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Khurmatullina AR, Andreev DN, Maev IV, Kucheryavyy YA, Beliy PA, Dzhafarova AR, Cherenkova VV, Sokolov FS. Prevalence and Risk of Sarcopenia in Patients with Chronic Pancreatitis: Systematic Review and Meta-Analysis. Nutrients 2025; 17:870. [PMID: 40077740 PMCID: PMC11902046 DOI: 10.3390/nu17050870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 02/24/2025] [Accepted: 02/27/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND/OBJECTIVES Sarcopenia is a condition marked by a continuous decline in skeletal muscle strength and volume, often leading to significant health complications. According to several articles, sarcopenia is highly prevalent in chronic pancreatitis (CP) due to exocrine pancreatic insufficiency. The aim of this meta-analysis was to determine the pooled prevalence and risk of sarcopenia among CP patients. METHODS The search process adhered to the PRISMA 2020 guidelines and was registered in PROSPERO under the identification number CRD42025637059. The search was conducted in the following databases: MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, and the Russian Science Citation Index (RSCI). It covered studies published between 1 January 1985 and 20 December 2024. Only studies published in English or Russian with detailed comprehensive statistics and adult CP were included. Studies with specific patient populations affecting data objectivity were excluded. Sensitivity analyses were conducted (first, only studies with more than 50 CP patients were considered. Second, the analysis was restricted to full articles, excluding abstracts from conferences). RESULTS In total, 16 studies with 1556 participants (1398 CP patients and 158 controls) met the criteria. The pooled prevalence of sarcopenia was 39.117% (95% CI: 28.891-49.852) in CP patients and 7.745% (95% CI: 2.154-42.622) in the control group. An association was found between sarcopenia and CP using the fixed-effects model when compared to the control group (RR = 2.194, 95% CI: 1.502-3.203). CONCLUSIONS Sarcopenia is underdiagnosed in CP patients despite its significant clinical impact. Management strategies, including pancreatic enzyme replacement therapy, nutritional support, and resistance training show potential in the treatment of this state. Further research is needed to establish standardized diagnostic criteria and unified treatment approaches. Early detection and comprehensive care are essential to improving outcomes in CP patients with sarcopenia.
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Affiliation(s)
- Alsu R. Khurmatullina
- Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 19435 Moscow, Russia
| | - Dmitrii N. Andreev
- Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia
| | - Igor V. Maev
- Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia
| | | | - Petr A. Beliy
- Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia
| | - Aida R. Dzhafarova
- Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia
| | | | - Filipp S. Sokolov
- Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia
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Ramsey ML, Lu A, Gumpper-Fedus K, Culp S, Bradley D, Conwell DL, Cruz-Monserrate Z, Groce JR, Han S, Krishna SG, Lee P, Mace T, Papachristou GI, Roberts KM, Shah ZK, Hart PA. Clinical risk factors for sarcopenia in acute and chronic pancreatitis. BMC Gastroenterol 2025; 25:60. [PMID: 39915752 PMCID: PMC11800437 DOI: 10.1186/s12876-025-03609-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 01/13/2025] [Indexed: 02/11/2025] Open
Abstract
BACKGROUND Sarcopenia is common in chronic pancreatitis (CP) and has been associated with unfavorable outcomes; however, it is not well studied in acute pancreatitis (AP). AIMS To evaluate risk factors for sarcopenia among individuals with AP or CP. METHODS A cross sectional analysis was performed among subjects with AP or CP seen in a tertiary care Pancreas Clinic. TeraRecon software was used to calculate the cross-sectional area of skeletal muscle, visceral fat, and subcutaneous fat at the level of the L3 vertebrae. Sarcopenia was classified using sex-specific skeletal muscle index. Univariate and multivariate logistic regressions were performed to assess differences between groups and associations with sarcopenia. RESULTS A total of 49 subjects with AP and 54 subjects with CP were included. Sarcopenia was more frequently observed in CP compared to AP (83.3% vs. 46.9%, p < 0.001). The multivariate logistic regression demonstrated CP, male sex, increased age, and decreased subcutaneous fat were independently associated with sarcopenia. CONCLUSION Sarcopenia is observed in both CP and AP. In addition to traditional risk factors (including male sex, older age, and decreased subcutaneous fat), CP is independently associated with sarcopenia. Further investigations are necessary to gain deeper insights into sarcopenia pathogenesis, which could inform potential intervention strategies.
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Affiliation(s)
- Mitchell L Ramsey
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA.
