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Su1888 Pancreatic Enzyme Replacement Therapy in Chronic Pancreatitis and Pancreatic Cancer- Are We Getting It Right?
(R=0.43, P<0.01) and un-weighed β-diversity analysis (R=0.31, P<0.01) as well as by specific bacterial taxa (Fig. 4). Conclusions: 1. CD24 negatively regulate PPARγ expression in male mice. 2. The association between CD24 and insulin sensitivity, and the oncogenic potential of CD24, suggest a possible mechanism for diabetes as a cancer risk factor. 3. CD24 KO male mice may serve as a model of male early obesity and insulin sensitivity.
AGA Abstracts
patient records on the patients' symptoms, evidence of PERT and the dose prescribed. Results: 117 patients with PC and 106 with CP were included in the study. Symptoms of pancreatic enzyme insufficiency (abdominal pain, weight loss or steatorrhoea) were recorded in 72/117 (61.5%) of PC patients compared with 75/106 (70.8%) of CP patients. PERT was prescribed in 14/72 (19.5%) patients with PC versus 53/75 (70.7%) with CP. The table below shows the enzyme formulation and dosages used in both groups. Conclusion: In our study we demonstrate that the majority of patients with PEI in CP are prescribed PERT, a stark contrast with a mere 20% in PC. However in both groups, most patients were not prescribed optimal doses of PERT though again, this figure was better in the CP group (14/ 53 or 26.4%) compared to the PC group (2/14 or 14.3%).This study highlights the missed opportunity to reduce symptoms and improve quality of life in CP and PC patients with a simple intervention. Increased awareness of the availability and appropriate dosing of PERT in conditions resulting in PEI is required. PERT dosing in Chronic Pancreatitis and Pancreatic Cancer Patients
Su1889 Can We Detect Chronic Pancreatitis With Low Pancreatic Enzyme Levels? Chang-Il Kwon, Hong Joo Kim, Paul Korc, Eun Kwang Choi, Gail McNulty, James L. Watkins, Evan L. Fogel, Lee McHenry, Michelle K. Zimmerman, Stuart Sherman, Glen A. Lehman Background/Aims: Chronic pancreatitis (CP) causes fibrosis with destruction of exocrine and endocrine tissue. This damage may affect pancreatic enzyme synthesis and entry into and clearance from the circulation. This may result in low serum enzyme levels. Older reports note lower serum pancreatic enzymes, especially lipase, in up to 50% of CP patients (Benini L, et al. Int J Pancreatol 1991). Low serum amylase and lipase levels in CP are not discussed in recent publications (Forsmark CE. Gastroenterology 2013; Harrison's Principles of Internal Medicine. 18th ed.). Serum amylase and lipase remain as readily available and inexpensive tests. The aim of this study is to compare serum pancreatic levels between CP patients and healthy controls, and to evaluate whether serum pancreatic enzyme levels could be used for detection of CP. Methods: Healthy volunteers were screened (to exclude history of pancreatic disease or surgery, severe gastrointestinal disease, excess alcohol intake, etc.) and prospectively enrolled in the control group (age, 18-79). Patients who were diagnosed with calcific CP between JAN/2012 and MAY/2014 and underwent ERCP were enrolled in the patient group by retrospective review from ERCP database. Serum amylase and lipase levels were compared between the two groups. Patients with an abnormal high serum level before ERCP were enrolled in the study only when their level returned to normal and pain was resolved or improved after ERCP. Patients with a condition (such as chronic kidney disease, pancreatic surgery, etc.) that may affect serum amylase and lipase levels or with hyperamylasemia were excluded from the analysis. Results: A total of 116 healthy volunteers were enrolled in the control group and 150 patients with calcific CP were enrolled in the patient group. The mean values±S.D. of the control group were compared with those of the patient group for age (42.0±13.9 vs. 54.0±12.2, p<0.001), serum amylase level (normal range, 19-86 U/L: 46.8±12.3 U/L vs. 34.8±17.2 U/L, p<0.001), and serum lipase level (normal range, 7-59 U/L: 24.5±10.1 U/L vs. 16.3±11.2 U/L, p<0.001). Using mean value 2 S.D. of control group, 45 patients (30%) had low amylase level, 28 patients (18.7%) had low lipase level and 16 patients (10.7%) had both levels low. On the ROC curve analysis for amylase level, AUC was 0.728 (95% CI), and sensitivity and specificity were 43.3% and 94.8%, respectively, with a cutoff value of 29.5 U/L. On the ROC curve analysis for lipase level, AUC was 0.725 (95% CI), and sensitivity and specificity were 33.3% and 95.7%, respectively, with a cutoff value of 10.5 U/L (Table 1). Conclusion: Our results suggest that low serum amylase and lipase levels can be used to aid in detection of CP. These results confirm older studies noting up to 50% sensitivity for CP diagnosis. Further studies in noncalcific chronic pancreatitis are needed.
