with tobacco (0.1-0.4mg/ml) or alcohol (10-100mM) and with CCK (positive control). Calcium levels were measured by fluorescence (fluo-4) and amylase secretion by spectrophotometry. Statistical analysis performed by ANOVA-test. Results: Tobacco significantly increases intracellular calcium levels ranging between 11.384.89% (0.1mg/ml) to 47.1111.75% (0.4mg/ml). Alcohol induces a similar increase between 14.402.06% (10mM) to 59.82.57% (75mM). This increasing is associated to a supraphysiologic pancreatic secretion of amylase only with tobacco (21% at 0.4mg/ml). Conclusions: Tobacco, as well as alcohol, increases significantly intracellular calcium levels into the PAC. This increase produced by tobacco is associated to supraphysiologic increase of amylase secretion, suggesting a role of tobacco in CP.
e15
Objective: The epidemiology of Chronic pancreatitis (CP) is unknown in Alava (Spain). PC assessment from our Pancreas Unit. Material and methods: Prospective cohort study in 319,227 people. 2011-2013 analysis. CP was defined by M-ANNHEIM, so 85 patients (pts) with CP were included, 68 men and 17 women, with 59.38 as average age. Results: 27 new diagnosis and 2 pts died during the analysis period. Etiology: alcohol-tobacco 44%, recurrent pancreatitis 30%, obstructive 5%, autoimmune 2%, metabolic 2% and idiopathic 17%. Main-symptoms: chronic abdominal pain 17%, recurrent abdominal pain 39%, diarrhea steatorrhea 18%. 82, 73 and 50 pts underwent, respectively, CT-scan, MRCP and EUS as diagnostic procedures. Calcification was found in 24 pts, with wirsung dilatation >6mm in 36 pts. Complications: pseudocyst 24pts, biliary stricture 22pts, duodenal stricture 10pts, splenic vein thrombosis 9pts, pseudoaneurysm and pancreatic fistula 4pts and 1 pancreatic neoplasm. EPI in need of PERT in 41pts(48%); Diabetes in 48pts(58%). Also, 21,2% needed opioid analgesics, 18,2% endoscopic treatment or 18,2% surgery. Conclusions: Chronic pancreatitis in Alava is not as uncommon a disease as firstly thought. Its main etiology is alcohol consumption and smoking. This series showed a significant prevalence of pain, PEI, Diabetes, complications and high resource consumption is also worth mentioning.
P37. P35. 13C-mixed triglyceride breath test in management of exocrine pancreatic insufficiency n, E. Iyo, M. Vanrell Garau, A. Llompart Rigo. L. Lluis Pons, C. Garrido Dura Gastroenterology Department, Son Espases University Hospital, Palma de Mallorca, Spain Aim: To evaluate the impact of the C13-MTG breath test in the management of Exocrine Pancreatic Insufficiency (EPI). Methods: Prospective study, 48 consecutive patients with suspicion of EPI. A breath test was performed on all of them: 19 treated with pancreatic enzymes to clarify whether the doses were optimal and 29 at basal conditions. Results: 62.5% male, mean age 53.8 years (SD¼14.67). The test indication was chronic pancreatitis in 41.7% (17 alcoholic, 2 Tropical and 1 autoimmune), biliopancreatic neoplasms in 25% (5 cystic tumors, 2 adenocarcinomas, 1 pancreatic neuroendocrine tumor, 1 cholangiocarcinoma, 1 lymphoma and 1 GIST. Nine were operated on with resection techniques: 6 CDP, 1 total and 2 distal pancreatectomy. The other indications were cystic fibrosis (14.6%), severe acute pancreatitis (12.5%), refractory celiac (2.1%), steatorrhea of unknown origin (2.1%) and abdominal pain (2.1%). 54.2% had symptoms: pain (56%), diarrhea/steatorrhea (32%), dyspepsia (8%) and loss of weight (4%). EPI was diagnosed in 20.8%: in 7 enzymes treatment was started, and in 3 the treatment was optimized. 50% of the cases of EPI had tumors and the percentage was lower in those receiving PPI with respect to those not (11.8% vs. 25.8%) with no significant difference (p ¼ 0.46). EPI percentage was higher for patients with resective surgery 55.6% vs. 12.8% (p <0.05). Conclusion: The test involved a therapeutic change in 20.8% of cases.