| | - Andrew Lu
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kristyn Gumpper-Fedus
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stacey Culp
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Bradley
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
- The Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Royce Groce
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
| | - Peter Lee
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
| | - Thomas Mace
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
| | - Kristen M Roberts
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
- The School of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zarine K Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 43210, USA
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Kilic GS, Tahtaci M, Yagmur F, Akin FE, Tayfur Yurekli O, Ersoy O. Influence of sarcopenia as determined by bioelectrical impedance analysis in acute pancreatitis. Medicine (Baltimore) 2024; 103:e40868. [PMID: 39654169 PMCID: PMC11630989 DOI: 10.1097/md.0000000000040868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 11/16/2024] [Accepted: 11/20/2024] [Indexed: 12/12/2024] Open
Abstract
Sarcopenia can be defined as the loss of muscle mass and strength. It is a poor prognostic factor for many diseases. Our study aims to assess the prevalence of sarcopenia in patients with acute pancreatitis using bioelectrical impedance analysis (BIA) and hand dynamometry while also investigating its impact on acute pancreatitis. Sixty patients admitted with a diagnosis of acute pancreatitis were included in this prospective study. Following their admissions, prognostic markers were calculated, muscle strengths were measured using a hand dynamometer, and body compositions were determined using a BIA device. Accordingly, acute pancreatitis patients were divided into 2 groups: sarcopenic and nonsarcopenic. The demographic characteristics, anthropometric measurements, Ranson score, Glasgow-Imrie score, Balthazar score, APACHE-II score, disease severity according to the Atlanta classification, length of hospital stay, and laboratory findings of the 2 groups were compared. Sarcopenia was identified in 11 cases among those with acute pancreatitis included in the study. In the sarcopenic group, the mean age, Glasgow-Imrie score and number of cases with severe acute pancreatitis according to the Atlanta classification were significantly higher; body mass index, upper arm circumference, skeletal muscle mass index, and grip strength were significantly lower (P < .05). This study is the first to evaluate sarcopenia in acute pancreatitis cases using BIA and hand dynamometry. Sarcopenia may play a significant role in predicting the prognosis of acute pancreatitis.
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Affiliation(s)
- Gizem Seray Kilic
- Department of Internal Medicine, Kusadasi State Hospital, Aydin, Turkey
| | - Mustafa Tahtaci
- Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Funda Yagmur
- Department of Psychology, Georgia State University, Atlanta, GA
| | - Fatma Ebru Akin
- Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Oyku Tayfur Yurekli
- Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Osman Ersoy
- Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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Ockenga J, Fromhold-Treu S, Löser C, Madl C, Martignoni M, Meier R, Rubin D, Schütte K, Stang K, Török HP, Wehle L, Weimann A. S3-Leitlinie Klinische Ernährung bei
Pankreaserkrankungen. AKTUELLE ERNÄHRUNGSMEDIZIN 2024; 49:451-475. [DOI: 10.1055/a-2328-6190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
ZusammenfassungSowohl die akute als auch die chronische Pankreatitis sind häufige Erkrankungen,
die ein erhebliches Risiko für eine Mangelernährung mit sich bringen und eine
Ernährungstherapie erfordern können. In ca. 20% der akuten Pankreatitiden tritt
eine nekrotisierende Pankreatitis auf, die mit einer erhöhten Morbidität und
Mortalität verbunden ist. Hier ist oftmals eine Ernährungstherapie mittels einer
enteralen oder parenteralen Ernährung notwendig, die neben medikamentösen,
endoskopischen, radiologischen oder chirurgischen Maßnahmen eine etablierte
Säule der multimodalen Therapie darstellt.Bei der chronischen Pankreatitis handelt es sich um eine chronische Entzündung
der Bauchspeicheldrüse mit Entwicklung einer Fibrose und langfristig Atrophie
des Organs. Bauchschmerzen, die zu einer verminderten oralen Aufnahme von
Nährstoffen führen, sowie exokrines und endokrines Versagen sind häufige
Komplikationen der Krankheit. All diese Faktoren stellen Risikofaktoren für eine
Unter- bzw. Mangelernährung dar. Daher sollten Patienten mit chronischer
Pankreatitis als ernährungsmedizinische Risikopatienten betrachtet, untersucht
und entsprechend behandelt werden. Darüber hinaus sollte bei Patienten mit
chronischer Pankreatitis auf Osteoporose und ein erhöhtes Frakturrisiko geachtet
werden, und entsprechende Präventivmaßnahmen erwogen werden.
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Affiliation(s)
- Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Gesundheit Nord gGmbH,
Bremen, Deutschland
| | - Sophie Fromhold-Treu
- Abteilung für Gastroenterologie, Endokrinologie und
Stoffwechselkrankheiten, Zentrum für Innere Medizin, Universitätsmedizin
Rostock, Rostock, Deutschland
| | - Christian Löser
- Medizinische Klinik, DRK-Kliniken Nordhessen, Kassel,
Deutschland
| | - Christian Madl
- Zentrum für Gastroenterologische und Hepatologische Erkrankungen und
Gastrointestinale Endoskopie, Krankenanstalt Rudolfstiftung, Wien,
Österreich
| | - Marc Martignoni
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar,
Technische Universität München, Deutschland
| | - Rémy Meier
- Arztpraxis MagenDarm Basel AG, Basel, Schweiz
| | - Diana Rubin
- Zentrum für Ernährungsmedizin, Vivantes Klinikum Spandau, Berlin,
Deutschland
| | - Kerstin Schütte
- Klinik für Allgemeine Innere Medizin und Gastroenterologie,
Niels-Stensen-Kliniken Marienhospital Osnabrück, Osnabrück,
Deutschland
| | | | - Helga Paula Török
- Medizinische Klinik und Poliklinik II, Campus Innenstadt, Klinikum der
Ludwig-Maximilians-Universität München, München, Deutschland
| | - Lena Wehle
- Deutsche Gesellschaft für Ernährungsmedizin e.V., Berlin,
Deutschland
| | - Arved Weimann
- Abteilung für Allgemein-, Viszeral- und Onkologische Chirurgie,
Klinikum St. Georg gGmbH, Leipzig, Deutschland
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Khatkov IE, Maev IV, Bordin DS, Kononenko IB, Kucheryavyy YA, Pokataev IA, Snegovoy AV, Tryakin AA, Feoktistova PS, Zhukova LG. Role of enzyme replacement therapy for exocrine and nutritional insufficiency in patients with malignancies: A review. JOURNAL OF MODERN ONCOLOGY 2024; 26:380-389. [DOI: 10.26442/18151434.2024.3.203007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Exocrine pancreatic insufficiency (EPI) is a condition in which the amount of secreted pancreatic enzymes is insufficient to maintain normal digestion. EPI is a frequent complication of pancreatic or other malignancies. The presence of EPI in a cancer patient may be suggested by symptoms of maldigestion, malabsorption, and alteration of nutritional markers; however, it is important to note that the EPI symptoms may be subtle. In the early stages, EPI may be latent and manifested by malnutrition. However, even in the later stages, the symptoms of EPI may be similar to those of cancer or be masked by the condition after chemoradiation therapy. Antitumor therapy itself may also cause EPI. Enzyme replacement therapy (ERT) is the standard of care for EPI, but it is rarely prescribed to cancer patients. However, supportive therapy plays an essential role in treating cancer patients because the quality of life and life expectancy of patients largely depend on the adequacy of the complex treatment. The review discusses the possible causes of EPI and its diagnosis and treatment in cancer patients. Special attention is paid to ERT regimens, including those for improving digestion and the drug's dosage form. It is shown that pancreatin in minimicrospheres is the drug of choice for ERT, since the minimum particle size facilitates the most physiological digestion process.