Su1888 Pancreatic Enzyme Replacement Therapy in Chronic Pancreatitis and Pancreatic Cancer- Are We Getting It Right? Sharmila Subramaniam, Natalie Nobar, Kalpesh Besherdas Introduction: Pancreatic enzyme insufficiency (PEI) is a well recognised cause of malnutrition in chronic pancreatitis and pancreatic cancer. Pancreatic enzyme replacement therapy (PERT) in the form of enteric coated pancreatin microspheres is recommended in both these groups of patients with symptoms of PEI to prevent weight loss and malnutrition and improve quality of life. Given that the probability of PEI is high in PC (80-90%), PERT is recommended without the use of formal diagnostic tests. The optimal starting dose of PERT is 40 000 to 50 000 lipase units per main meal. The aim of this study was to evaluate the use of PERT including appropriate dosing in chronic pancreatitis (CP)and pancreatic cancer (PC) and to ascertain if there was a difference in prescribing practice between these groups. Methods: A single centre retrospective analysis of patients diagnosed with CP and PC since 2010 in a large North London district general hospital was performed using local upper gastrointestinal cancer multidisciplinary team records and clinical coding. We identified 149 patients with PC and 110 with CP. 32 patients from the PC group and 4 from the CP group were excluded from the study due to poor documentation in the records leading to insufficient information surrounding enzyme supplementation and dosages. Information was collected from electronic
AGA Abstracts
S-544
AGA Abstracts
patient records on the patients' symptoms, evidence of PERT and the dose prescribed. Results: 117 patients with PC and 106 with CP were included in the study. Symptoms of pancreatic enzyme insufficiency (abdominal pain, weight loss or steatorrhoea) were recorded in 72/117 (61.5%) of PC patients compared with 75/106 (70.8%) of CP patients. PERT was prescribed in 14/72 (19.5%) patients with PC versus 53/75 (70.7%) with CP. The table below shows the enzyme formulation and dosages used in both groups. Conclusion: In our study we demonstrate that the majority of patients with PEI in CP are prescribed PERT, a stark contrast with a mere 20% in PC. However in both groups, most patients were not prescribed optimal doses of PERT though again, this figure was better in the CP group (14/ 53 or 26.4%) compared to the PC group (2/14 or 14.3%).This study highlights the missed opportunity to reduce symptoms and improve quality of life in CP and PC patients with a simple intervention. Increased awareness of the availability and appropriate dosing of PERT in conditions resulting in PEI is required. PERT dosing in Chronic Pancreatitis and Pancreatic Cancer Patients
Su1889 Can We Detect Chronic Pancreatitis With Low Pancreatic Enzyme Levels? Chang-Il Kwon, Hong Joo Kim, Paul Korc, Eun Kwang Choi, Gail McNulty, James L. Watkins, Evan L. Fogel, Lee McHenry, Michelle K. Zimmerman, Stuart Sherman, Glen A. Lehman Background/Aims: Chronic pancreatitis (CP) causes fibrosis with destruction of exocrine and endocrine tissue. This damage may affect pancreatic enzyme synthesis and entry into and clearance from the circulation. This may result in low serum enzyme levels. Older reports note lower serum pancreatic enzymes, especially lipase, in up to 50% of CP patients (Benini L, et al. Int J Pancreatol 1991). Low serum amylase and lipase levels in CP are not discussed in recent publications (Forsmark CE. Gastroenterology 2013; Harrison's Principles of Internal Medicine. 