P36. Chronic pancreatitis study in Txagorritxu-Araba University Hospital (Vitoria-Gasteiz, Alava, Basque-Country) pez, A. Marcaide, P. Ramírez de la Piscina, I. Duca, L. C. Marra-Lo Urtasun, I. Ganchegi, S. Estrada, E. Delgado, F. García-Campos. Hospital Universitario Araba Txagorritxu, Spain
Pancreatic enzyme replacement therapy in exocrine pancreatic insufficiency: Evaluation of dosage and adjust dosage effect pez, A. Marcaide, P. Ramírez de la Piscina, I. Duca, R. C. Marra-Lo Bengoa, S. Zabaleta, E. Delgado, F. García-Campos. Hospital Universitario Araba Txagorritxu, Spain Objective: To evaluate efficacy of different dosage of oral pancreatic enzyme replacement therapy (PERT) in Exocrine Pancreatic Insufficiency (EPI) due to Chronic Pancreatitis (CP). Material and methods: Cohort prospective study from 01/2011 to 01/ 2013 of EPI due to CP in Araba University Hospital. PERT indication was evident steatorrhoea (>15 gr/d), lipid malabsortion, weight loss or n related symptoms. maldigestio Pancrelipase (Pancreatin¼P) dosage was: P150mg(¼10000-lipase) 3-33 per day in pts receiving PERT previously; while P300mg(¼25000-lipase) 1-2-2 per day admin in new diagnoses. Dosage adjustment was according to maldigestion, malabsortion, different type of diet and nutritional profile. Results: 83 PC were included, 79,5% men (59,4 years), resulting 48,2% PEI requiring PERT (¼40pts). Initially, Pancrelipase dosage was P150mg¼19pts(22,9%): 5pts(2-2-2), 12pts(3-3-3), 2pts(4-4-4) and P300mg¼21pts(25,3%): 15pts(1-2-2), 3pts(2-2-2), 3pts(2-1-2-1-2). During follow-up, PERT was modified from P150mg to P300mg in 10 pts(25%), adding IBP in 5pts(12,5%) and 2 of them needed supplemental nutritional support. After a 6 months re-evaluation, we obtained a 90-95% response rate. Conclusions: PEI treatment with PERT was effective in most of patients. In non-responders dosage upload and add IBP, improved response rate. Randomized long-term studies are needed.
P38. Autoimmune pancreatitis: Experience in diagnosis, treatment and long-term results L. Secanella Medayo, F. Garcia Borobia, J. Busquets Barenys, N. Pelaez ~ ol, C. Valls Duran, J. Gornals Soler, A. Rafecas Renau, J. Serra, T. Serrano Pin Fabregat Prous. Hospital Universitari de Bellvitge, Spain Objectives: To describe our experience in the diagnosis, treatment and follow-up of patients (p) with suspected autoimmune pancreatitis (AIP). Materials and methods: From 1999 to 2013 we collected 23p according to IAP guidelines. Diagnostic studies were CT and/or RM, and
Alterations in intracellular calcium levels and amylase secretion were suggested as responsible for the inflammatory process associated to chronic pancreatitis (CP). The effect of tobacco in this context is unclear. Hypothesis: Tobacco promotes CP development in vitro across the modification of intracellular calcium levels and enzyme secretion. Aim: To evaluate the role of tobacco compared with alcohol, in the intracellular calcium levels and amylase secretion in pancreatic acinar cells (PAC). Methods: PAC were isolated from pancreas from Swiss mice and stimulated with tobacco (0.1-0.4mg/ml) or alcohol (10-100mM) and with CCK (positive control). Calcium levels were measured by fluorescence (fluo-4) and amylase secretion by spectrophotometry. Statistical analysis performed by ANOVA-test. Results: Tobacco significantly increases intracellular calcium levels ranging between 11.384.89% (0.1mg/ml) to 47.1111.75% (0.4mg/ml). Alcohol induces a similar increase between 14.402.06% (10mM) to 59.82.57% (75mM). This increasing is associated to a supraphysiologic pancreatic secretion of amylase only with tobacco (21% at 0.4mg/ml). Conclusions: Tobacco, as well as alcohol, increases significantly intracellular calcium levels into the PAC. This increase produced by tobacco is associated to supraphysiologic increase of amylase secretion, suggesting a role of tobacco in CP.
e15
Objective: The epidemiology of Chronic pancreatitis (CP) is unknown in Alava (Spain). PC assessment from our Pancreas Unit. Material and methods: Prospective cohort study in 319,227 people. 2011-2013 analysis. CP was defined by M-ANNHEIM, so 85 patients (pts) with CP were included, 68 men and 17 women, with 59.38 as average age. Results: 27 new diagnosis and 2 pts died during the analysis period. Etiology: alcohol-tobacco 44%, recurrent pancreatitis 30%, obstructive 5%, autoimmune 2%, metabolic 2% and idiopathic 17%. Main-symptoms: chronic abdominal pain 17%, recurrent abdominal pain 39%, diarrhea steatorrhea 18%. 82, 73 and 50 pts underwent, respectively, CT-scan, MRCP and EUS as diagnostic procedures. Calcification was found in 24 pts, with wirsung dilatation >6mm in 36 pts. Complications: pseudocyst 24pts, biliary stricture 22pts, duodenal stricture 10pts, splenic vein thrombosis 9pts, pseudoaneurysm and pancreatic fistula 4pts and 1 pancreatic neoplasm. EPI in need of PERT in 41pts(48%); Diabetes in 48pts(58%). Also, 21,2% needed opioid analgesics, 18,2% endoscopic treatment or 18,2% surgery. Conclusions: Chronic pancreatitis in Alava is not as uncommon a disease as firstly thought. Its main etiology is alcohol consumption and smoking. This series showed a significant prevalence of pain, PEI, Diabetes, complications and high resource consumption is also worth mentioning.
