The pancreas
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Chronic pancreatitis is a progressive inflammatory disease in which there is irreversible destruction of pancreatic tissue. Its clinical course is characterised by severe pain and, in the later stages, exocrine and endocrine pancreatic insufficiency. In the early stages of its evolution, it is frequently complicated by attacks of acute pancreatitis, which are responsible for the recurrent pain that may be the only clinical symptom. The incidence of chronic pancreatitis in several European, North American and Japanese studies ranges from 2 to 10 new cases per 100 000 population per year, with a prevalence of around 13 cases per 100 000, although there are suspicions that the prevalence is actually higher. In certain parts of the world, such as southern India, the prevalence is much higher (100-200 per 100 000). The disease occurs more frequently in men (male:female ratio of 4:1), and the mean age of onset is about 40 years.
Nutrition in Acute and Chronic Pancreatitis
Mary J. Marian, Gerard E. Mullin in Integrating Nutrition Into Practice, 2017
The most common presenting symptom of chronic pancreatitis is abdominal pain (usually begins as intermittent pain and then becomes constant). While patients with abdominal pain and calcifications are easily diagnosed as having chronic pancreatitis, the diagnosis of noncalcific chronic pancreatitis can be challenging for many reasons. There are many other conditions and diseases that can present with similar symptoms and no tests that accurately differentiate early or mild chronic pancreatitis from these other conditions and diseases. In addition, diagnostic endoscopic and radiological imaging studies are used to detect structural changes of the pancreas that may be correlated fibrosis but it should be emphasized that pancreatic fibrosis can be seen in asymptomatic patients who consume alcohol or smoke, are obese, or who are older. The single strongest risk factor for chronic pancreatitis is a prior history of acute recurrent pancreatitis [35,36].
Liver, Biliary Tract and Pancreatic Disease
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
Causes of chronic pancreatitis are: Alcohol (over 60% of cases)HyperlipidaemiaMalnutritionCystic fibrosisHypercalcaemiaHereditary (autosomal dominant)Idiopathic causesGenetic risk factors, including variants in cationic trypsinogen (PRSS1), serine protease inhibitor Kazal-type 1 (SPINK1) and carboxypeptidase A1 (CPA1)Autoimmunity
Assessment of small intestinal bacterial overgrowth in chronic pancreatitis patients using jejunal aspirate culture and glucose hydrogen breath test
Published in Scandinavian Journal of Gastroenterology, 2021
Rajesh Sanjeevi, Kapil Dev Jamwal, Sudipta Dhar Chowdhury, Balamurugan Ramadass, R. Gayathri, Amit Kumar Dutta, Anjilivelil Joseph Joseph, Balakrishnan S. Ramakrishna, Ashok Chacko
Chronic pancreatitis is a syndrome of chronic progressive pancreatic inflammation and scarring, leading to irreversible damage of the pancreas with resultant loss of exocrine and endocrine function [1]. Pancreatic exocrine insufficiency (PEI) is an under-recognized problem amongst patients with chronic pancreatitis [2]. Destruction of pancreatic acini reduces pancreatic enzyme secretions resulting in PEI. Though lipid digestion is predominantly affected, PEI can also lead to carbohydrate and protein maldigestion [3]. PEI can lead to bloating, steatorrhoea or diarrhea and significantly impair the quality of life [4]. Changes in pancreatic exocrine function have been shown to produce changes in microbial diversity within the gastrointestinal tract [5]. One such pathological form of microbial dysbiosis that occurs in chronic pancreatitis is small intestinal bacterial overgrowth (SIBO). SIBO has been defined as a clinical syndrome caused by the presence of an excess amount of bacteria in the small bowel [6]. Symptoms of SIBO can mimic symptoms of PEI. Factors that predispose chronic pancreatitis patients to SIBO include decreased pancreatic proteolytic enzymes, use of narcotics, ethanol use, use of proton pump inhibitors (PPIs) and diabetic neuropathy [7–10].
High-density and targeted glycoproteomic profiling of serum proteins in pancreatic cancer and intraductal papillary mucinous neoplasm
Published in Scandinavian Journal of Gastroenterology, 2018
Linus Aronsson, Roland Andersson, Monika Bauden, Bodil Andersson, Thomas Bygott, Daniel Ansari
The limitations of this study need to be acknowledged. The diagnostic performance of our biomarker panels was high. In this cohort, CA19-9 alone had an AUC of 0.903 for detection of pancreatic cancer, which is higher than usually reported in the literature. Healthy individuals were used as controls. Chronic pancreatitis was not included in the evaluation. Conceivably, a diagnostic test for pancreatic cancer is intended for application in asymptomatic individuals. Patients with chronic pancreatitis are usually symptomatic. Most importantly, extensive validation of the biomarker candidates is needed to confirm the diagnostic performance. It is also of great importance to recognize that many patients diagnosed with malignant disease in the pancreas display various health conditions, requiring diverse pharmaceutical treatment. It has been shown that hyperglycemia can be noted several months prior to diagnosis [28] and hyperglycemia was found to increase the glycosylation of several N-glycans in different diseases [29]. In our cohort, a total of 16 patients (all with pancreatic cancer) had manifest diabetes mellitus and 7 out of these cases were considered new-onset. Unfortunately, fasting glucose levels were not routinely measured and the glycemic status was not adjusted for in our analysis. Furthermore, the analytical method used in the present study measured the glycosylation levels of serum proteins and no additional characterization of the individual glycans was performed. In the future, additional analysis can be applied to the biomarker candidates in order to characterize the glycan features in detail.
Increased heat shock protein 70 expression attenuates pancreatic fibrosis induced by dibutyltin dichloride
Published in Scandinavian Journal of Gastroenterology, 2018
Jae Min Lee, Kwang Gyun Lee, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik Lee, Soon Ho Um, Chang Duck Kim
Chronic pancreatitis is characterized by destruction of the pancreatic parenchyma and fibrosis due to repeated stimulus and damage and presents as a deterioration of pancreatic exocrine function and loss of endocrine function [1]. Chronic pancreatitis is related to recurrent pancreatic injury in acute pancreatitis. Although previous studies have investigated the mechanisms that lead to chronic pancreatitis [2,3], the treatment for chronic pancreatitis has not been clearly elucidated. Moreover, although various methods to treat chronic pancreatitis have been employed, such as digestive enzyme supplementation [4–7], antioxidant therapy [8,9], endoscopy [10,11], and surgery [12,13], their effects have not been established. Therefore, a new idea and approach would be required to treat chronic pancreatitis. Various experimental models of pancreatitis are available [14]; however, animal models of chronic pancreatitis should be validated before treatment evaluation.
Related Knowledge Centers
- Acute Pancreatitis
- Alcohol Abuse
- Inflammation
- Malabsorption
- Pancreas
- Pancreatic Cancer
- Steatorrhea
- Pancreatitis
- Tobacco Smoke
- Pancreatic Enzymes