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Affiliation(s)
- Igor E. Khatkov
- Loginov Moscow Clinical Scientific Center
- Russian University of Medicine
| | | | - Dmitry S. Bordin
- Loginov Moscow Clinical Scientific Center
- Russian University of Medicine
- Tver State Medical University
| | - Inessa B. Kononenko
- Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of National Medical Research Radiological Centre
| | | | - Ilya A. Pokataev
- Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department
| | - Anton V. Snegovoy
- Russian University of Medicine
- Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of National Medical Research Radiological Centre
| | | | - Polina S. Feoktistova
- Loginov Moscow Clinical Scientific Center
- Central State Medical Academy of the President of the Russian Federation
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Tomaszewska E, Wojtysiak D, Grzegorzewska A, Świątkiewicz M, Donaldson J, Arciszewski MB, Dresler S, Puzio I, Szymańczyk S, Dobrowolski P, Bonior J, Mielnik-Błaszczak M, Kuc D, Muszyński S. Understanding Secondary Sarcopenia Development in Young Adults Using Pig Model with Chronic Pancreatitis. Int J Mol Sci 2024; 25:8735. [PMID: 39201422 PMCID: PMC11354544 DOI: 10.3390/ijms25168735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/02/2024] Open
Abstract
Chronic pancreatitis (CP) in young individuals may lead to disease-related secondary sarcopenia (SSARC), characterized by muscle loss and systemic inflammation. In this study, CP was induced in young pigs, and serum levels of key hormones, muscle fiber diameters in various muscles, and the mRNA expression of genes related to oxidative stress and programmed cell death were assessed. A decrease in muscle fiber diameters was observed in SSARC pigs, particularly in the longissimus and diaphragm muscles. Hormonal analysis revealed alterations in dehydroepiandrosterone, testosterone, oxytocin, myostatin, and cortisol levels, indicating a distinct hormonal response in SSARC pigs compared to controls. Oxytocin levels in SSARC pigs were significantly lower and myostatin levels higher. Additionally, changes in the expression of catalase (CAT), caspase 8 (CASP8), B-cell lymphoma 2 (BCL2), and BCL2-associated X protein (BAX) mRNA suggested a downregulation of oxidative stress response and apoptosis regulation. A reduced BAX/BCL2 ratio in SSARC pigs implied potential caspase-independent cell death pathways. The findings highlight the complex interplay between hormonal changes and muscle degradation in SSARC, underscoring the need for further research into the apoptotic and inflammatory pathways involved in muscle changes due to chronic organ inflammation in young individuals.
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Affiliation(s)
- Ewa Tomaszewska
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland; (I.P.); (S.S.)
| | - Dorota Wojtysiak
- Department of Animal Genetics, Breeding and Ethology, Faculty of Animal Sciences, University of Agriculture in Kraków, 30-059 Kraków, Poland;
| | - Agnieszka Grzegorzewska
- Department of Animal Physiology and Endocrinology, University of Agriculture in Kraków, 30-059 Kraków, Poland;
| | - Małgorzata Świątkiewicz
- Department of Animal Nutrition and Feed Science, National Research Institute of Animal Production, 32-083 Balice, Poland;
| | - Janine Donaldson
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa;
| | - Marcin B. Arciszewski
- Department of Animal Anatomy and Histology, University of Life Sciences in Lublin, 20-950 Lublin, Poland;
| | - Sławomir Dresler
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland;
- Department of Plant Physiology and Biophysics, Faculty of Biology and Biotechnology, Maria Curie-Skłodowska University, 20-033 Lublin, Poland
| | - Iwona Puzio
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland; (I.P.); (S.S.)
| | - Sylwia Szymańczyk
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland; (I.P.); (S.S.)
