Sarcopenia is closely associated with pancreatic exocrine insufficiency in patients with pancreatic disease

Shintakuya, Ryuta; Uemura, Kenichiro; Murakami, Yoshiaki; Kondo, Naru; Nakagawa, Noritoshi; Urabe, K; Okano, Keisuke; Awai, Kazuo; Higaki, Toru; Sueda, Taijiro

doi:10.1016/j.pan.2016.10.005

Cited by 82 publications

(66 citation statements)

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“…The consequences of exocrine insufficiency in patients with pancreatic cancer include acceleration of weight loss and sarcopenia, reduced ability to tolerate chemotherapy or surgery, and possibly increased mortality. Sarcopenia is closely associated with exocrine insufficiency in patients with pancreatic cancer, 19 and is a predictor of increased morbidity and mortality in patients with pancreatic cancer 20,21 . Pancreatic enzyme replacement therapy (PERT) may be an independent predictor of prolonged survival after pancreatic cancer surgery 22 …”

Section: Introductionmentioning

confidence: 99%

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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Background: Patients with chronic pancreatitis or pancreatic cancer commonly develop exocrine pancreatic insufficiency, and may not be adequately treated with pancreatic enzyme replacement therapy (PERT). Aims:To estimate the frequency of diagnostic testing for exocrine insufficiency, and appropriate use of PERT, in a commercially insured population in the US. Methods:We utilised a nationally representative administrative database representing 48.67 million individuals in over 80 US healthcare plans to assess testing for and treatment of exocrine insufficiency in patients who received a diagnosis of chronic pancreatitis (n = 37 061) or pancreatic cancer (n = 32 461) from 2001 to 2013. We identified the details of any testing for exocrine insufficiency and PERT use. We defined appropriate PERT use as a dosage of ≥120 000 USP units of lipase daily. Multiple logistic regression was used to identify predictors of appropriate use of PERT. Results:In patients with chronic pancreatitis, 6.5% had any testing for exocrine insufficiency, 30.4% filled a prescription for PERT, and 8.5% were prescribed an adequate dose. In those with pancreatic cancer, 1.9% had testing for exocrine insufficiency, 21.9% filled a prescription for PERT, and 5.5% were prescribed an adequate dose.Number of comorbidities, testing for exocrine insufficiency, pancreatic surgery and duration of enrolment were independent predictors for use and appropriate dosing. Conclusions:Testing for exocrine insufficiency, and appropriate dosing of PERT in patients with chronic pancreatitis or pancreatic cancer, is infrequent and inconsistent in an insured US population. Efforts are needed to educate medical providers on the best practices for managing exocrine pancreatic insufficiency in these patients. | 959FORSMARK et Al.

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Section: Introductionmentioning

confidence: 99%

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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“…44 In adults with pancreatic diseases, EPI is strongly associated (P < .001) with muscle wasting. 45 These consequences of EPI-related malnutrition can be further compounded if patients consciously choose to avoid certain foods, such as fatty items, that are likely to produce troublesome symptoms. 46 Exocrine pancreatic insufficiency is one of the factors that contributes to the malnutrition that is commonly present in patients (Table 3).…”

Section: Importance Of Diagnosing Exocrine Pancreatic Insufficiencymentioning

confidence: 99%

“…In children with CF, malabsorption of proteins and fat caused by untreated EPI is associated with poor growth . In adults with pancreatic diseases, EPI is strongly associated ( P < .001) with muscle wasting . These consequences of EPI‐related malnutrition can be further compounded if patients consciously choose to avoid certain foods, such as fatty items, that are likely to produce troublesome symptoms …”

Section: Introductionmentioning

confidence: 99%

Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician

2018

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SummaryAimsIn exocrine pancreatic insufficiency (EPI), the quantity and/or activity of pancreatic digestive enzymes are below the levels required for normal digestion, leading to maldigestion and malabsorption. Diagnosis of EPI is often challenging because the characteristic signs and symptoms overlap with those of other gastrointestinal conditions. Additionally, there is no single convenient, or specific diagnostic test for EPI. The aim of this review is to provide a framework for differential diagnosis of EPI vs other malabsorptive conditions.MethodsThis is a non‐systematic narrative review summarising information pertaining to the aetiology, diagnosis and management of EPI.ResultsExocrine pancreatic insufficiency may be caused by pancreatic disorders, including chronic pancreatitis, cystic fibrosis, pancreatic resection and pancreatic cancer. EPI may also result from extra‐pancreatic conditions, including coeliac disease, Zollinger‐Ellison syndrome and gastric surgery. Timely and accurate diagnosis of EPI is important, as delays in treatment prolong maldigestion and malabsorption, with potentially serious consequences for malnutrition, overall health and quality of life. Symptoms of EPI are non‐specific; therefore, a high index of clinical suspicion is required to make a correct diagnosis.

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“…After pancreatic surgery for cancer, the percentage of exocrine insufficiency increases toward 74–100% . Interestingly, exocrine insufficiency is associated with a low muscle mass, indicating that it contributes to muscle wasting in pancreatic cancer cachexia. Pancreatic exocrine insufficiency should therefore be identified pre‐ and postoperatively and adequately managed as soon as possible.…”

Section: Cancer Cachexiamentioning

confidence: 99%

ERAS: Improving outcome in the cachectic HPB patient

Dijk

Woerden

Cakir

et al. 2017

Journal of Surgical Oncology

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The enhanced recovery after surgery (ERAS) program has reduced postoperative morbidity and duration of hospital stay but not mortality in patients undergoing hepatopancreatobiliary (HPB) surgery. Many HPB patients suffer from cancer cachexia, a syndrome of severe weight and muscle loss. This may affect outcomes of HPB surgery even within an ERAS program. A tailored ERAS approach may be essential in further improving outcome in this vulnerable patient category.

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Sarcopenia is closely associated with pancreatic exocrine insufficiency in patients with pancreatic disease

Abstract: Sarcopenia is independently associated with PEI in patients with pancreatic disease.

Cited by 82 publications

References 29 publications

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician

ERAS: Improving outcome in the cachectic HPB patient

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