Database : MEDLINE
Search on : Steatorrhea [Words]
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[PMID]: 29248457
[Au] Autor:Zolghadri Y; Pal Choudhuri S; Ocal O; Layeghi-Ghalehsoukhteh S; Berhe F; Hale MA; Wilkie TM
[Ad] Address:Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Basic Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
[Ti] Title:Malnutrition in Pancreatic Ductal Adenocarcinoma (PDA): Dietary Pancreatic Enzymes Improve Short-Term Health but Stimulate Tumor Growth.
[So] Source:Am J Pathol;188(3):616-626, 2018 Mar.
[Is] ISSN:1525-2191
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Pancreatic ductal adenocarcinoma (PDA) is a deadly cancer that resists efforts to identify better chemotherapeutics. PDA is associated with chronic pancreatitis and acinar cell dedifferentiation. This reduces enzyme production by the exocrine pancreas, resulting in digestive insufficiencies. Malabsorption of partially digested food causes bloating, overfilled intestines, abdominal pain, excessive feces, steatorrhea, and malnutrition. These maladies affect quality of life and restrict treatment options for pancreatitis and PDA. Here, we characterize health benefits and risks of dietary pancreatic enzymes in three mouse models of PDA-KC, KCR8-16, and KIC. KC expresses oncogenic Kras in pancreatic tissue whereas KCR8-16 also has deletions of the Rgs8 and Rgs16 genes. Rgs proteins inhibit the release of digestive enzymes evoked by G-protein-coupled-receptor agonists. KC and KCR8-16 mice developed dedifferentiated exocrine pancreata within 2 months of age and became malnourished, underweight, hypoglycemic, and hypothermic. KC mice adapted but KCR8-16 mice rapidly transitioned to starvation after mild metabolic challenges. Dietary pancreatic enzyme supplements reversed these symptoms in KC and KCR8-16 animals, and extended survival. Therefore, we tested the benefits of pancreatic enzymes in an aggressive mouse model of PDA (KIC). Median survival improved with dietary pancreatic enzyme supplements and was extended further when combined with warfarin and gemcitabine chemotherapy. However, dietary pancreatic enzymes stimulated tumor growth in the terminal stages of disease progression in KIC mice.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review

  2 / 1343 MEDLINE  
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[PMID]: 29521945
[Au] Autor:Witvliet-van Nierop JE; Wierdsma NJ; Ottens-Oussoren K; Meijerink MR; Bouma G; Kazemier G; de van der Schueren MAE
[Ad] Address:Department of Nutrition and Dietetics Internal Medicine VU University Medical Center Amsterdam, the Netherlands j.witvliet@vumc.nl Department of Nutrition and Dietetics Internal Medicine VU University Medical Center Amsterdam, the Netherlands Department of Gastroenterology VU University Medical Center Amsterdam, the Netherlands Department of Nutrition and Dietetics Internal Medicine VU University Medical Center Amsterdam, the Netherlands Department of Radiology and Nuclear Medicine VU University Medical Center Amsterdam, the Netherlands Department of Gastroenterology VU University Medical Center Amsterdam, the Netherlands Department of Surgery VU University Medical Center Amsterdam, the Netherlands Department of Nutrition and Dietetics Internal Medicine VU University Medical Center Amsterdam, the Netherlands.
[Ti] Title:Fecal Elastase Fails to Detect Steatorrhea in Patients With Locally Advanced Pancreatic Cancer.
[So] Source:Pancreas;47(4):e15-e16, 2018 Apr.
[Is] ISSN:1536-4828
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review
[do] DOI:10.1097/MPA.0000000000001020

