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Reasons for the lack of effectiveness of substitution enzyme therapy in chronic pancreatitis (CP)
S70
Abstracts / Pancreatology 13 (2013) S2–S98
ESWL was performed with an electromagnetic lithotripter. The etiology of chronic calcifying pancreatitis were gene mutations (PRSS1, CFTR, SPINK1) in 9 patients. Results: 12 patients had 15 endoscopic-ESWL sessions. ESWL was administered twice in 3 children. Pancreatic stones fragmentation was achieved in all patients. The procedures were well tolerated by all children. There were no complications related to ESWL. Early pain relief occurred in all cases. Acute episodes of CP after endoscopic-ESWL treatment were observed in 3 patients (25%). Recurrence of endoscopically irretrievable pancreatic stones was revealed in 4 cases. Conclusion: 1. ESWL is a safe and effective therapy in treating children with chronic pancreatitis and irreversible pancreatic stones. 2. ESWL should be considered complementary and not alternative therapy to endoscopic drainage.
PII-57 Abstract id: 110. Efficiency of pancreatic duct stenting therapy in children with chronic pancreatitis
Aims: evaluation of clinical characteristics of chronic pancreatitis complicated by small intestinal bacterial overgrowth. Patients & methods: 52 patients with CP have been involved in study (22 m & 30 f), mean age 56.6 11.9 years. Pancreatic surgery had been performed in 14 (26.9%) patients: partial pancreaticoduodenectomy in 5 cases, pancreatic drainage surgery in 9. Exocrine pancreatic function was assessed by faecal elastase test. SIBO was detected clinically (bloating, abdominal dyscomfort, diarrhea), by hydrogen breath test with lactulose, and by faecal content and spectrum of short-chain fatty acids (SCFA). Results: Clinical stigmas of SIBO were found in 34 (65.4%) cases, however hydrogen breath test was positive in 19 (36.5%) and significant increase of common level of SCFA was found in 17 (32.7%) patients. The level of SCFA in patients with uncomplicated CP was 7.23.1 mg/g, after pancreatic surgery – 10.57.6 mg/g (p¼0.02). The most pronounced increase of common level of SCFA was observed in patients after resection surgery (13.04.4 mg/g) and with decreased exocrine pancreatic function (12.22.6 mg/g). Conclusion: Factors predisposing patients with chronic pancreatitis to SIBO development are exocrine pancreatic insufficiency and pancreatoduodenal resection.
Grzegorz Oracz 1, Jan Pertkiewicz 2, Jaroslaw Kierkus 1, Maciej Dadalski 1, Jozef Ryzko 1. 1 2
The Childrens Memorial Health Institute, Poland Endotherapy, Poland
Introduction: Chronic pancreatitis (CP) is a rare disease in childhood. Although Endoscopic Retrograde Cholangiopancreatography (ERCP) is commomnly performed in children, effect of pancreatic duct stenting therapy in children with CP is unknown. Aims: The aim of the study was to elaborate efficiency of pancreatic duct stenting in children with chronic pancreatitis. Patients & methods: 208 children with CP hospitalized since 1988 to 2012 were enrolled into the study. ERCP was performed in 157 patients (75.5%). In 86 cases (55.5%) ERCP was done at least 2 times (2 to 21 examinations). Results of endoscopic therapy were documented. Number of pancreatitis episodes/year before and after treatment was analyzed. Results: A total of 481 ERCP were performed. ERCP was successful in 475 cases (98.7%) with a complication rate 1.9% (9/475 procedures). ERCP showed mean 1.68 Cambridge grade. The total number of 223 pancreatic duct stenting procedures were performed in 72 children (34,6%). In 26 cases (11,6%) 2 stents at the same time were inserted. Median number of stent replacement was 3. Median interwal between stent replacement was 4.5 months (1-24 months). We observed statistically significant decrease in the number of pancreatitis episodes/year from 1.75 /year to 0.23 /year after endoscopic treatment (p<0.05). Pancreatic duct stenting was performed more frequently in patients with hereditary pancreatitis (61.5%; p<0.05) and with CP and anatomic anomalies of pancreatic duct (65%; p<0.05). Conclusion: Pancreatic duct stenting therapy is a safe and effective procedure in children with CP. This therapy should be recommended for children with hereditary pancreatitis and patients with anatomic anomalies of pancreatic duct.
