Alcohol-related chronic exocrine pancreatic insufficiency: diagnosis and therapeutic management. A proposal for treatment by the Italian Association for the Study of the Pancreas (AISP) and the Italian Society of Alcohology (SIA)

Pezzilli, Raffaele; Caputo, Fabio; Testino, Gianni; Patussi, Valentino; Greco, Giovanni; Macciò, Livia; Rossin, Maria Raffaella; Mioni, Davide; Balbinot, Patrizia; Gandin, Claudia; Zanesini, Francesca; Frulloni, Luca; Aricò, S; Bottaro, Luigi Carlo; Pellicano, Rinaldo; Scafato, Emanuele

doi:10.23736/s0026-4806.19.06043-9

Cited by 12 publications

(4 citation statements)

References 89 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, alcohol is also a risk factor for chronic pancreatitis leading to pancreatic exocrine insufficiency which can further exacerbate malabsorption. 106 3. Impaired energy metabolism: Patients with ALD especially alcoholic hepatitis have a hypermetabolic state.…”

Section: Nutritionmentioning

confidence: 99%

Extrahepatic Manifestations in Alcoholic Liver Disease

Nath

Anand

2022

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Section: Nutritionmentioning

confidence: 99%

Extrahepatic Manifestations in Alcoholic Liver Disease

Nath

Anand

2022

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

“…Possible reasons given for this apparent inconsistency included the relatively small size of the sample and the uncertainty of the control ‘non-drinkers’ group. Independently, it has also been established that about one-half of the cases of PDAC are due to the impact of alcohol on pancreatitis [ 331 ]. Furthermore, alcohol consumption has detrimental effects on the physiology of the liver, which is closely associated with PDAC [ 332 ].…”

Section: Lifestyle Factorsmentioning

confidence: 99%

Pancreatic Cancer (PDAC): Introduction of Evidence-Based Complementary Measures into Integrative Clinical Management

Jentzsch

Davis

Djamgoz

2020

Cancers

View full text Add to dashboard Cite

The most common form of pancreatic cancer is pancreatic ductal adenocarcinoma (PDAC), which comprises some 85% of all cases. Currently, this is the fourth highest cause of cancer mortality worldwide and its incidence is rising steeply. Commonly applied clinical therapies offer limited chance of a lasting cure and the five-year survival rate is one of the lowest of the commonly occurring cancers. This review cultivates the hypothesis that the best management of PDAC would be possible by integrating ‘western’ clinical medicine with evidence-based complementary measures. Protecting the liver, where PDAC frequently first spreads, is also given some consideration. Overall, the complementary measures are divided into three groups: dietary factors, nutraceutical agents and lifestyle. In turn, dietary factors are considered as general conditioners, multi-factorial foodstuffs and specific compounds. The general conditioners are alkalinity, low-glycemic index and low-cholesterol. The multi-factorial foodstuffs comprise red meat, fish, fruit/vegetables, dairy, honey and coffee. The available evidence for the beneficial effects of the specific dietary and nutraceutical agents was considered at four levels (in order of prominence): clinical trials, meta-analyses, in vivo tests and in vitro studies. Thus, 9 specific agents were identified (6 dietary and 3 nutraceutical) as acceptable for integration with gemcitabine chemotherapy, the first-line treatment for pancreatic cancer. The specific dietary agents were the following: Vitamins A, C, D and E, genistein and curcumin. As nutraceutical compounds, propolis, triptolide and cannabidiol were accepted. The 9 complementary agents were sub-grouped into two with reference to the main ‘hallmarks of cancer’. Lifestyle factors covered obesity, diabetes, smoking, alcohol and exercise. An integrative treatment regimen was devised for the management of PDAC patients. This involved combining first-line gemcitabine chemotherapy with the two sub-groups of complementary agents alternately in weekly cycles. The review concludes that integrated management currently offers the best patient outcome. Opportunities to be investigated in the future include emerging modalities, precision medicine, the nerve input to tumors and, importantly, clinical trials.

show abstract

“…The continual exposure of alcohol and steady foundation of inflammation leads to "burn out" of these pancreatic cells that ultimately harbors both exocrine and endocrine pancreatic insufficiency. Exocrine pancreatic insufficiency is characterized by malabsorptive diarrhea that also contributes to decreased vitamin intake (106). The progression of exocrine insufficiency is heightened with concomitant tobacco abuse, and thus, the first line in management is unsurprisingly cessation of alcohol and tobacco products (107).…”

Section: Chronic Pancreatitis and Pancreatic Insufficiencymentioning

confidence: 99%

Nonalcoholic fatty liver disease and alcoholic liver disease: metabolic diseases with systemic manifestations

Kovalic¹,

Cholankeril²

2019

Transl. Gastroenterol. Hepatol

View full text Add to dashboard Cite

The progression of liver disease is portrayed by several common, overarching signs and symptoms. Classically, these include findings such as spider angiomata, jaundice, palmar erythema, and as cirrhosis decompensates, ascites, variceal hemorrhage (VH), hepatic encephalopathy (HE), and hepatocellular carcinoma (HCC). Aside from these universal hallmarks among cirrhotics, patients with nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) harbor their own distinct systemic associations and manifestations. NAFLD is tightly linked to metabolic syndrome, which appears to be a driving force for a multitude of comorbidities, such as insulin resistance, cardiovascular disease, chronic kidney disease (CKD), obstructive sleep apnea (OSA), as well as increased malignancy risk. ALD also maintains a variety of comorbidities congruent with systemic effects of chronic alcohol use. These findings are highlighted by cardiovascular conditions, neuronal damage, myopathy, nutritional deficiencies, chronic pancreatitis, in addition to increased malignancy risk. While a general, guideline-driven management for all cirrhotic patients remains imperative for minimizing risk of complications, a tailored treatment strategy is useful for patients with NAFLD and ALD who entertain their own constellation of unique systemic manifestations.

show abstract

Alcohol-related chronic exocrine pancreatic insufficiency: diagnosis and therapeutic management. A proposal for treatment by the Italian Association for the Study of the Pancreas (AISP) and the Italian Society of Alcohology (SIA)

Cited by 12 publications

References 89 publications

Extrahepatic Manifestations in Alcoholic Liver Disease

Extrahepatic Manifestations in Alcoholic Liver Disease

Pancreatic Cancer (PDAC): Introduction of Evidence-Based Complementary Measures into Integrative Clinical Management

Nonalcoholic fatty liver disease and alcoholic liver disease: metabolic diseases with systemic manifestations

Contact Info

Product

Resources

About