  3 / 1343 MEDLINE  
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[PMID]: 29420554
[Au] Autor:Wang Y; Liu Z; Han Y; Xu J; Huang W; Li Z
[Ad] Address:Changhai Hospital,Second Military Medical University, Yangpu District, Shanghai, China.
[Ti] Title:Medium Chain Triglycerides enhances exercise endurance through the increased mitochondrial biogenesis and metabolism.
[So] Source:PLoS One;13(2):e0191182, 2018.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Medium Chain Triglycerides (MCT) is a dietary supplement and usually used along with medications for treating food absorption disorders including diarrhea, steatorrhea and liver disease. It has been shown that MCT plays a role in lowering weight, and decreasing metabolic syndrome, abdominal obesity and inflammation. However, it is still unknown whether MCT enhances exercise endurance. Here, we demonstrated that MCT containing diet improves high temperature induced exercise performance impairment. We found that MCT up-regulates the expression and protein levels of genes involved in mitochondrial biogenesis and metabolism. Further investigation demonstrated that the increased mitochondrial biogenesis and metabolism is mediated through the activation of Akt and AMPK signaling pathways and inhibition of TGF-ß signaling pathway. Collectively, our findings indicate a beneficial effect of dietary MCT in exercise performance through the increase of mitochondrial biogenesis and metabolism.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[St] Status:In-Process
[do] DOI:10.1371/journal.pone.0191182

  4 / 1343 MEDLINE  
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[PMID]: 29374614
[Au] Autor:Vanga RR; Tansel A; Sidiq S; El-Serag HB; Othman M
[Ad] Address:Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX. Electronic address: rohini.vanga@gmail.com.
[Ti] Title:Diagnostic Performance of Measurement of Fecal Elastase-1 in Detection of Exocrine Pancreatic Insufficiency - Systematic Review and Meta-analysis.
[So] Source:Clin Gastroenterol Hepatol;, 2018 Jan 25.
[Is] ISSN:1542-7714
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND & AIMS: Tests to quantify fecal levels of chymotrypsin like elastase family member 3 (CELA3 or elastase-1) in feces are widely used to identify patients with exocrine pancreatic insufficiency (EPI). However, the diagnostic accuracy of this test, an ELISA, is not clear. We performed a systematic review and meta-analysis to determine the accuracy of measurement of fecal elastase-1 in detection of EPI. METHODS: We searched PubMed, Embase, and reference lists for articles through November 2016 describing studies that compared fecal level of elastase-1 with results from a reference standard, direct method (secretin stimulation test), or indirect method (measurement of fecal fat) for detection of EPI. Sensitivity and specificity values were pooled statistically using bivariate diagnostic meta-analysis. RESULTS: We included total of 428 cases of EPI and 673 individuals without EPI (controls), from 14 studies, in the meta-analysis. The assay for elastase-1, compared to secretin stimulation test, identified patients with pancreatic insufficiency with a pooled sensitivity value of 0.77 (95% CI, 0.58-0.89) and specificity value of 0.88 (95% CI, 0.78-0.93). In an analysis of 345 cases of EPI and 312 controls, from 6 studies, the fecal elastase-1 assay identified patients with EPI with a pooled sensitivity value of 0.96 (95% CI, 0.79-0.99) and specificity value of 0.88 (95% CI, 0.59-0.97), compared to quantitative fecal fat estimation. In patients with low pre-test probability of EPI (5%), the fecal elastase-1 assay would have a false-negative rate of 1.1% and a false-positive rate of 11%, indicating a high yield in ruling out EPI but not in detection of EPI. In contrast, in patients with high pre-test probability of EPI (40%), approximately 10% of patients with EPI would be missed (false negatives). CONCLUSION: In a systematic review and meta-analysis of studies that compared fecal level of elastase-1 for detection of EPI, we found that normal level of elastase-1 (above 200 mcg/g) can rule out EPI in patients with a low probability of this disorder (such as those with irritable bowel syndrome with diarrhea). However, in these patients, an abnormal level of elastase-1 (below 200 mcg/g) has a high false-positive rate.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1801
[Cu] Class update date: 180213
[Lr] Last revision date:180213
[St] Status:Publisher