PII-59 Abstract id: 10. Reasons for the lack of effectiveness of substitution enzyme therapy in chronic pancreatitis (CP) Natalya Gubergrits, Oksana Golubova. Donetsk National Medical University n. a. M. Gorky, Ukraine Introduction: Substitution therapy of exocrine pancreatic insufficiency is not always successful in spite of its modern possibilities. Aims: To analyze the reasons for the lack of effectiveness of substitution enzyme therapy in CP. Patients & methods: The study included 564 patients with CP, who had the exocrine pancreatic insufficiency that was confirmed by the fecal elastase test. All patients received minimicrospherical variant of pancreatine in a dose corresponding to the stage of pancreatic insufficiency. Patients with impaired trophological status received 25-40 thousands FIP units of lipase for the main meal and 10-25 thousands FIP units of lipase for the intermediate meal. Results: Effect of substitution therapy was inadequate one in 102 (18.1%) patients. Upon analyzing the reasons for the lack of treatment’s effect it turned out that 21 (20.6%) patients didn’t perform doctor’s prescriptions accurately, 26 (25.5%) patients took animal fat in great quantities, 8 (7.8%) patients had insufficient pancreatine dose, 15 (14.7%) patients were diagnosed as those having giardiasis, syndrome of bacterial overgrowth in the small intestine was revealed in 28 (27.5%) patients, and 4 (3.9%) patients had celiac disease. Conclusion: Syndrome of bacterial overgrowth in the small intestine appears to be one of the most common reasons for the lack of effectiveness of substitution enzyme therapy in CP. Attention should also be paid to the amount of consumed fat (there’s a need of nutritionist’s consultation), it’s necessary to exclude giardiasis, celiac disease, to seek for the compliance with patients regarding the implementation of recommendations for the treatment.
PII-58 Abstract id: 143. Importance of small intestinal bacterial overgrowth in chronic pancreatitis PII-60 Abstract id: 60. Dmitry Bordin, Yulia Osipenko, Vladimir Drozdov, Svetlana Silvestrova, Galina Varvanina. Central Research Institute of Gastroenterology, Moscow, Russia Introduction: Chronic pancreatitis (CP) is one of disorders predisposes patients to the small intestinal bacterial overgrowth (SIBO). SIBO related to exocrine pancreatic dysfunction and stagnation or dysmotility of small intestinal.
Management of biliary and duodenal complications of chronic pancreatitis: A prospective non-randomised study Rashchynski Siarhei 1, Tretyak Stanislav 2, Shimanski Igor 3, Rashchinskaya Nina 3. 1
Data Analysis and Interpretation, Drafting of the manuscript, Belarus Critical Revision of the Manuscript, Belarus 3 Data Analysis and Interpretation, Belarus 2
Abstracts / Pancreatology 13 (2013) S2–S98
ESWL was performed with an electromagnetic lithotripter. The etiology of chronic calcifying pancreatitis were gene mutations (PRSS1, CFTR, SPINK1) in 9 patients. Results: 12 patients had 15 endoscopic-ESWL sessions. ESWL was administered twice in 3 children. Pancreatic stones fragmentation was achieved in all patients. The procedures were well tolerated by all children. There were no complications related to ESWL. Early pain relief occurred in all cases. Acute episodes of CP after endoscopic-ESWL treatment were observed in 3 patients (25%). Recurrence of endoscopically irretrievable pancreatic stones was revealed in 4 cases. Conclusion: 1. ESWL is a safe and effective therapy in treating children with chronic pancreatitis and irreversible pancreatic stones. 2. ESWL should be considered complementary and not alternative therapy to endoscopic drainage.
PII-57 Abstract id: 110. Efficiency of pancreatic duct stenting therapy in children with chronic pancreatitis
Aims: evaluation of clinical characteristics of chronic pancreatitis complicated by small intestinal bacterial overgrowth. Patients & methods: 52 patients with CP have been involved in study (22 m & 30 f), mean age 56.6 11.9 years. Pancreatic surgery had been performed in 14 (26.9%) patients: partial pancreaticoduodenectomy in 5 cases, pancreatic drainage surgery in 9. Exocrine pancreatic function was assessed by faecal elastase test. SIBO was detected clinically (bloating, abdominal dyscomfort, diarrhea), by hydrogen breath test with lactulose, and by faecal content and spectrum of short-chain fatty acids (SCFA). Results: Clinical stigmas of SIBO were found in 34 (65.4%) cases, however hydrogen breath test was positive in 19 (36.5%) and significant increase of common level of SCFA was found in 17 (32.7%) patients. The level of SCFA in patients with uncomplicated CP was 7.23.1 mg/g, after pancreatic surgery – 10.57.6 mg/g (p¼0.02). The most pronounced increase of common level of SCFA was observed in patients after resection surgery (13.04.4 mg/g) and with decreased exocrine pancreatic function (12.22.6 mg/g). Conclusion: Factors predisposing patients with chronic pancreatitis to SIBO development are exocrine pancreatic insufficiency and pancreatoduodenal resection.
