Diagnosis of Exocrine Pancreatic Insufficiency

Hart, Phil A.; Conwell, Darwin L.

doi:10.1007/s11938-015-0057-8

Cited by 38 publications

(54 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These results are contradictory to old dogmas which emphasize the need of standardized fat intake before quantification of fecal fat[23]. As Hart and Conwell discuss, non-standardized fat intake is not a major problem in fecal fat quantification and it is not necessary to admit patients to hospital for performance of the test[5]. Moreover, our results indicate that documentation of nutrients and calculation of coefficient of fat absorption may be dispensable.…”

Section: Discussioncontrasting

confidence: 79%

See 1 more Smart Citation

Fecal Fat Analyses in Chronic Pancreatitis Importance of Fat Ingestion before Stool Collection

Erchinger

Engjom

Jurmy³

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

ObjectiveQuantitative determination of fecal fat still is the gold standard for measuring malabsorption. We evaluated the importance of standardized food intake before and under the collection of feces.Material and MethodsIn a project, evaluating patients with suspected chronic pancreatitis (CP) and healthy volunteers (HC), stools were collected for 72 hours coupled to registration of nutritional intake over five consecutive days. Patient groups were created by a modified Layer score, which includes imaging findings, clinical parameters and pancreas function testing.ResultsWe found 12 patients with CP, 11 patients without CP and 13 healthy individuals in our database. Median fecal fat in CP patients was 12 g/day, in non-CP patients 5 g/day and in healthy controls 5 g/day. Median fat absorption coefficient was 81% in those with chronic pancreatitis, 92% in those without CP and 92% in healthy controls. Corresponding median fat intake was 65 g/day, 68 g/day and 81 g/day in the respective groups. Spearman Rank Order Correlation between fecal fat (g/d) and fat absorption coefficient in all study subjects (n = 36) was good (-0.88 (p<0.001)). When we stratified groups according to fat intake, correlation between fecal fat and fat absorption was also good (-0.86 to -0.95).ConclusionIn the diagnoses of fat malabsorption, calculating the ratio of fat absorption did not give additional information compared to fecal fat.

show abstract

Section: Discussioncontrasting

confidence: 79%

“…In many cases, patient adherence to a standardized five days’ diet containing 100 g/d fat is poor. Stool collection according to protocol requires highly motivated patients [5,8]. In some specialized centers, admission of patients over five days is part of the procedure to guarantee that performance is correct.…”

Section: Introductionmentioning

confidence: 99%

Fecal Fat Analyses in Chronic Pancreatitis Importance of Fat Ingestion before Stool Collection

Erchinger

Engjom

Jurmy³

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…There are multiple challenges with the current diagnostic approach of EPI, including the lack of an accurate, non-invasive test to diagnose EPI in general. 8 Nevertheless, estimates of the prevalence of EPI based on fecal elastase-1 levels in PDAC is approximately 60–80%. 9 Despite the high prevalence of EPI in this disease group, there have been no studies to demonstrate the efficacy of PERT in PDAC, with the exception of patients who have previously undergone surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Pancreatic Cancer–Associated Weight Loss and Nutritional Interventions

et al. 2017

Self Cite

View full text Add to dashboard Cite

Objectives Pancreatic ductal adenocarcinoma (PDAC) is often accompanied by weight loss. We sought to characterize factors associated with weight loss and observed nutritional interventions, as well as define the effect of weight loss on survival. Methods Consecutive subjects diagnosed with PDAC (n = 123) were retrospectively evaluated. Univariate analysis was used to compare subjects with and without substantial (>5%) weight loss. Multivariate logistic regression was performed to identify factors associated with weight loss, and survival analyses were performed Kaplan-Meier curves and Cox survival models. Results Substantial weight loss at diagnosis was present in 71.5% of subjects, and was independently associated with higher baseline body mass index, longer symptom duration, and increased tumor size. Recommendations for nutrition consultation and pancreatic enzyme replacement therapy occurred in 27.6% and 36.9% of subjects, respectively. Weight loss (>5%) was not associated with worse survival on multivariate analysis (hazard ratio (HR) 1.32, 95% CI, 0.76–2.30), unless a higher threshold (>10%) was used (HR 1.77, 95% CI, 1.09–2.87). Conclusions Despite the high prevalence of weight loss at PDAC diagnosis, there are low observed rates of nutritional interventions. Weight loss based on current criteria for cancer cachexia is not associated with poor survival in PDAC.

show abstract

“…Pancreatic Function Tests (PFTs) are typically classified as indirect (noninvasive) or direct (invasive) 32 . Indirect PFTs refer to the evaluation of pancreatic exocrine function without direct hormonal stimulation of the gland.…”

Section: Imaging For Chronic Pancreatitismentioning

confidence: 99%

“…Although CP may potentially develop in any location, this commonly occurs in the pancreatic head. The term groove pancreatitis describes the anatomic variant of CP that characteristically involves the pancreatic head, duodenum, and pancreatioduodenal groove 32 . Focal CP allows for parenchymal sparing which can also be confused with PDAC or other causes of a pancreatic mass 33 .…”

Section: Imaging For Chronic Pancreatitismentioning

confidence: 99%