The Exocrine Pancreas and Protein-Calorie Malnutrition

Abstract

Pancreatic function tests, using a dual-tube technique and stimulating the pancreas with secretin and pancreozymin, were performed on patients with kwashiorkor (before and after treatment), marasmus, and chronic malnutrition as well as on a group of control children. The volume output from the pancreas, the pH of the juice and the enzymes amylase, lipase, trypsin, chymotrypsin, and ribonuclease were studied. The color index of the juice was also measured. The results demonstrated that the volume output and the ability to raise the pH of the pancreatic juice was not affected in the malnourished children. Patients with kwashiorkor and marasmus, however, had a grossly deficient enzyme output. There was complete and early restoration of pancreatic function after the initiation of dietary therapy in kwashiorkor and marasmus. The older chronically malnourished patients demonstrated a range of results varying from normal to abnormal. A significant positive correlation was demonstrated between enzyme output and the serum albumin concentration. There was no quantitative deficit in the output of bile among children with protein-calorie malnutrition.

Pancreatic Enzyme Replacement Therapy in Children with Severe Acute Malnutrition: A Randomized Controlled Trial

“…Previous studies have demonstrated the high prevalence of exocrine pancreatic insufficiency in children with severe acute malnutrition. [12][13][14][15][16][17][18][19][20][21][22][23][24] Sauniere et al 30 reported on the use of pancreatic enzymes in children with edematous severe acute malnutrition, but the study was small. Their placebo-controlled intervention consisted of giving porcine pancreatic powder 3 times daily for 5 days to 8 children in Ivory Coast and for 28 days to 8 Senegalese patients.…”

Association of postnatal severe acute malnutrition with pancreatic exocrine and endocrine function in children and adults: a systematic review

“…There were thirty-two cross-sectional studies, (18,22,24,27,29,32,(34)(35)(36)39,42,43,48,51,53,54,57,58,60,(66)(67)(68)71,72,(75)(76)(77)(78)(79)(81)(82)(83) , twenty-seven cohort studies, (17,(19)(20)(21)28,30,31,33,37,41,46,47,49,50,52,55,56,59,61,(63)(64)…”

“…Individual studies' quality scores are shown in Supplementary Data 3. Twelve studies had an overall quality rating considered to be high (16,59,(67)(68)(69)(72)(73)(74)(75)(76)78) , fifteen studies were rated as medium (39,44,45,55,58,62,65,66,70,71,77,79,80,82,83) , seventeen studies were rated as low (17,18,(23)(24)(25)27,29,30,35,40,43,46,52,53,57,60,81) and the remaining twenty-four as very low (19)(20)(21)(22)26,28,(31)(32)…”

“…Most papers addressing exocrine pancreas function were from hospital-based studies of acute malnutrition in young children, at admission, during treatment or at hospital discharge; two papers (24,28) also included some children longer after discharge (Table 1). Among the seven studies which measured duodenal enzymes, most both before and after pancreas stimulation (19,(22)(23)(24)(25)(26)28) , all but one (22) found decreases in several enzymes (amylase, lipase, trypsin, and chymotrypsin). Short-term nutritional therapy in hospital usually increased enzyme levels but not always to levels of well-nourished controls.…”

Assessment of exocrine pancreatic function in children and adolescents with direct and indirect testing

“…The Dreiling tube collection method is invasive, impractical, difficult for patients to complete, and radiation exposure associated with verification of tube positioning, and can be time consuming to perform. Protocols for specimen collection in the publications are variable and the duration of the tests vary from 45 min to 150 min ( 124 – 127 ). In children specifically, this method of collection has never gained favor.…”