| | - Piotr Dobrowolski
- Department of Functional Anatomy and Cytobiology, Faculty of Biology and Biotechnology, Maria Curie-Sklodowska University, 20-033 Lublin, Poland;
| | - Joanna Bonior
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Kraków, Poland;
| | - Maria Mielnik-Błaszczak
- Chair and Department of Developmental Dentistry, Medical University of Lublin, 20-081 Lublin, Poland; (M.M.-B.); (D.K.)
| | - Damian Kuc
- Chair and Department of Developmental Dentistry, Medical University of Lublin, 20-081 Lublin, Poland; (M.M.-B.); (D.K.)
| | - Siemowit Muszyński
- Department of Biophysics, Faculty of Environmental Biology, University of Life Sciences in Lublin, 20-950 Lublin, Poland;
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Zhang QH, Ma JD, Lu YM, Zhang RN, Zhao ZH, Li YT, Chen QP. Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis. World J Gastrointest Surg 2024; 16:1857-1870. [PMID: 38983342 PMCID: PMC11230021 DOI: 10.4240/wjgs.v16.i6.1857] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength, as well as a decline in functional ability, which is associated with malnutrition, hormonal changes, chronic inflammation, disturbance of intestinal flora, and exercise quality. Pancreatoduodenectomy is a commonly employed clinical intervention for conditions such as pancreatic head cancer, ampulla of Vater cancer, and cholangiocarcinoma, among others, with a notably high rate of postoperative complications. Sarcopenia is frequent in patients undergoing pancreatoduodenectomy. However, data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy (PD) are both limited and inconsistent. AIM To assess the influence of sarcopenia on outcomes in patients undergoing PD. METHODS The PubMed, Cochrane Library, Web of Science, and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD. Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria. Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted. Forest and funnel plots were used, respectively, to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias. RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis. The patients in the sarcopenia group (n = 833) had higher overall postoperative complication rates [odds ratio (OR) = 3.42, 95% confidence interval (CI): 1.95-5.99, P < 0.0001], higher Clavien-Dindo class ≥ III major complication rates (OR = 1.41, 95%CI: 1.04-1.90, P = 0.03), higher bacteremia rates (OR = 4.46, 95%CI: 1.42-13.98, P = 0.01), higher pneumonia rates (OR = 2.10, 95%CI: 1.34-3.27, P = 0.001), higher pancreatic fistula rates (OR = 1.42, 95%CI: 1.12-1.79, P = 0.003), longer hospital stays (OR = 2.86, 95%CI: 0.44-5.28, P = 0.02), higher mortality rates (OR = 3.17, 95%CI: 1.55-6.50, P = 0.002), and worse overall survival (hazard ratio = 2.81, 95%CI: 1.45-5.45, P = 0.002) than those in the non-sarcopenia group (n = 1548). However, no significant inter-group differences were observed regarding wound infections, urinary tract infections, biliary fistulas, or postoperative digestive bleeding. CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD. Patients with preoperative sarcopenia have increased rates of complications and mortality, in addition to a poorer overall survival rate and longer hospital stays after PD.
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Affiliation(s)
- Qi-Hui Zhang
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Jin-Dong Ma
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Yan-Min Lu
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Run-Nan Zhang
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Zhong-Hua Zhao
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Ya-Tong Li
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Qiang-Pu Chen
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
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8
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Freckelton J, Rajagopalan A, Moore GT, Croagh D. Handgrip Strength Predicts Survival in Patients With Pancreatic Cancer. Pancreas 2024; 53:e405-e409. [PMID: 38517481 DOI: 10.1097/mpa.0000000000002319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Pancreatic ductal adenocarcinoma (PDAC) is a common cancer with a poor prognosis and is associated with a high prevalence of cachexia, a metabolic syndrome of muscle wasting due to complex mechanisms. In addition to loss of muscle mass, cancer patients also experience functional deterioration. The aim of this study is to determine whether there is an association between muscle mass and function and clinical outcomes, particularly survival. METHODS We performed a prospective cohort study including all patients with PDAC at Monash Health from March 2016 to December 2017. We conducted body composition analysis for myopenia and handgrip strength testing. We constructed Kaplan-Meier curves to estimate whether myopenia and low hand grip strength were associated with poorer survival. RESULTS Myopenia was not associated with a significant difference in PDAC-specific survival (log-rank P = 0.60). However, low handgrip strength was associated with significantly worse PDAC-specific survival compared with other patients (log-rank hazard ratio, 1.88; 95% confidence interval, 1.15-3.09; P = 0.004). CONCLUSIONS The relationship between survival in PDAC and handgrip strength, but not anatomical muscle mass, suggests that functional testing of strength may be important in prognostication of patients with PDAC, alongside existing tools such as the Eastern Cooperative Oncology Group performance status.
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Petrov MS, Olesen SS. Metabolic Sequelae: The Pancreatitis Zeitgeist of the 21st Century. Gastroenterology 2023; 165:1122-1135. [PMID: 37549751 DOI: 10.1053/j.gastro.2023.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
Holistic management of pancreatitis means that gastroenterologists in the 21st Century should think beyond improving in-hospital outcomes of pancreatitis alone. In particular, there is considerable room for optimizing the management of new-onset diabetes, exocrine pancreatic insufficiency, and other metabolic sequelae of pancreatitis. The present article provides state-of-the-art information on classification, terminology, and burden of the common sequelae of pancreatitis. A high-risk group of patients with pancreatitis is identified, which is positioned to benefit the most from the metabolic sequelae surveillance program introduced in this article. The program involves continuous follow-up after pancreatitis diagnosis, with the focus on early identification of new-onset diabetes after pancreatitis and exocrine pancreatic insufficiency. The metabolic sequelae surveillance program is scalable and has the potential to reduce the burden of pancreatitis through tertiary prevention in the decades to come.
