7d70ec3a172e511b547f632f2dfd77fc pmc_9861070.pdf d2fe6ff3346abb3fd797f4a592e5f21e09f162ee pmc_9861070.pdf 7e67c8c3c248fba8ed52d72c3358acc41efb048d92998ad83f605874ab120fb9 pmc_9861070.pdf Title: Prevalence of Radiological Chronic Pancreatitis and Exocrine Pancreatic Insufficiency in Patients with Decompensated Liver Disease: Is Fecal Elastase Useful in This Setting? Subject: Chronic alcohol consumption is a well-known etiological factor for both chronic pancreatitis (CP) and liver cirrhosis. However, there is discussion over how often these two entities are present together in the same patient. The main goal of our study is to establish the prevalence of CP and low fecal elastase (FE-1) in patients with decompensated liver disease (DLD). In addition, we aim to identify the demographic, epidemiological and clinical factors associated with EPI and CP in patients with decompensated liver cirrhosis. This was an observational single-center study including 119 consecutive patients hospitalized for acute decompensation of cirrhosis, mostly of alcoholic etiology. Patients underwent computed tomography (CT) or magnetic resonance imaging (MRI) to assess the radiological features of CP. We also performed two FE-1 tests and complete blood tests to assess the presence of exocrine pancreatic insufficiency (EPI) and nutritional status, including micronutrients. The results of our study show that 32 patients (26.9%) had low fecal elastase suggesting EPI and 11 (9.2%) had CP. Patients meeting radiological CP criteria had lower FE-1 than patients without CP. There were no statistically significant differences in micronutrient deficiencies according to the presence of CP or not. Likewise, we did not find any statistically significant differences in micronutrient deficiencies among patients with normal and low FE-1 indicative of EPI. FE-1 alone may not be suitable for assessing EPI in patients with acute DLD. Detecting co-existing pancreatic disease may be important in a subset of patients with DLD, when the FE-1 levels are significantly low, potentially suggestive of a pancreatic anomaly. Moreover, the clinical manifestations of EPI and CP are not useful in detecting CP in DLD patients. Likewise, CP cannot explain all causes of EPI in these patients. Keywords: chronic pancreatitis; exocrine pancreatic insufficiency; decompensated cirrhosis; micronutrient deficiencies Author: Gemma Llibre-Nieto, Alba Lira, Mercedes Vergara, Meritxell Casas, Cristina Solé, José Ferrusquía-Acosta, Valentí Puig-Diví, Laia Grau-López, Josep Maria Barradas, Marta Solà, Mireia Miquel and Jordi Sánchez-Delgado Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jan 17 03:03:10 2023 CET ModDate: Tue Jan 17 03:07:59 2023 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 309809 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- AWHDWW+VnURWPalladioL Type 1 Custom yes yes no 10 0 KJZWMF+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 AFWWAS+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 UNVYMG+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 JUXSQN+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 JGMOZW+CMSY10 Type 1 Builtin yes yes no 71 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 78 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 88 0 UJUUJI+PazoMath Type 1 Builtin yes yes no 111 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-05-23 02:34:29 CEST RepresentationInformation: pmc_9861070.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-02-02 03:39:53 CET Size: 309809 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 246 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Study Design Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Sampling and Inclusion Criteria Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Sample Size Calculation Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Data Collection and Measurements Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Definition of Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Statistical Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Ethics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Children: Item: Title: Patient Characteristics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Chronic Pancreatitis and Decompensated Liver Disease Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Chronic Pancreatitis and EPI Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Micronutrient Deficiencies and Low Fecal Elastase Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Info: Title: Prevalence of Radiological Chronic Pancreatitis and Exocrine Pancreatic Insufficiency in Patients with Decompensated Liver Disease: Is Fecal Elastase Useful in This Setting? Author: Gemma Llibre-Nieto, Alba Lira, Mercedes Vergara, Meritxell Casas, Cristina Solé, José Ferrusquía-Acosta, Valentí Puig-Diví, Laia Grau-López, Josep Maria Barradas, Marta Solà, Mireia Miquel and Jordi Sánchez-Delgado Subject: Chronic alcohol consumption is a well-known etiological