State of anxiety may be associated with exocrine pancreatic insufficiency in functional dyspepsia patients with pancreatic enzyme abnormalities

Abstract

We have reported that refractory functional dyspepsia patients with pancreatic enzyme abnormalities (FD-P). We tried to analyze the prevalence of exocrine pancreatic insufficiency (EPI) in FD-P patients to clarify whether the pathophysiology of FD patients including clinical symptoms and quality of life were associated with EPI. We enrolled forty-nine patients presenting with typical symptoms of FD-P patients (n = 20) and asymptomatic patients with pancreatic enzyme abnormalities (AP-P) (n = 29). Five pancreatic enzymes (p-amylase, lipase, elastase-1, trypsin, and PLA2) were measured and STAI-state/-trait and SF-8 were evaluated. Pancreatic exocrine function was analyzed using Nbenzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA). There were no significant differences in patient background between FD-P and AP-P patients. BT-PABA test scores for FD-P patients (61.67 ± 5.55) were significantly (p = 0.01) lower than in AP-P patients (95.38 ± 2.36). Physical component scale (PCS) in FD-P patients was significantly (p = 0.002) lower than that in AP-P patients. STAIstate was relatively (p = 0.054) associated with BT-PABA test in FD-P and AP-P patients by multiple logistic regression analysis. The prevalence of EPI in FD-P patients was significantly higher than that in AP-P patients and was relatively associated with state of anxiety. Further studies will be needed to clarify how EPI or pancreatic enzyme abnormalities are associated with the pathophysiology of FD-P patients.

Trypsin may be associated with duodenal eosinophils through the expression of PAR2 in early chronic pancreatitis and functional dyspepsia with pancreatic enzyme abnormalities

“…Diagnosis of FD-P patients based on no abnormal findings on upper GI endoscopy, abdominal US, and CT scan could not be completely excluded ECP patients without endosonography. In addition, in our data, exocrine pancreatic dysfunction in patients with FD-P was widely observed as well as previous study [ 33 , 34 ]. Exocrine pancreatic function is regulated by gut hormones such as CCK and 5-HT [ 35 , 36 ] and is associated with gastric emptying [ 37 , 38 ].…”

“…our data, exocrine pancreatic dysfunction in patients with FD-P was widely observed as well as previous study [33,34]. Exocrine pancreatic function is regulated by gut hormones such as CCK and 5-HT [35,36] and is associated with gastric emptying [37,38].…”

Comparison of clinical characteristics, eating behaviors, and clinical symptoms following fat intake in functional dyspepsia with functional dyspepsia with pancreatic enzyme abnormalities between Singapore and Japan

“…In this study, patients with FD‐P also significantly exhibited epigastric pain and early satiety following fat intake compared with patients with FD. Considering that patients with FD‐P exhibit almost 60% of exocrine pancreatic dysfunction, 21 fat intake‐related gut hormones such as CCK and GLP‐1 may aggravate clinical symptoms such as epigastric pain and early satiety following high‐fat meals in Japanese patients with FD‐P. In contrast, in Singaporean populations, patients with FD‐P also exhibit epigastric pain and early satiety following high‐fat meals, albeit insignificantly.…”

“…We reported that physical quality of life in patients with FD‐P was significantly different from that in patients with FD in Japan. Our previous study reported that exocrine pancreatic function in patients with FD‐P was significantly impaired compared with the asymptomatic patients with pancreatic enzyme abnormalities 21 . Because exocrine pancreatic insufficiency is regulated by factors such as CCK, GLP‐1, 5‐HT, as well as the vasovagal pathway system, 24–26 physical quality of life in patients with FD‐P may be easily impaired by external stress through the disturbed vasovagal pathway.…”

“…Our previous study reported that exocrine pancreatic function in patients with FD-P was significantly impaired compared with the asymptomatic patients with pancreatic enzyme abnormalities. 21 Because exocrine pancreatic insufficiency is regulated by factors such as CCK, GLP-1, 5-HT, as well as the vasovagal pathway system, [24][25][26] physical quality of life in patients with FD-P may be easily impaired by external stress through the disturbed vasovagal pathway. Further studies will be needed to clarify the differences of clinical responses to fat intakes and of eating behaviors in Singapore and Japan in more many numbers of subjects.…”