18th ed.). Serum amylase and lipase remain as readily available and inexpensive tests. The aim of this study is to compare serum pancreatic levels between CP patients and healthy controls, and to evaluate whether serum pancreatic enzyme levels could be used for detection of CP. Methods: Healthy volunteers were screened (to exclude history of pancreatic disease or surgery, severe gastrointestinal disease, excess alcohol intake, etc.) and prospectively enrolled in the control group (age, 18-79). Patients who were diagnosed with calcific CP between JAN/2012 and MAY/2014 and underwent ERCP were enrolled in the patient group by retrospective review from ERCP database. Serum amylase and lipase levels were compared between the two groups. Patients with an abnormal high serum level before ERCP were enrolled in the study only when their level returned to normal and pain was resolved or improved after ERCP. Patients with a condition (such as chronic kidney disease, pancreatic surgery, etc.) that may affect serum amylase and lipase levels or with hyperamylasemia were excluded from the analysis. Results: A total of 116 healthy volunteers were enrolled in the control group and 150 patients with calcific CP were enrolled in the patient group. The mean values±S.D. of the control group were compared with those of the patient group for age (42.0±13.9 vs. 54.0±12.2, p<0.001), serum amylase level (normal range, 19-86 U/L: 46.8±12.3 U/L vs. 34.8±17.2 U/L, p<0.001), and serum lipase level (normal range, 7-59 U/L: 24.5±10.1 U/L vs. 16.3±11.2 U/L, p<0.001). Using mean value 2 S.D. of control group, 45 patients (30%) had low amylase level, 28 patients (18.7%) had low lipase level and 16 patients (10.7%) had both levels low. On the ROC curve analysis for amylase level, AUC was 0.728 (95% CI), and sensitivity and specificity were 43.3% and 94.8%, respectively, with a cutoff value of 29.5 U/L. On the ROC curve analysis for lipase level, AUC was 0.725 (95% CI), and sensitivity and specificity were 33.3% and 95.7%, respectively, with a cutoff value of 10.5 U/L (Table 1). Conclusion: Our results suggest that low serum amylase and lipase levels can be used to aid in detection of CP. These results confirm older studies noting up to 50% sensitivity for CP diagnosis. Further studies in noncalcific chronic pancreatitis are needed.
Su1888 Pancreatic Enzyme Replacement Therapy in Chronic Pancreatitis and Pancreatic Cancer- Are We Getting It Right? Sharmila Subramaniam, Natalie Nobar, Kalpesh Besherdas Introduction: Pancreatic enzyme insufficiency (PEI) is a well recognised cause of malnutrition in chronic pancreatitis and pancreatic cancer. Pancreatic enzyme replacement therapy (PERT) in the form of enteric coated pancreatin microspheres is recommended in both these groups of patients with symptoms of PEI to prevent weight loss and malnutrition and improve quality of life. Given that the probability of PEI is high in PC (80-90%), PERT is recommended without the use of formal diagnostic tests. The optimal starting dose of PERT is 40 000 to 50 000 lipase units per main meal. The aim of this study was to evaluate the use of PERT including appropriate dosing in chronic pancreatitis (CP)and pancreatic cancer (PC) and to ascertain if there was a difference in prescribing practice between these groups. Methods: A single centre retrospective analysis of patients diagnosed with CP and PC since 2010 in a large North London district general hospital was performed using local upper gastrointestinal cancer multidisciplinary team records and clinical coding. We identified 149 patients with PC and 110 with CP. 32 patients from the PC group and 4 from the CP group were excluded from the study due to poor documentation in the records leading to insufficient information surrounding enzyme supplementation and dosages. Information was collected from electronic
AGA Abstracts
S-544