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Affiliation(s)
- Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand.
| | - Søren S Olesen
- Department of Gastroenterology and Hepatology, Center for Pancreatic Diseases and Mech-Sense, Aalborg University Hospital, Aalborg, Denmark; Clinical Institute, Aalborg University, Aalborg, Denmark
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10
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Walia D, Saraya A, Gunjan D. Vascular complications of chronic pancreatitis and its management. World J Gastrointest Surg 2023; 15:1574-1590. [PMID: 37701688 PMCID: PMC10494584 DOI: 10.4240/wjgs.v15.i8.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 08/25/2023] Open
Abstract
Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.
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Affiliation(s)
- Dinesh Walia
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anoop Saraya
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepak Gunjan
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
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11
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Kumar V, Barkoudah E, Jin DX, Banks P, McNabb-Baltar J. Hospital Frailty Risk Score (HFRS) Predicts Adverse Outcomes Among Hospitalized Patients with Chronic Pancreatitis. Dig Dis Sci 2023:10.1007/s10620-023-07946-w. [PMID: 37140839 DOI: 10.1007/s10620-023-07946-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The prevalence of frailty among patients with chronic pancreatitis (CP) and its impact on clinical outcomes is unclear. We report the impact of frailty on mortality, readmission rates, and healthcare utilization among patients with chronic pancreatitis in the United States. METHODS We extracted data on patients hospitalized with a primary or secondary diagnosis of CP from the Nationwide Readmissions Database 2019. We applied a previously validated hospital frailty risk scoring system to classify CP patients into frail and non-frail on index hospitalization and compared the characteristics of frail and non-frail patients. We studied the impact of frailty on mortality, readmission, and healthcare utilization. RESULTS Of 56,072 patients with CP, 40.78% of patients were classified as frail. Frail patients experienced a higher rate of unplanned and preventable hospitalizations. Almost two-thirds of frail patients were younger than 65, and one-third had no or only single comorbidity. On multivariate analysis, frailty was independently associated with two times higher mortality risk (adjusted hazard ratio [aHR], 2.05; 95% CI 1.7-2.5). Frailty was also associated with a higher risk of all-cause readmission with an aHR of 1.07; (95% CI 1.03-1.1). Frail patients experienced a longer length of stay, higher hospitalization costs, and hospitalization charges. Infectious causes were the most common cause of readmission among frail patients compared to acute pancreatitis among non-frail patients. CONCLUSIONS Frailty is independently associated with higher mortality, readmission rates, and healthcare utilization among patients with chronic pancreatitis in the US.
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Affiliation(s)
- Vivek Kumar
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ebrahim Barkoudah
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David X Jin
- Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Peter Banks
- Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Julia McNabb-Baltar
- Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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12
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Tomaszewska E, Świątkiewicz M, Muszyński S, Donaldson J, Ropka-Molik K, Arciszewski MB, Murawski M, Schwarz T, Dobrowolski P, Szymańczyk S, Dresler S, Bonior J. Repetitive Cerulein-Induced Chronic Pancreatitis in Growing Pigs-A Pilot Study. Int J Mol Sci 2023; 24:ijms24097715. [PMID: 37175426 PMCID: PMC10177971 DOI: 10.3390/ijms24097715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Chronic pancreatitis (CP) is an irreversible and progressive inflammatory disease. Knowledge on the development and progression of CP is limited. The goal of the study was to define the serum profile of pro-inflammatory cytokines and the cell antioxidant defense system (superoxidase dismutase-SOD, and reduced glutathione-GSH) over time in a cerulein-induced CP model and explore the impact of these changes on selected cytokines in the intestinal mucosa and pancreatic tissue, as well as on selected serum biochemical parameters. The mRNA expression of CLDN1 and CDH1 genes, and levels of Claudin-1 and E-cadherin, proteins of gut barrier, in the intestinal mucosa were determined via western blot analysis. The study showed moderate pathomorphological changes in the pigs' pancreas 43 days after the last cerulein injection. Blood serum levels of interleukin (IL)-1-beta, IL-6, tumor necrosis factor alpha (TNF-alpha), C-reactive protein (CRP), lactate dehydrogenase (LDH), gamma-glutamyl transpeptidase (GGTP), SOD and GSH were increased following cerulein injections. IL-1-beta, IL-6, TNF-alpha and GSH were also increased in jejunal mucosa and pancreatic tissue. In duodenum, decreased mRNA expression of CDH1 and level of E-cadherin and increased D-lactate, an indicator of leaky gut, indicating an inflammatory state, were observed. Based on the current results, we can conclude that repetitive cerulein injections in growing pigs not only led to CP over time, but also induced inflammation in the intestine. As a result of the inflammation, the intestinal barrier was impaired.