  5 / 1343 MEDLINE  
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[PMID]: 29275422
[Au] Autor:Lv A; Qian HG; Qiu H; Wu JH; Hao CY
[Ti] Title:Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience.
[So] Source:Dig Surg;, 2017 Dec 22.
[Is] ISSN:1421-9883
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:AIMS: To compare the short- and long-term outcomes in patients with pancreatic benign or borderline neoplasm who underwent central pancreatectomy (CP) and distal pancreatectomy (DP). METHODS: The inclusion criteria were as follows: (1) single benign or low-grade malignant tumor; (2) tumor confined to the pancreatic neck or proximal body; and (3) tumor amenable to either CP or DP. Short and long-term outcomes, including complications, pancreatic exocrine and endocrine function, and quality of life (QoL) were analyzed retrospectively. RESULTS: Sixteen patients who underwent CP and 26 patients who underwent DP were included. The median follow-up period was 53 months (range 21-117 months). Patients undergoing CP were significantly more likely to experience complications (68.7 vs. 23%, p = 0.003) especially grade B/C postoperative pancreatic fistula (62.5 vs. 23%, p = 0.011) than those undergoing DP. During the long-term follow-up, 2 patients in the DP group developed new-onset diabetes mellitus, but no patient in CP group developed this condition (8 vs. 0%, p = 0.382). Evidence of exocrine insufficiency, including severe diarrhea or steatorrhea, was not observed in either group. Both groups were equally satisfied with the overall health status and overall QoL. CONCLUSION: CP is associated with excellent pancreatic function but a significantly increased postoperative morbidity and risk compared to DP. Therefore, the indication of CP should be chosen strictly.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171224
[Lr] Last revision date:171224
[St] Status:Publisher
[do] DOI:10.1159/000485806

  6 / 1343 MEDLINE  
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[PMID]: 29137169
[Au] Autor:Vujasinovic M; Valente R; Thorell A; Rutkowski W; Haas SL; Arnelo U; Martin L; Löhr JM
[Ad] Address:Center for Digestive Diseases, Karolinska University Hospital, SE-141 86 Stockholm, Sweden. miroslav.vujasinovic@sll.se.
[Ti] Title:Pancreatic Exocrine Insufficiency after Bariatric Surgery.
[So] Source:Nutrients;9(11), 2017 Nov 13.
[Is] ISSN:2072-6643
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:Morbid obesity is a lifelong disease, and all patients require complementary follow-up including nutritional surveillance by a multidisciplinary team after bariatric procedures. Pancreatic exocrine insufficiency (PEI) refers to an insufficient secretion of pancreatic enzymes and/or sodium bicarbonate. PEI is a known multifactorial complication after upper gastrointestinal surgery, and might constitute an important clinical problem due to the large number of bariatric surgical procedures in the world. Symptoms of PEI often overlap with sequelae of gastric bypass, making the diagnosis difficult. Steatorrhea, weight loss, maldigestion and malabsorption are pathognomonic for both clinical conditions. Altered anatomy after bypass surgery can make the diagnostic process even more difficult. Fecal elastase-1 (FE1) is a useful diagnostic test. PEI should be considered in all patients after bariatric surgery with prolonged gastrointestinal complaints that are suggestive of maldigestion and/or malabsorption. Appropriate pancreatic enzyme replacement therapy should be part of the treatment algorithm in patients with confirmed PEI or symptoms suggestive of this complication.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1711
[Cu] Class update date: 171115
[Lr] Last revision date:171115
[St] Status:In-Process