Grzegorz Oracz 1, Jan Pertkiewicz 2, Jaroslaw Kierkus 1, Maciej Dadalski 1, Jozef Ryzko 1. 1 2
The Childrens Memorial Health Institute, Poland Endotherapy, Poland
Introduction: Chronic pancreatitis (CP) is a rare disease in childhood. Although Endoscopic Retrograde Cholangiopancreatography (ERCP) is commomnly performed in children, effect of pancreatic duct stenting therapy in children with CP is unknown. Aims: The aim of the study was to elaborate efficiency of pancreatic duct stenting in children with chronic pancreatitis. Patients & methods: 208 children with CP hospitalized since 1988 to 2012 were enrolled into the study. ERCP was performed in 157 patients (75.5%). In 86 cases (55.5%) ERCP was done at least 2 times (2 to 21 examinations). Results of endoscopic therapy were documented. Number of pancreatitis episodes/year before and after treatment was analyzed. Results: A total of 481 ERCP were performed. ERCP was successful in 475 cases (98.7%) with a complication rate 1.9% (9/475 procedures). ERCP showed mean 1.68 Cambridge grade. The total number of 223 pancreatic duct stenting procedures were performed in 72 children (34,6%). In 26 cases (11,6%) 2 stents at the same time were inserted. Median number of stent replacement was 3. Median interwal between stent replacement was 4.5 months (1-24 months). We observed statistically significant decrease in the number of pancreatitis episodes/year from 1.75 /year to 0.23 /year after endoscopic treatment (p<0.05). Pancreatic duct stenting was performed more frequently in patients with hereditary pancreatitis (61.5%; p<0.05) and with CP and anatomic anomalies of pancreatic duct (65%; p<0.05). Conclusion: Pancreatic duct stenting therapy is a safe and effective procedure in children with CP. This therapy should be recommended for children with hereditary pancreatitis and patients with anatomic anomalies of pancreatic duct.
PII-59 Abstract id: 10. Reasons for the lack of effectiveness of substitution enzyme therapy in chronic pancreatitis (CP) Natalya Gubergrits, Oksana Golubova. Donetsk National Medical University n. a. M. Gorky, Ukraine Introduction: Substitution therapy of exocrine pancreatic insufficiency is not always successful in spite of its modern possibilities. Aims: To analyze the reasons for the lack of effectiveness of substitution enzyme therapy in CP. Patients & methods: The study included 564 patients with CP, who had the exocrine pancreatic insufficiency that was confirmed by the fecal elastase test. All patients received minimicrospherical variant of pancreatine in a dose corresponding to the stage of pancreatic insufficiency. Patients with impaired trophological status received 25-40 thousands FIP units of lipase for the main meal and 10-25 thousands FIP units of lipase for the intermediate meal. Results: Effect of substitution therapy was inadequate one in 102 (18.1%) patients. Upon analyzing the reasons for the lack of treatment’s effect it turned out that 21 (20.6%) patients didn’t perform doctor’s prescriptions accurately, 26 (25.5%) patients took animal fat in great quantities, 8 (7.8%) patients had insufficient pancreatine dose, 15 (14.7%) patients were diagnosed as those having giardiasis, syndrome of bacterial overgrowth in the small intestine was revealed in 28 (27.5%) patients, and 4 (3.9%) patients had celiac disease. Conclusion: Syndrome of bacterial overgrowth in the small intestine appears to be one of the most common reasons for the lack of effectiveness of substitution enzyme therapy in CP. Attention should also be paid to the amount of consumed fat (there’s a need of nutritionist’s consultation), it’s necessary to exclude giardiasis, celiac disease, to seek for the compliance with patients regarding the implementation of recommendations for the treatment.
PII-58 Abstract id: 143. Importance of small intestinal bacterial overgrowth in chronic pancreatitis PII-60 Abstract id: 60. Dmitry Bordin, Yulia Osipenko, Vladimir Drozdov, Svetlana Silvestrova, Galina Varvanina. Central Research Institute of Gastroenterology, Moscow, Russia Introduction: Chronic pancreatitis (CP) is one of disorders predisposes patients to the small intestinal bacterial overgrowth (SIBO). SIBO related to exocrine pancreatic dysfunction and stagnation or dysmotility of small intestinal.
Management of biliary and duodenal complications of chronic pancreatitis: A prospective non-randomised study Rashchynski Siarhei 1, Tretyak Stanislav 2, Shimanski Igor 3, Rashchinskaya Nina 3. 1
Data Analysis and Interpretation, Drafting of the manuscript, Belarus Critical Revision of the Manuscript, Belarus 3 Data Analysis and Interpretation, Belarus 2