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Affiliation(s)
- Ewa Tomaszewska
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Małgorzata Świątkiewicz
- Department of Animal Nutrition and Feed Science, National Research Institute of Animal Production, 32-083 Balice, Poland
| | - Siemowit Muszyński
- Department of Biophysics, Faculty of Environmental Biology, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Janine Donaldson
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa
| | - Katarzyna Ropka-Molik
- Department of Animal Molecular Biology, National Research Institute of Animal Production, 32-083 Balice, Poland
| | - Marcin B Arciszewski
- Department of Animal Anatomy and Histology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Maciej Murawski
- Department of Animal Nutrition, Biotechnology and Fisheries, Faculty of Animal Science, University of Agriculture in Kraków, 30-059 Kraków, Poland
| | - Tomasz Schwarz
- Department of Animal Genetics, Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, 30-059 Kraków, Poland
| | - Piotr Dobrowolski
- Department of Functional Anatomy and Cytobiology, Faculty of Biology and Biotechnology, Maria Curie-Sklodowska University, 20-033 Lublin, Poland
| | - Sylwia Szymańczyk
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Sławomir Dresler
- Department of Analytical Chemistry, Medical University of Lublin, 20-059 Lublin, Poland
- Department of Plant Physiology and Biophysics, Faculty of Biology and Biotechnology, Maria Curie-Skłodowska University, 20-033 Lublin, Poland
| | - Joanna Bonior
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland
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13
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Oyebola T, Mavilakandy A, Stephenson JA, Boyce R, Bhardwaj N, Garcea G. Sarcopenia: An Assessment into the Prevalence and Disease Burden in Chronic Pancreatitis Patients. J Frailty Sarcopenia Falls 2023; 8:38-43. [PMID: 36873829 PMCID: PMC9975973 DOI: 10.22540/jfsf-08-038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 03/04/2023] Open
Abstract
Objectives To evaluate the prevalence of sarcopenia in patients referred to a Multidisciplinary Chronic Pancreatitis (CP) Clinic at the University Hospitals of Leicester. Methods All patients who had undergone CT scans were identified. Controls were identified from CT colonograms with no features of malignancy or pancreatic pathology. The psoas muscle index (PMI) was calculated using the formula: total psoas muscle cross-sectional area at the third lumbar vertebral level (cm2)/ the patient's height squared (m2). PMI cut-offs were <6.31cm2/m2 and <3.91cm2/m2 for males and females, respectively. Results 58 CP CT scans were available for analysis along with 62 control scans. 71.9% of CP patients had a PMI below the cut-off for their gender, compared to 45.2% of the controls. The mean PMI (±SD) for male CP patients and male controls were 5.54cm2/m2 (±1.60) and 6.73 cm2/m2 (±1.54), (P=0.0023). The mean PMI (±SD) for female CP patients and female controls were 3.82 cm2/m2 (+/-1.46) and 4.98 cm2/m2 (+/-1.43), (P=0.0021). Conclusions CP patients had a mean PMI below the cut-off value, suggesting that CP patients are largely sarcopenic. As malnutrition is a significant feature of CP, optimisation of nutrition may help to ameliorate sarcopenia in CP patients.
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Affiliation(s)
- Taiwo Oyebola
- Leicester Medical School, Lancaster Rd, Leicester, United Kingdom.,Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Akash Mavilakandy
- Leicester Medical School, Lancaster Rd, Leicester, United Kingdom.,Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom.,Department of Cardiovascular sciences, University of Leicester, United Kingdom
| | - James A Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, United Kingdom
| | - Ruth Boyce
- Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Neil Bhardwaj
- Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Giuseppe Garcea
- Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom
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14
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Surci N, Bassi C, Salvia R, Marchegiani G, Casetti L, Deiro G, Bergmann C, Walenta K, Tamandl D, Schindl M, Sahora K, Mühlbacher J. Long-Term Follow-Up after Surgery for Chronic Pancreatitis: A Bicentric Retrospective Experience. Dig Surg 2023; 39:169-175. [PMID: 35917792 PMCID: PMC9909709 DOI: 10.1159/000526263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The impact of surgery on nutritional status, pancreatic function, and symptoms of patients affected by chronic pancreatitis (CP) has not been unequivocally determined. This study aimed to evaluate clinical follow-up after surgery for CP in an Italian-Austrian population. MATERIALS AND METHODS Patients operated for CP at two high-volume centers between 2000 and 2018 were analyzed. The following parameters were compared between the pre- and postoperative period: nutritional status, endocrine and exocrine pancreatic functions, and chronic pain. RESULTS Overall, 186 patients underwent surgery for CP. Among these, 68 (40%) answered a specific follow-up questionnaire. The body mass index showed a significant increase between pre- and postoperative assessments (21.1 vs. 22.5 p = 0.003). Furthermore, a 60% decrease in the prevalence of chronic pain (81 vs. 21%, p < 0.001) was observed. On the contrary, both exocrine and endocrine pancreatic functions pointed toward a worsening after surgery, with consistent higher rates of patients presenting with diabetes mellitus, as well as patients requiring insulin therapy and oral intake of pancreatic enzymes. The analysis of body composition performed on 40 (24%) patients with a complete imaging pack revealed no significant change in the nutritional status after surgery. DISCUSSION/CONCLUSION Despite the good results observed in terms of pain relief, the surgical approach led to a consistent worsening of the global pancreatic function. No significant influence of surgery on the nutritional status of patients was detected.