  7 / 1343 MEDLINE  
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[PMID]: 29085272
[Au] Autor:Kumar R; Bhargava A; Jaiswal G
[Ad] Address:Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Geetanjali University, Udaipur, India.
[Ti] Title:A case report on total pancreatic lipomatosis: An unusual entity.
[So] Source:Int J Health Sci (Qassim);11(4):71-73, 2017 Sep-Oct.
[Is] ISSN:1658-3639
[Cp] Country of publication:Saudi Arabia
[La] Language:eng
[Ab] Abstract:Total pancreatic lipomatosis (PL) is an unusual entity of pathologic significance and speculative origin. It refers to complete replacement of pancreatic parenchyma by fat cells. Fat replacement may vary from mild fatty infiltration to massive replacement of the pancreas by adipose tissue, resulting in malabsorption syndrome due to pancreatic insufficiency. We present a case of a 60-year-old elderly woman with atypical abdominal complaints, diabetes mellitus, weight loss, and steatorrhea. Abdominal computed tomograms were diagnostic of PL. Magnetic resonance imaging verified this impression. The patient improved clinically after the 8-week trial of high-dose oral pancreatic enzyme replacement therapy. There is a marked reduction of steatorrhea and weight gain. This case report focuses on pathophysiology, diagnosis, and treatment guidelines of PL.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[St] Status:PubMed-not-MEDLINE

  8 / 1343 MEDLINE  
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[PMID]: 29020456
[Au] Autor:Gallo M; Muscogiuri G; Pizza G; Ruggeri RM; Barrea L; Faggiano A; Colao A; NIKE Group
[Ad] Address:a Oncological Endocrinology Unit, Department of Medical Sciences , University of Turin, AOU Città della Salute e della Scienza di Torino , Turin , Italy.
[Ti] Title:The management of neuroendocrine tumors: a nutritional viewpoint.
[So] Source:Crit Rev Food Sci Nutr;:0, 2017 Oct 11.
[Is] ISSN:1549-7852
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Nutritional status in patients with neuroendocrine tumours (NETs), especially of gastroenteropancreatic origin, can be deeply affected by excessive production of gastrointestinal hormones, peptides, and amines, which can lead to malabsorption, diarrhoea, steatorrhea, and altered gastrointestinal motility. Besides, the surgical and/or medical management of NETs can lead to alteration of gastrointestinal secretory, motor, and absorptive functions, with both dietary and nutritional consequences. Indeed, disease-related malnutrition is a frequently encountered yet both underrecognized and understudied clinical phenomenon in patients with NETs, with substantial prognostic and socioeconomic consequences. Most of these conditions can be alleviated by a tailored nutritional approach, also with the aim of improving the efficacy of cancer treatments. In this setting, skilled nutritionists can play a fundamental role in the multidisciplinary health care team in NETs management and their presence should be recommended. The aim of this review is to provide dietary advices for each specific condition in patients with NETs, underlining the importance of a nutritional approach to treat malnutrition in this setting. Further, we will provide preliminary evidence coming from our data on the assessment of nutritional status in a single cohort of patients with NETs.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171011
[Lr] Last revision date:171011
[St] Status:Publisher
[do] DOI:10.1080/10408398.2017.1390729