P37. P35. 13C-mixed triglyceride breath test in management of exocrine pancreatic insufficiency n, E. Iyo, M. Vanrell Garau, A. Llompart Rigo. L. Lluis Pons, C. Garrido Dura Gastroenterology Department, Son Espases University Hospital, Palma de Mallorca, Spain Aim: To evaluate the impact of the C13-MTG breath test in the management of Exocrine Pancreatic Insufficiency (EPI). Methods: Prospective study, 48 consecutive patients with suspicion of EPI. A breath test was performed on all of them: 19 treated with pancreatic enzymes to clarify whether the doses were optimal and 29 at basal conditions. Results: 62.5% male, mean age 53.8 years (SD¼14.67). The test indication was chronic pancreatitis in 41.7% (17 alcoholic, 2 Tropical and 1 autoimmune), biliopancreatic neoplasms in 25% (5 cystic tumors, 2 adenocarcinomas, 1 pancreatic neuroendocrine tumor, 1 cholangiocarcinoma, 1 lymphoma and 1 GIST. Nine were operated on with resection techniques: 6 CDP, 1 total and 2 distal pancreatectomy. The other indications were cystic fibrosis (14.6%), severe acute pancreatitis (12.5%), refractory celiac (2.1%), steatorrhea of unknown origin (2.1%) and abdominal pain (2.1%). 54.2% had symptoms: pain (56%), diarrhea/steatorrhea (32%), dyspepsia (8%) and loss of weight (4%). EPI was diagnosed in 20.8%: in 7 enzymes treatment was started, and in 3 the treatment was optimized. 50% of the cases of EPI had tumors and the percentage was lower in those receiving PPI with respect to those not (11.8% vs. 25.8%) with no significant difference (p ¼ 0.46). EPI percentage was higher for patients with resective surgery 55.6% vs. 12.8% (p <0.05). Conclusion: The test involved a therapeutic change in 20.8% of cases.
P36. Chronic pancreatitis study in Txagorritxu-Araba University Hospital (Vitoria-Gasteiz, Alava, Basque-Country) pez, A. Marcaide, P. Ramírez de la Piscina, I. Duca, L. C. Marra-Lo Urtasun, I. Ganchegi, S. Estrada, E. Delgado, F. García-Campos. Hospital Universitario Araba Txagorritxu, Spain
Pancreatic enzyme replacement therapy in exocrine pancreatic insufficiency: Evaluation of dosage and adjust dosage effect pez, A. Marcaide, P. Ramírez de la Piscina, I. Duca, R. C. Marra-Lo Bengoa, S. Zabaleta, E. Delgado, F. García-Campos. Hospital Universitario Araba Txagorritxu, Spain Objective: To evaluate efficacy of different dosage of oral pancreatic enzyme replacement therapy (PERT) in Exocrine Pancreatic Insufficiency (EPI) due to Chronic Pancreatitis (CP). Material and methods: Cohort prospective study from 01/2011 to 01/ 2013 of EPI due to CP in Araba University Hospital. PERT indication was evident steatorrhoea (>15 gr/d), lipid malabsortion, weight loss or n related symptoms. maldigestio Pancrelipase (Pancreatin¼P) dosage was: P150mg(¼10000-lipase) 3-33 per day in pts receiving PERT previously; while P300mg(¼25000-lipase) 1-2-2 per day admin in new diagnoses. Dosage adjustment was according to maldigestion, malabsortion, different type of diet and nutritional profile. Results: 83 PC were included, 79,5% men (59,4 years), resulting 48,2% PEI requiring PERT (¼40pts). Initially, Pancrelipase dosage was P150mg¼19pts(22,9%): 5pts(2-2-2), 12pts(3-3-3), 2pts(4-4-4) and P300mg¼21pts(25,3%): 15pts(1-2-2), 3pts(2-2-2), 3pts(2-1-2-1-2). During follow-up, PERT was modified from P150mg to P300mg in 10 pts(25%), adding IBP in 5pts(12,5%) and 2 of them needed supplemental nutritional support. After a 6 months re-evaluation, we obtained a 90-95% response rate. Conclusions: PEI treatment with PERT was effective in most of patients. In non-responders dosage upload and add IBP, improved response rate. Randomized long-term studies are needed.
P38. Autoimmune pancreatitis: Experience in diagnosis, treatment and long-term results L. Secanella Medayo, F. Garcia Borobia, J. Busquets Barenys, N. Pelaez ~ ol, C. Valls Duran, J. Gornals Soler, A. Rafecas Renau, J. Serra, T. Serrano Pin Fabregat Prous. Hospital Universitari de Bellvitge, Spain Objectives: To describe our experience in the diagnosis, treatment and follow-up of patients (p) with suspected autoimmune pancreatitis (AIP). Materials and methods: From 1999 to 2013 we collected 23p according to IAP guidelines. Diagnostic studies were CT and/or RM, and