Subclinical pancreatic exocrine insufficiency is associated with osteopathy in patients with chronic pancreatitis: Implications for management.

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pancreatology Pub Date : 2024-12-25 DOI:10.1016/j.pan.2024.12.017

Mehul Gupta, Shallu Midha, Vikas Sachdeva, Jairam Singh, Shivam Pandey, Chetanya Mittal, Varun Teja, Tanmay Vajpai, Anugrah Dhooria, Nikhil Tandon, Soumya Jagannath, Pramod Kumar Garg

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Abstract

Background and aims: Patients with chronic pancreatitis (CP) may develop pancreatic exocrine insufficiency (PEI) but data regarding subclinical PEI are scarce. Our objective was to detect subclinical PEI in patients with CP and its functional consequences.

Methods: We prospectively included patients with CP from April 2018-December 2021. Mild PEI and severe PEI were diagnosed if fecal elastase (FE) was 100-200 μg/g and <100 μg/g stool respectively. Vitamin levels and DEXA scan were done to assess functional consequences of PEI. Presence of subclinical PEI in CP (low FE-1 but without steatorrhea) with consequent osteopathy was the primary outcome.

Results: Of 120 patients with CP, subclinical PEI (low FE-1 but no steatorrhea) was present in 84/120(70%) patients: 6/8(75%) in early CP, 41/53(77%) in definite CP and 37/55(67.2%) in advanced CP. Overall, 72.1% patients had osteopathy including 53(62%) among patients with subclinical PEI. There was no difference in osteopathy between subclinical and severe PEI. Patients with severe PEI had lower vitamin A levels as compared to mild PEI and no PEI patients [1.3 ± 0.5 mg/ml vs. 1.7 ± 0.6 mg/ml vs. 1.8 ± 0.5 mg/ml; p = 0.04]. There was no difference in vitamin D levels. Osteopathy was present in 40/56 (71.4%) in advanced, 26/56 (46.4%) in definite and 2/8 (25%) in early CP patients (p = 0.09). On multivariable analysis, patients with advanced CP had the higher risk of osteopathy (odds ratio 7.6, 95% CI 1.9-29.7).

Conclusions: Subclinical PEI was present even in early CP with increased risk of osteopathy and fat-soluble vitamin deficiency.

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背景和目的：慢性胰腺炎（CP）患者可能会出现胰腺外分泌功能不全（PEI），但有关亚临床 PEI 的数据却很少。我们的目的是检测 CP 患者的亚临床 PEI 及其功能性后果：我们前瞻性地纳入了2018年4月至2021年12月的CP患者。如果粪便弹性蛋白酶（FE）为 100-200 μg/g，则诊断为轻度 PEI 和重度 PEI：在 120 名 CP 患者中，84/120（70%）名患者存在亚临床 PEI（FE-1 低但无脂肪泻）：6/8（75%）为早期 CP，41/53（77%）为明确 CP，37/55（67.2%）为晚期 CP。总体而言，72.1%的患者患有骨质疏松症，其中亚临床 PEI 患者中有 53 人（62%）患有骨质疏松症。亚临床和重度 PEI 患者的骨质疏松程度没有差异。与轻度 PEI 和无 PEI 患者相比，重度 PEI 患者的维生素 A 水平较低 [1.3 ± 0.5 mg/ml vs. 1.7 ± 0.6 mg/ml vs. 1.8 ± 0.5 mg/ml; p = 0.04]。维生素 D 水平没有差异。40/56（71.4%）例晚期 CP 患者存在骨病，26/56（46.4%）例明确 CP 患者存在骨病，2/8（25%）例早期 CP 患者存在骨病（p = 0.09）。经多变量分析，晚期 CP 患者发生骨病的风险更高（几率比 7.6，95% CI 1.9-29.7）：结论：亚临床 PEI 即使存在于早期 CP 中，也会增加骨病和脂溶性维生素缺乏的风险。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.