  9 / 1343 MEDLINE  
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[PMID]: 28992886
[Au] Autor:El Nakeeb A; Sultan AM; Atef E; Salem A; Abu Zeid M; Abu El Eneen A; El Ebidy G; Abdel Wahab M
[Ad] Address:Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt. Electronic address: elnakeebayman@yahoo.com.
[Ti] Title:Tailored pancreatic reconstruction after pancreaticoduodenectomy: a single-center experience of 892 cases.
[So] Source:Hepatobiliary Pancreat Dis Int;16(5):528-536, 2017 Oct 15.
[Is] ISSN:1499-3872
[Cp] Country of publication:Singapore
[La] Language:eng
[Ab] Abstract:BACKGROUND: Pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debatable even for pancreatic surgeons. Ideally, pancreatic reconstruction after PD should reduce the risk of postoperative pancreatic fistula (POPF) and its severity if developed with preservation of both exocrine and endocrine pancreatic functions. It must be tailored to control the morbidity linked to the type of reconstruction. This study was to show the best type of pancreatic reconstruction according to the characters of pancreatic stump. METHODS: We studied all patients who underwent PD in our center from January 1993 to December 2015. Patients were categorized into three groups depending on the presence of risk factors of postoperative complications: low-risk group (absent risk factor), moderate-risk group (presence of one risk factor) and high-risk group (presence of two or more risk factors). RESULTS: A total of 892 patients underwent PD for resection of periampullary tumor. BMI >25 kg/m , cirrhotic liver, soft pancreas, pancreatic duct diameter <3 mm, and pancreatic duct location from posterior edge <3 mm are risk variables for development of postoperative complications. POPF developed in 128 (14.3%) patients. Delayed gastric emptying occurred in 164 (18.4%) patients, biliary leakage developed in 65 (7.3%) and pancreatitis presented in 20 (2.2%). POPF in low-, moderate- and high-risk groups were 26 (8.3%), 65 (15.7%) and 37 (22.7%) patients, respectively. Postoperative morbidity and mortality were significantly lower with pancreaticogastrostomy (PG) in high-risk group, while pancreaticojejunostomy (PJ) decreases incidence of postoperative steatorrhea in all groups. CONCLUSIONS: Selection of proper pancreatic reconstruction according to the risk factors of patients may reduce POPF and postoperative complications and mortality. PG is superior to PJ as regards short-term outcomes in high-risk group but PJ provides better pancreatic function in all groups and therefore, PJ is superior in low- and moderate-risk groups.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171020
[Lr] Last revision date:171020
[St] Status:In-Process

  10 / 1343 MEDLINE  
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[PMID]: 28985688
[Au] Autor:Durie P; Baillargeon JD; Bouchard S; Donnellan F; Zepeda-Gomez S; Teshima C
[Ad] Address:a Hospital for Sick Children and University of Toronto , Toronto , ON , Canada.
[Ti] Title:Diagnosis and management of pancreatic exocrine insufficiency (PEI) in primary care: consensus guidance of a Canadian expert panel.
[So] Source:Curr Med Res Opin;:1-9, 2017 Oct 25.
[Is] ISSN:1473-4877
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Pancreatic exocrine insufficiency (PEI) results in maldigestion due to inadequate activity of pancreatic enzymes in the small bowel. PEI can arise from a variety of medical conditions that reduce enzyme synthesis within the pancreatic parenchyma or from secondary factors that may occur despite optimal parenchymal function, such as pancreatic duct obstruction or impaired or poorly synchronized enzyme release. PURPOSE: To provide practical guidance for primary care physicians managing patients who are at risk of PEI or who present with symptoms of PEI. METHODS: For each of six key clinical questions identified by the authors, PubMed searches were conducted to identify key English-language papers up to April 2017. Forward and backward searches on key articles were conducted using Web of Science. Clinical recommendations proposed by the co-chairs (P.D. and C.T.) were vetted and approved based on the authors? FINDINGS: The most characteristic symptom of PEI is steatorrhea ? voluminous, lipid-rich stools; other common signs and symptoms include unexplained weight loss and deficiencies of fat-soluble vitamins and other micronutrients. Pancreatic enzyme replacement therapy (PERT) can relieve symptoms and long-term sequelae of PEI. Diagnosis of PEI and initiation of PERT are usually the responsibility of gastroenterology specialists. However, primary care physicians (PCPs) are well positioned to identify potential cases of PEI and to participate in the collaborative, long-term management of patients already seen by a specialist. CONCLUSIONS: In this document, a panel of Canadian gastroenterologists has conducted a critical review of the literature on PEI and PERT and has developed practical diagnostic and treatment recommendations for PCPs. These recommendations provide guidance on identifying patients at risk of PEI, the triggers for PEI testing and referral, and best practices for co-managing patients with confirmed PEI.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171025
[Lr] Last revision date:171025
[St] Status:Publisher
[do] DOI:10.1080/03007995.2017.1389704


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