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Affiliation(s)
- Niccolò Surci
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria,Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Giacomo Deiro
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Christina Bergmann
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Walenta
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Radiology, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Martin Schindl
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Mühlbacher
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria,*Jakob Mühlbacher, jakob.muehlbacherMühlbachermeduniwien.ac.at
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15
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Singh A, Aggarwal M, Garg R, Stevens T, Chahal P. Post-pancreatitis diabetes mellitus: insight on optimal management with nutrition and lifestyle approaches. Ann Med 2022; 54:1776-1786. [PMID: 35786076 PMCID: PMC9254994 DOI: 10.1080/07853890.2022.2090601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Pancreatitis is the leading gastrointestinal cause of hospitalizations. There are multiple short- and long-term complications associated with pancreatitis. Post-pancreatitis diabetes mellitus (PPDM) is one of the less explored complications of pancreatitis. Nonetheless, it has attracted considerable attention during the last decade. PPDM is now the second most common cause of new-onset diabetes mellitus (DM) in adults after type II DM surpassing type 1 DM. However, there exists a knowledge gap amongst practitioners regarding diagnosis, complications, and management of PPDM. In this narrative, we aim to provide a brief review regarding risks, diagnosis and management of PPDM with a special focus on dietary and lifestyle management strategies.KEY MESSAGESPost-pancreatitis diabetes mellitus (PPDM) is now the second most common cause of new-onset diabetes mellitus (DM) in adults after type II DM surpassing type 1 DM.New-onset diabetes in patients with pancreatitis could also be an early marker of occult pancreatic malignancy.Management of PPDM is complex and requires a team-based approach including gastroenterologists, endocrinologists, primary care physicians, nutritionists, and behavioural health specialists.
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Affiliation(s)
- Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Manik Aggarwal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Stevens
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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16
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Whitcomb DC, Duggan SN, Martindale R, Lowe M, Stallings VA, Conwell D, Barkin JA, Papachristou GI, Husain SZ, Forsmark CE, Kaul V. AGA-PancreasFest Joint Symposium on Exocrine Pancreatic Insufficiency. GASTRO HEP ADVANCES 2022; 2:395-411. [PMID: 39132652 PMCID: PMC11307793 DOI: 10.1016/j.gastha.2022.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/03/2022] [Indexed: 08/13/2024]
Abstract
Exocrine pancreatic insufficiency (EPI) is a clinically defined syndrome based on the physician's assessment of a patient's maldigestion. However, current clinical definitions are inadequate in determining (1) the threshold of reduced pancreatic digestive enzyme secretion that determines "pancreatic insufficiency" in an individual patient; (2) the role of pancreatic function tests; (3) effects of differing metabolic needs, nutrition intake, and intestinal function/adaptation (4) when pancreatic enzyme replacement therapy is needed; and (5) how to monitor and titrate multiple therapies. Experts and key opinion leaders were invited to PancreasFest 2021 to discuss and help clarify mechanistic issues critical to defining EPI and to address misconceptions and barriers limiting advancements in patient care. Clinically EPI is defined as inadequate delivery of pancreatic digestive enzymes to meals to meet nutritional needs and is reversed with appropriate treatment. A new mechanistic definition of EPI was proposed that includes the disorders essence and character: (1) EPI is a disorder caused by failure of the pancreas to deliver a minimum/threshold level of specific pancreatic digestive enzymes to the intestine in concert with ingested nutrients, followed by enzymatic digestion of a series of individual snacks and meals over time to meet nutritional and metabolic needs, given (a) the specific macronutritional and micronutritional needs; (b) nutrient intake; (c) exocrine pancreatic function; and (d) intestinal anatomy, function, diseases, and adaptative capacity. (2) EPI is characterized by variable deficiencies in micronutrients and macronutrients, especially essential fats and fat-soluble vitamins, by gastrointestinal symptoms of nutrient maldigestion and by improvement or correction of nutritional state with lifestyle changes, disease treatment, optimized diet, dietary supplements, and/or administration of adequate pancreatic enzyme replacement therapy. EPI is complex and individualized and multidisciplinary approaches are needed to optimize therapy. Better pancreas function tests and biomarkers are needed to diagnose EPI and guide treatment.
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Affiliation(s)
- David C. Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Cell Biology and Molecular Physiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sinead N. Duggan
- Department of Surgery, School of Medicine, Trinity College Dublin, Tallaght University Hospital, Dublin, Republic of Ireland
| | - Robert Martindale
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Mark Lowe
- Department of Pediatric Science, Washington University School of Medicine, St. Louis, Missouri
| | - Virginia A. Stallings
- Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Darwin Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Jodie A. Barkin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida
| | - Georgios I. Papachristou
- Division of Gastroenterology, Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sohail Z. Husain
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford School of Medicine and Stanford Medicine Children's Health, Stanford, California
| | - Christopher E. Forsmark
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, Florida
| | - Vivek Kaul
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
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17
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Zhang T, Cheng JK, Hu YM. Gut microbiota as a promising therapeutic target for age-related sarcopenia. Ageing Res Rev 2022; 81:101739. [PMID: 36182084 DOI: 10.1016/j.arr.2022.101739] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/30/2022] [Accepted: 09/25/2022] [Indexed: 01/31/2023]
Abstract
Sarcopenia is characterized by a progressive loss of skeletal muscle mass and function with aging. Recently, sarcopenia has been shown to be closely related with gut microbiota. Strategies such as probiotics and fecal microbiota transplantation have shown potential to ameliorate the muscle loss. This review will focus on the age-related sarcopenia, in particular on the relationship between gut microbiota and age-related sarcopenia, how gut microbiota is engaged in sarcopenia, and the potential role of gut microbiota in the treatment of age-related sarcopenia.
