Combination of high‐density cholesterol level, elastic score, and severity of exocrine pancreatic dysfunction may be useful for a predictive factor for patients with early chronic pancreatitis

Abstract

Background: This study aimed to clarify whether any risk factors including clinical characteristics, endosonographic features, and exocrine pancreatic dysfunction may be useful for a predictive factor for patients with early chronic pancreatitis. Methods: A total of 163 consecutive patients that presented with functional dyspepsia with pancreatic enzyme abnormalities (FD-P) (n = 46), early chronic pancreatitis (ECP) (n = 47), and asymptomatic patients with pancreatic enzyme abnormalities (AP-P) (n = 70) based on the Rome III classification and the Japan Pancreatic Association were included in this study. The enrolled patients were evaluated using endosonography (EUS) and EUS elastography. The levels of the five pancreatic enzymes were measured. Pancreatic exocrine function was analyzed using N-benzoyl-l-tyrosyl-p-aminobenzoic acid (BT-PABA). Results: There were no significant differences in clinical characteristics such as age, gender, body mass index, alcohol consumption, and smoking among patients with AP-P, FD-P, and ECP. The ratio of BT-PABA test less than 35% in patients with ECP was significantly (P = 0.043) higher than in AP-P patients. Elastic score was a useful tool to differentiate the FD-P group from the ECP group. The high-density cholesterol levels in patients with ECP were significantly lower than those in AP-P. In addition, the combination of total and high-density cholesterol levels, BT-PABA test, and elastic score has a higher area under the curve value (0.708) of patients with ECP than in the other groups. Conclusions: The combination of high-density cholesterol levels, elastic score, and severity of exocrine pancreatic dysfunction may be useful for a predictive factor for patients with ECP.

Apolipoprotein A2 isoforms associated with exocrine pancreatic insufficiency in early chronic pancreatitis

“…In our data, asymptomatic patients with pancreatic enzyme abnormalities (AP‐P), functional dyspepsia with pancreatic enzyme abnormalities (FD‐P), and early chronic pancreatitis (ECP) exhibited mild to moderate exocrine pancreatic dysfunction, whereas some of these patients exhibited severe exocrine pancreatic dysfunction 11,12 . Although the evaluation of exocrine pancreatic dysfunction and the diagnosis of EPI in the early stage of chronic pancreatitis are very critical and several diagnostic tests for EPI are available, there are some limitations in diagnosing exocrine pancreatic dysfunction 13–15 .…”

“…[32][33][34] Although estimating exocrine pancreatic dysfunction is critical to prevent ECP from progressing into advanced chronic pancreatitis, accurate evaluation of exocrine pancreatic dysfunction and EPI in the early stages may be difficult. 35 Considering that we have determined severe exocrine pancreatic dysfunction in patients with AP-P, FD-P, and ECP, 11,12 evaluating exocrine pancreatic dysfunction using a more convenient examination may be critical in preventing ECP progression. EPI is most commonly caused by diseases that injure the pancreatic parenchyma, such as chronic pancreatitis and cystic fibrosis, as well as pancreatic resection.…”

“…To indirectly measure the actual exocrine pancreatic dysfunction, EPI has been measured using fecal elastase, 13,40 C-mixed triglyceride breath test, 41 and PFD test. 11,12 There are several diagnostic instructions for EPI, but all available examinations have limitations. [13][14][15] Several extrapancreatic factors such as slow gastric emptying rate, impairment of intestinal absorption, and renal insufficiency are known to limit the accuracy of oral pancreatic function tests.…”

“…In our data, asymptomatic patients with pancreatic enzyme abnormalities (AP-P), functional dyspepsia with pancreatic enzyme abnormalities (FD-P), and early chronic pancreatitis (ECP) exhibited mild to moderate exocrine pancreatic dysfunction, whereas some of these patients exhibited severe exocrine pancreatic dysfunction. 11,12 Although the evaluation of exocrine pancreatic dysfunction and the diagnosis of EPI in the early stage of chronic pancreatitis are very critical and several diagnostic tests for EPI are available, there are some limitations in diagnosing exocrine pancreatic dysfunction. [13][14][15] Considering previous reports on the relationship between pancreatic morphology and exocrine pancreatic dysfunction, 16,17 Hayasaki et al demonstrated the clinical significance of apoA2 isoforms, AT, and ATQ levels in patients with pancreatic cancer by comparing them with alternations of pancreatic morphology such as the diameter of the main pancreatic duct or pancreatic parenchymal volume as a marker of pancreatic exocrine dysfunction.…”

“…[13][14][15] Considering previous reports on the relationship between pancreatic morphology and exocrine pancreatic dysfunction, 16,17 Hayasaki et al demonstrated the clinical significance of apoA2 isoforms, AT, and ATQ levels in patients with pancreatic cancer by comparing them with alternations of pancreatic morphology such as the diameter of the main pancreatic duct or pancreatic parenchymal volume as a marker of pancreatic exocrine dysfunction. 18 Because we have reported that the ratio of EPI in patients with ECP was higher than those in patients with FD-P and AP-P, 12 we would like to try to compare the N-benzoyl-paminobenzoic acid (BT-PABA) test with apoA2 isoforms, apoA2-AT, and apoA2-ATQ levels as new biomarkers for the evaluation of exocrine pancreatic dysfunction among patients with ECP, FD-P, and AP-P.…”