factor for both chronic pancreatitis (CP) and liver cirrhosis. However, there is discussion over how often these two entities are present together in the same patient. The main goal of our study is to establish the prevalence of CP and low fecal elastase (FE-1) in patients with decompensated liver disease (DLD). In addition, we aim to identify the demographic, epidemiological and clinical factors associated with EPI and CP in patients with decompensated liver cirrhosis. This was an observational single-center study including 119 consecutive patients hospitalized for acute decompensation of cirrhosis, mostly of alcoholic etiology. Patients underwent computed tomography (CT) or magnetic resonance imaging (MRI) to assess the radiological features of CP. We also performed two FE-1 tests and complete blood tests to assess the presence of exocrine pancreatic insufficiency (EPI) and nutritional status, including micronutrients. The results of our study show that 32 patients (26.9%) had low fecal elastase suggesting EPI and 11 (9.2%) had CP. Patients meeting radiological CP criteria had lower FE-1 than patients without CP. There were no statistically significant differences in micronutrient deficiencies according to the presence of CP or not. Likewise, we did not find any statistically significant differences in micronutrient deficiencies among patients with normal and low FE-1 indicative of EPI. FE-1 alone may not be suitable for assessing EPI in patients with acute DLD. Detecting co-existing pancreatic disease may be important in a subset of patients with DLD, when the FE-1 levels are significantly low, potentially suggestive of a pancreatic anomaly. Moreover, the clinical manifestations of EPI and CP are not useful in detecting CP in DLD patients. Likewise, CP cannot explain all causes of EPI in these patients. Keywords: chronic pancreatitis; exocrine pancreatic insufficiency; decompensated cirrhosis; micronutrient deficiencies Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jan 17 03:03:10 CET 2023 ModDate: Tue Jan 17 03:07:59 CET 2023 ID: 0xcb3450079874f6ccf689587dd70163cc, 0xcb3450079874f6ccf689587dd70163cc Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: AFWWAS+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: AFWWAS+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: JGMOZW+CMSY10 FontSubset: true FirstChar: 6 LastChar: 21 FontDescriptor: FontName: JGMOZW+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: UNVYMG+URWPalladioL-Ital FontSubset: true FirstChar: 2 LastChar: 150 FontDescriptor: FontName: UNVYMG+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: WBVKDJ+URWPalladioL-BoldItal FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: WBVKDJ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: AWHDWW+VnURWPalladioL FontSubset: true FirstChar: 161 LastChar: 243 FontDescriptor: FontName: AWHDWW+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: JUXSQN+VnURWPalladioL-Bold FontSubset: true FirstChar: 160 LastChar: 226 FontDescriptor: FontName: JUXSQN+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: OVNEXW+EURM10 FontSubset: true FirstChar: 22 LastChar: 22 FontDescriptor: FontName: OVNEXW+EURM10 Flags: Symbolic FontBBox: -32, -243, 1060, 720 FontFile: true Font: BaseFont: KJZWMF+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 134 FontDescriptor: FontName: KJZWMF+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: UJUUJI+PazoMath FontSubset: true FirstChar: 160 LastChar: 160 FontDescriptor: FontName: UJUUJI+PazoMath Flags: Symbolic FontBBox: -40, -283, 878, 946 FontFile: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 34, 293, 152, 302 Annotation: Subtype: Link Rect: 34, 283, 72, 290 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 169, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 317, 642, 328, 655 Annotation: Subtype: Link Rect: 486, 642, 497, 655 Annotation: Subtype: Link Rect: 135, 616, 146, 630 Annotation: Subtype: Link Rect: 116, 17, 250, 28 Annotation: Subtype: Link Rect: 404, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 426, 87, 445 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 360, 695, 367, 704 ActionDest: 108 Annotation: Subtype: Link Rect: 367, 695, 374, 704 ActionDest: 108 Annotation: Subtype: Link Rect: 249, 670, 255, 679 ActionDest: 108 Annotation: Subtype: Link Rect: 256, 670, 263, 679 ActionDest: 108 Annotation: Subtype: Link Rect: 203, 645, 210, 654 ActionDest: 108 Annotation: Subtype: Link Rect: 399, 557, 406, 566 ActionDest: 108 Annotation: Subtype: Link Rect: 409, 557, 416, 566 ActionDest: 108 Annotation: Subtype: Link Rect: 513, 519, 520, 528 ActionDest: 108 Annotation: Subtype: Link Rect: 198, 469, 205, 478 ActionDest: 108 Annotation: Subtype: Link Rect: 206, 469, 213, 478 ActionDest: 108 Annotation: Subtype: Link Rect: 523, 456, 534, 465 ActionDest: 108 Annotation: Subtype: Link Rect: 352, 431, 364, 440 ActionDest: 108 Annotation: Subtype: Link Rect: 309, 406, 321, 415 ActionDest: 108 Annotation: Subtype: Link Rect: 