Abstract
Pancreatic insufficiency (PI) may be an extraintestinal manifestation of inflammatory bowel diseases (IBD). We report the results of a cross-sectional study that was carried out to investigate both the prevalence of PI in IBD patients and its clinical course over a 6-month follow-up period. In total, 100 Crohn’s disease (CD) patients, 100 ulcerative colitis (UC) patients, and 100 controls were screened for PI by the fecal elastase-1 (FE-1) test. The decision limits employed were: ≤200 μg/g stool for PI and ≤100 μg/g for severe PI. Patients with abnormal FE-1 values were re-tested after 6 months. Odds ratios (OR) for PI were estimated by unconditional logistic regression analysis. PI was found in 22 UC and 14 CD patients. The OR for the FE-1 test ≤200 μg/g was 10.5 [95% confidence interval (CI): 2.5–44.8] for IBD patients compared to the controls. The risk of PI was related to three or more bowel movements per day (OR = 25.0), the passage of loose stools (OR = 7.7), and previous surgery (OR = 3.7). At the 6-month follow-up, FE-1 values became normal in 24 patients and showed persistently low concentrations in 12. These patients had a larger number of bowel movements per day (OR = 5.4), previous surgery (OR = 5.7), and a longer duration of the disease (OR = 4.2). PI is frequently found in IBD patients, particularly in those with loose stools, a larger number of bowel movements/day and previous surgery. PI is reversible in most patients, and persistent PI is not associated with clinically active disease.
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Herrlinger KR, Stange EF (2000) Pancreas in inflammatory bowel diseases. Int J Pancreatol 27:171–179
Seyrig JA, Jian R, Modigliani R, Golfain D, Florent C, Messing B, Bitoun A (1985) Idiopathic pancretitis associated with inflammatory bowel disease. Dig Dis Sci 30:1121–1126
Gurian LE, Keeffe EB (1982) Pancreatic insufficiency associated with ulcerative colitis and pericholangitis. Gastroenterology 82:581–585
Piontek M, Hengels KJ, Strohmeyer G (1990) Crohn’s disease: what about the pancreas? J Clin Gastroenterol 12:491–493
Angelini G, Cavallini G, Bovo P, Brocco G, Castagnini A, Lavarini E, Merigo F, Tallon N, Scuro LA (1988) Pancreatic function in chronic inflammatory bowel disease. Int J Pancreatol 3:185–193
Heikius B, Niemela S, Lehtola J, Karttunen T, Lahde S (1996) Pancreatic duct abnormalities and pancreatic function in patients with chronic inflammatory bowel disease. Scand J Gastroenterol 31:517–532
Goldberg DM (2000) Proteases in the evaluation of pancreatic function and pancreatic disease. Clin Chim Acta 291:201–221
Dominici R, Franzini C (2002) Faecal elastase-1 as a test for pancreatic function: a review. Clin Chem Lab Med 40:325–332
Panteghini M, Bais R, van Solinge WW (2006) Elastase-1. In: Burtis CA, Ashwood ER, Bruns DE (eds) Tietz textbook of clinical chemistry and molecular diagnostics. Elsevier Saunders, St. Louis, pp 623–627
Lőser C, Mőllgaard A, Főlsch UR (1996) Faecal elastase 1: a novel, highly sensitive, and specific tubeless pancreatic function test. Gut 39:580–586
Siegmund E, Lohr JM, Schuff-Werner P (2004) The diagnostic validity of non-invasive pancreatic function tests – a meta-analysis. Z Gastroenterol 42:1117–1128
Best WR, Becktel JM, Singelton JW, Kern F Jr (1976) Development of a Crohn’s disease activity index. Gastroenterology 79:439–444
Truelove SC, Witts LJ (1955) Cortisone in ulcerative colitis: final report on a therapeutic trial. Br Med J 2:1041–1048
Lüth S, Teyssen S, Forssmann K, Kölbel C, Krummenauer F, Singer MV (2001) Fecal elastase-1 determination: ‘Gold Standard’ of indirect pancreatic function tests? Scand J Gastroenterol 36:1092–1099
Barthet M, Hastier P, Bernard JP, Bordes G, Frederick J, Allio S, Mambrini P, Saint-Paul MC, Delmont JP, Salducci J, Grimaud JC, Sahel J (1999) Chronic pancreatitis and inflammatory bowel disease: true or coincidental association? Am J Gastroenterol 94:2141–2148
Hegnhoj J, Hansen CP, Rannem T, Sobirk H, Andersen LB, Andersen JR (1990) Pancreatic function in Crohn’s disease. Gut 31:1076–1079
Brydon WG, Kingstone K, Ghosh S (2004) Limitations of faecal elastase-1 and chymotrypsin as tests of exocrine pancreatic disease in adults. Ann Clin Biochem 41:78–81
Masoero G, Zaffino C, Laudi C, Lombardo L, Rocca R, Gallo L, Della Monica P, Pera A (2000) Fecal pancreatic elastase 1 in the work up of patients with chronic diarrhea. Int J Pancreatol 28:175–179
Adler G, Schmid RM (1997) Chronic pancreatitis: still puzzling? Gastroenterology 112:1762–1765
Ball WP, Baggenstoss AH, Bargen JA (1950) Pancreatic lesions associated with chronic ulcerative colitis. Arch Pathol 50:345–358
Chapin LE, Scudamore HH, Baggenstoss AH, Bargen JA (1956) Regional enteritis associated visceral changes. Gastroenterology 30:404–415
Ketikoglou I, Moulakakis A (2005) Autoimmune pancreatitis. Digest Liver Dis 37:211–215
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Maconi, G., Dominici, R., Molteni, M. et al. Prevalence of Pancreatic Insufficiency in Inflammatory Bowel Diseases. Assessment by Fecal Elastase-1. Dig Dis Sci 53, 262–270 (2008). https://doi.org/10.1007/s10620-007-9852-y
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DOI: https://doi.org/10.1007/s10620-007-9852-y