review of literature on clinical pancreatology - The Pancreapedia

patients with a proven exocrine pancreatic insufficiency [290].Function in diabetes mellitusRecently it has been shown that there is not only endocrine insufficiency in diabetic patients,but a frequent co-morbidity <strong>of</strong> both, the endocrine and exocrine pancreas. The records <strong>of</strong>1992 patients with diabetes mellitus who had been treated in one hospital during a 2-yearperiod were re-evaluated. Defined parameters were documented in standardized datasheets. Records were further checked for the results <strong>of</strong> imaging procedures <strong>of</strong> the pancreas.In 307 patients fecal elastase-1 concentrations had been performed and documented. Onlythese patients were included in further evaluation. Fecal elastase-1 concentrations wereinversely correlated with diabetes duration and HbA1c-levels but not with age. C-peptidelevels correlated positively with fecal elastase-1 concentrations. BMI and fecal elastase-1concentrations were also significantly correlated. There was no correlation between diabetestherapy and exocrine pancreatic function as there was no correlation with any concomitantmedication. The presence <strong>of</strong> diabetes-associated antibodies was not related to fecalelastase-1 concentrations. According to the documented data 38 were classified as type-1diabetes (12 %), 167 as type-2 (54 %), and 88 patients met the diagnostic criteria <strong>of</strong> type-3(29 %). Fourteen patients could not be classified because <strong>of</strong> lacking information (5 %). Theauthors concluded that exocrine insufficiency might be explained as a complication <strong>of</strong>diabetes mellitus. However, it is more likely that type-3 diabetes is much more frequent thanpreviously believed. Consequently the evaluation <strong>of</strong> exocrine function and morphologyshould be included into the clinical workup <strong>of</strong> any diabetic patient at least at the time <strong>of</strong>manifestation [291].Pancreas divisumTo assess the long-term outcomes <strong>of</strong> endoscopic minor papilla therapy in a spectrum <strong>of</strong>symptomatic patients with pancreas divisum. Patients with pancreas divisum coded in aprospective database as having had minor papilla endotherapy (1997- 2003, n=145) weregrouped into 3 categories: (1) acute recurrent pancreatitis, (2) chronic pancreatitis, and (3)chronic/recurrent epigastric pain. Telephone follow-up was conducted (78 % <strong>of</strong> patients),including quesions regarding interval co-interventions and narcotic use. Primary success wasdefined as clinical improvement (better or cured on a Likert scale), without needing narcotics,after one therapeutic endoscopic retrograde cholangiopancreatography. Primary successrates in acute recurrent pancreatitis, chronic pancreatitis, and chronic/recurrent epigastricpain were achieved in 53 percentage, 18 percent, and 41 percent, respectively; andsecondary success rates (< 2 additional endoscopic retrograde cholangiopancreatographies),71 percent, 46 percent, and 55 percent, respectively (median follow-up, 43months; range, 14-116 months). Younger age (median age, 47 years [no success] vs 58years [success]) and chronic pancreatitis (odds ratio, 0.10; 95 % confidence interval 0.03 to0.39) independently predicted a lower chance <strong>of</strong> success. It was concluded that significantlong-term improvement can be achieved with endoscopic therapy in selected patients withpancreas divisum, although many require multiple procedures. Older patients, withoutchronic pancreatitis, were most likely to respond [292].Pancreatic stellate cellsPancreatitis and pancreatic cancer represent two major diseases <strong>of</strong> the exocrine pancreas.Pancreatitis exhibits both acute and chronic manifestations. The commonest causes <strong>of</strong> acutepancreatitis are gallstones and alcohol abuse; the latter is also the predominant cause <strong>of</strong>chronic pancreatitis. Recent evidence indicates that endotoxinemia, which occurs in