536, 394, 543, 403 ActionDest: 108 Annotation: Subtype: Link Rect: 544, 394, 556, 403 ActionDest: 108 Annotation: Subtype: Link Rect: 482, 368, 494, 377 ActionDest: 108 Annotation: Subtype: Link Rect: 531, 318, 543, 327 ActionDest: 108 Annotation: Subtype: Link Rect: 544, 318, 556, 327 ActionDest: 108 Annotation: Subtype: Link Rect: 432, 293, 444, 302 ActionDest: 108 Annotation: Subtype: Link Rect: 444, 293, 456, 302 ActionDest: 108 Annotation: Subtype: Link Rect: 251, 256, 263, 264 ActionDest: 108 Annotation: Subtype: Link Rect: 497, 167, 509, 177 ActionDest: 108 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 492, 518, 499, 527 ActionDest: 108 Annotation: Subtype: Link Rect: 192, 141, 203, 150 ActionDest: 115 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 233, 635, 245, 644 ActionDest: 115 Annotation: Subtype: Link Rect: 234, 554, 246, 562 ActionDest: 115 Annotation: Subtype: Link Rect: 234, 197, 241, 209 ActionDest: 82 Page: Sequence: 5 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 260, 632, 267, 641 ActionDest: 92 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 335, 356, 342, 365 ActionDest: 95 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 241, 89, 248, 101 ActionDest: 82 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 432, 585, 439, 594 ActionDest: 108 Annotation: Subtype: Link Rect: 431, 534, 443, 543 ActionDest: 115 Annotation: Subtype: Link Rect: 444, 534, 456, 543 ActionDest: 115 Annotation: Subtype: Link Rect: 304, 208, 316, 217 ActionDest: 108 Annotation: Subtype: Link Rect: 316, 208, 328, 217 ActionDest: 115 Annotation: Subtype: Link Rect: 530, 195, 542, 204 ActionDest: 115 Annotation: Subtype: Link Rect: 375, 145, 387, 154 ActionDest: 115 Annotation: Subtype: Link Rect: 354, 107, 366, 117 ActionDest: 115 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 414, 509, 421, 519 ActionDest: 108 Annotation: Subtype: Link Rect: 222, 459, 234, 468 ActionDest: 115 Annotation: Subtype: Link Rect: 203, 334, 215, 343 ActionDest: 115 Annotation: Subtype: Link Rect: 202, 296, 209, 305 ActionDest: 108 Annotation: Subtype: Link Rect: 402, 246, 409, 255 ActionDest: 108 Annotation: Subtype: Link Rect: 352, 221, 359, 230 ActionDest: 108 Annotation: Subtype: Link Rect: 497, 158, 509, 167 ActionDest: 115 Annotation: Subtype: Link Rect: 372, 108, 379, 117 ActionDest: 108 Annotation: Subtype: Link Rect: 266, 83, 278, 92 ActionDest: 115 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 435, 673, 447, 682 ActionDest: 115 Annotation: Subtype: Link Rect: 382, 535, 394, 544 ActionDest: 115 Annotation: Subtype: Link Rect: 395, 535, 407, 544 ActionDest: 115 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 473, 478, 510, 489 Annotation: Subtype: Link Rect: 468, 455, 505, 466 Annotation: Subtype: Link Rect: 95, 433, 133, 443 Annotation: Subtype: Link Rect: 139, 433, 175, 443 Annotation: Subtype: Link Rect: 519, 409, 557, 420 Annotation: Subtype: Link Rect: 237, 386, 275, 397 Annotation: Subtype: Link Rect: 281, 386, 317, 397 Annotation: Subtype: Link Rect: 519, 363, 557, 374 Annotation: Subtype: Link Rect: 469, 340, 506, 351 Annotation: Subtype: Link Rect: 512, 340, 548, 351 Annotation: Subtype: Link Rect: 465, 328, 503, 339 Annotation: Subtype: Link Rect: 199, 306, 237, 316 Annotation: Subtype: Link Rect: 91, 283, 128, 293 Annotation: Subtype: Link Rect: 90, 260, 128, 270 Annotation: Subtype: Link Rect: 479, 236, 516, 247 Annotation: Subtype: Link Rect: 521, 236, 557, 247 Annotation: Subtype: Link Rect: 519, 213, 557, 224 Annotation: Subtype: Link Rect: 59, 203, 95, 213 Annotation: Subtype: Link Rect: 59, 145, 96, 155 Annotation: Subtype: Link Rect: 151, 110, 188, 121 Annotation: Subtype: Link Rect: 200, 87, 238, 98 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 181, 711, 218, 721 Annotation: Subtype: Link Rect: 460, 687, 498, 698 Annotation: Subtype: Link Rect: 131, 665, 168, 675 Annotation: Subtype: Link Rect: 483, 641, 520, 652 Annotation: Subtype: Link Rect: 392, 618, 429, 629 Annotation: Subtype: Link Rect: 435, 618, 471, 629 Annotation: Subtype: Link Rect: 95, 584, 133, 594 Annotation: Subtype: Link Rect: 226, 560, 264, 571 Annotation: Subtype: Link Rect: 270, 560, 306, 571 Annotation: Subtype: Link Rect: 479, 549, 515, 560 Annotation: Subtype: Link Rect: 521, 549, 557, 560 Annotation: Subtype: Link Rect: 104, 515, 141, 525 Annotation: Subtype: Link Rect: 147, 515, 183, 525 Annotation: Subtype: Link Rect: 371, 491, 408, 502 Annotation: Subtype: Link Rect: 226, 457, 264, 468 Annotation: Subtype: Link Rect: 270, 457, 306, 468 Annotation: Subtype: Link Rect: 477, 411, 515, 422 Annotation: Subtype: Link Rect: 521, 411, 557, 422 Annotation: Subtype: Link Rect: 374, 388, 411, 399 Annotation: Subtype: Link Rect: 417, 388, 453, 399 Annotation: Subtype: Link Rect: 450, 365, 487, 376 Annotation: Subtype: Link Rect: 494, 365, 530, 376 Checksum: 29ee59ff Type: CRC32 Checksum: 7d70ec3a172e511b547f632f2dfd77fc Type: MD5 Checksum: d2fe6ff3346abb3fd797f4a592e5f21e09f162ee Type: SHA-1