Exocrine Pancreatic Insufficiency
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
Currently, there are six Food and Drug Administration (FDA)-approved pancreatic enzyme replacement therapy (PERT) preparations in the United States. They are all of porcine origin. To avoid the activation of pancreatic enzyme preparations by gastric acid and pepsin and prolong their contact with the intestine, the delayed-release forms have been developed. One formulation contains a proton pump inhibitor, to inhibit stomach acid, thus increasing efficacy of the pancreatic enzymes. H2-receptor antagonists or proton pump inhibitors may be added to the medical regimen to provide the same effect. Patients with CF and other forms of pancreatic insufficiency need the pancreatic enzymes to treat their malnutrition, growth delay, diarrhea, and steatorrhea, but this replacement therapy does not provide full symptom relief in all patients.
Cystic Fibrosis and Pancreatic Disease
Praveen S. Goday, Cassandra L. S. Walia in Pediatric Nutrition for Dietitians, 2022
Due to pancreatic insufficiency or the potential to develop pancreatic insufficiency over time, a review of gastrointestinal symptoms should be completed. An assessment of baseline stool frequency, consistency, and appearance, in addition to gastrointestinal symptom review, may help identify malabsorption. If malabsorption is noted and/or poor weight gain is documented, confirming PERT doses and timing (i.e., at beginning of meal), and identifying any potential barriers to adherence will be critical.
Tube Feedings Formulas and Methods
Michael M. Rothkopf, Jennifer C. Johnson in Optimizing Metabolic Status for the Hospitalized Patient, 2023
Underlying bowel diseases such as Crohn’s and ulcerative colitis may be present. Bowel ischemia due to mesenteric artery stenosis could be present. In addition, recovery from intestinal obstruction and/or surgery can be a cause of hospital diarrhea. Pancreatitis and the resulting pancreatic insufficiency may be another cause.
Diet and bowel symptoms among colon cancer survivors
Published in Acta Oncologica, 2022
Mette Borre, Janne Fassov, Therese Juul, Søren Laurberg, Peter Christensen, Annette Boesen Bräuner, Ole Thorlacius Ussing, Michael Bødker Lauritzen, Asbjørn Mohr Drewes, Pia Møller Faaborg, Klaus Krogh
Patients having undergone right-sided resection mainly suffer from increased frequency of defecation and loose stools, while patients having undergone left-sided resection may have fragmentation and a feeling of obstructed defecation [5,6,8,13,14]. The underlying pathophysiology behind colorectal dysfunction in CC survivors remains incompletely understood and several factors coexist. The main causes appear to be a small intestinal bacterial overgrowth and bile-acid malabsorption, but excessive fiber intake and pancreatic insufficiency have also been reported [38]. Phillips et al. found that 40% of patients surviving right-sided CC had bile acid malabsorption [39]. Treatment of bile acid diarrhea includes bile acid sequestrants [12,13,40,41] and reduced dietary intake of fat [12–14,40,42]. In our study, 39 (8.5%) patients with right-sided resection and 21 (6%) patients with a left-sided resection reported poor or very poor bowel function. This is less than in the study by the study by Bulchi et al. reported that 20.6% of patients with a right-sided resection and 15.7% of those with a left-sided resection had bowel dysfunction [43].
Trypsinogen and chymotrypsinogen: potent anti-tumor agents
Published in Expert Opinion on Biological Therapy, 2021
Aitor González-Titos, Pablo Hernández-Camarero, Shivan Barungi, Juan Antonio Marchal, Julian Kenyon, Macarena Perán
The pancreas plays a very important role in the digestive function through the secretion of several enzymes necessary for the degradation of nutrients. These enzymes are secreted by acinar cells as zymogens (inactive forms also known as (pro)enzymes) [3]. Once secreted, they are transferred to the small intestine where they are activated. The most studied zymogens are Trypsinogen and Chymotrypsinogen. In the case of Trypsinogen, it is activated to Trypsin in the small intestine by enterokinase. Once activated, it is capable of activating the rest of the pancreatic zymogens, including Chymotrypsinogen into Chymotrypsin [4]. A failure in the production of these proteins can cause poor absorption of nutrients, the most common diseases that lead to exocrine pancreatic insufficiency are chronic pancreatitis and cystic fibrosis [5].
Surgical management of pancreatic neuroendocrine tumors: an introduction
Published in Expert Review of Anticancer Therapy, 2019
Elisabeth Hain, Rémy Sindayigaya, Jade Fawaz, Joseph Gharios, Gaspard Bouteloup, Philippe Soyer, Jérôme Bertherat, Frédéric Prat, Benoit Terris, Romain Coriat, Sébastien Gaujoux
Pancreas-sparing pancreatectomies reduce the risk of surgically induced pancreatic insufficiency especially compared to pancreaticoduodenectomy. Endocrine insufficiency incidence after pancreas-sparing pancreatectomies ranges from 0% for enucleation and up to 16% for central pancreatectomy [81,82], still lower than after standard pancreatic resection (Table 4). However, overall postoperative morbidity of pancreas-sparing surgery is usually significantly higher compared to standard resection. Overall morbidity is 25% to 70% after central pancreatectomy [83,84] and 43% to 47% after enucleation [85,86], compared to 30% to 50% after pancreaticoduodenectomy and 25% to 30% after distal pancreatectomy [81]. The higher morbidity is mainly represented by pancreatic fistula [87].
Related Knowledge Centers
- Digestive Enzyme
- Malabsorption
- Pancreas
- Protease
- Type 1 Diabetes
- Type 2 Diabetes
- Digestion
- Cystic Fibrosis
- Pancreatitis
- Shwachman–Diamond Syndrome