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Affiliation(s)
- Ting Zhang
- Department of Geriatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jin-Ke Cheng
- State Key Laboratory of Oncogenes and Related Genes, Renji Hospital Affiliated, Shanghai Key Laboratory for Tumor Microenvironment and Inflammation, Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yao-Min Hu
- Department of Geriatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
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18
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Monaghan B, Monaghan A, Mockler D, Ul Ain Q, Duggan SN, Conlon KC, Gormley J. Physical activity for chronic pancreatitis: a systematic review. HPB (Oxford) 2022; 24:1217-1222. [PMID: 35289280 DOI: 10.1016/j.hpb.2022.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. Sarcopenia is a degenerative loss of skeletal muscle mass, quality, and strength and is commonly associated with chronic pancreatitis. Regular physical activity and adequate functional fitness have been found to ameliorate the risk and effects of sarcopenia in other chronic diseases. The objective of this systematic review was to collate all the published evidence which has examined any type of physical activity as an intervention in the chronic pancreatitis patient population. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. The search strategy was designed by the medical librarian (DM) for Embase and then modified for the other search platforms. Two of the researchers (BM) and (AM) then performed the literature search using the databases Embase, Medline, CINAHL, and Web of Science. RESULTS An electronic identified a total of 571 references imported to Covidence as 420 when the duplicates (151) were removed. 420 titles were screened and 390 were removed as not relevant from their titles. 30 full text papers were selected and from these, only one full text paper was deemed suitable for inclusion. CONCLUSIONS There is currently insufficient evidence to advise physical activity in the chronic pancreatitis population. However, given the evidence to support physical activity in many other chronic diseases this review highlights the need for urgent investigation of physical activity as an intervention on this specific patient population.
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Affiliation(s)
- Brenda Monaghan
- Discipline of Physiotherapy, School of Medicine, University of Dublin, Trinity College, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.
| | - Ann Monaghan
- Discipline of Physiotherapy, School of Medicine, University of Dublin, Trinity College, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - David Mockler
- John Stearne Library, University of Dublin, Trinity College, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Qurat Ul Ain
- Professional Surgical Unit, Department of Surgery, University of Dublin, Trinity College Tallaght Hospital, Dublin 24 D24NROA, Ireland
| | - Sinead N Duggan
- Professional Surgical Unit, Department of Surgery, University of Dublin, Trinity College Tallaght Hospital, Dublin 24 D24NROA, Ireland
| | - Kevin C Conlon
- Professional Surgical Unit, Department of Surgery, University of Dublin, Trinity College Tallaght Hospital, Dublin 24 D24NROA, Ireland
| | - John Gormley
- Discipline of Physiotherapy, School of Medicine, University of Dublin, Trinity College, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
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19
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Bundred J, Thakkar RG, Pandanaboyana S. Systematic review of sarcopenia in chronic pancreatitis: prevalence, impact on surgical outcomes, and survival. Expert Rev Gastroenterol Hepatol 2022; 16:665-672. [PMID: 35712996 DOI: 10.1080/17474124.2022.2091544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic pancreatitis (CP) is characterized by progressive inflammatory changes to the pancreas, leading to loss of endocrine and exocrine function. Emerging literature suggests sarcopenia may adversely affect outcomes for chronic pancreatitis patients. This systematic review examines the evidence surrounding the impact of sarcopenia on patients with CP. AREAS COVERED A systematic literature search of MEDLINE (via PUBMED), Cochrane and EMBASE databases was undertaken to identify articles describing body composition assessment in patients with CP. Data collected included definitions of sarcopenia, sarcopenia assessment methodology, baseline demographics, surgical outcomes, and short- and long-term outcomes. EXPERT OPINION In total, nine studies reported on 977 patients with a sarcopenia prevalence of 32.3% (95% CI 22.9-42.6%). CT remains the primary modality to assess for sarcopenia, due to ease of access. None of the studies reporting on post-operative outcomes for patients with chronic pancreatitis found a significant increase in complications among those with sarcopenia. Mortality within 1 year in the outpatient setting from one study of patients with CP was 16% in sarcopenic patients versus 3% (HR: 6.69 (95% CI: 1.79-24.9), p < 0.001) in those with no sarcopenia.Sarcopenia is prevalent in patients with CP occurring in approximately a third of patients. Sarcopenia is associated with an adverse impact on long-term survival.
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Affiliation(s)
- James Bundred
- Leeds Teaching Hospitals NHS Trust, Saint James University Hospital, Leeds, UK
| | - Rohan G Thakkar
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
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20
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Ábrahám S, Tóth I, Benkő R, Matuz M, Kovács G, Morvay Z, Nagy A, Ottlakán A, Czakó L, Szepes Z, Váczi D, Négyessy A, Paszt A, Simonka Z, Petri A, Lázár G. Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years' experience at a tertiary care centre. Surg Endosc 2022; 36:2850-2860. [PMID: 34415432 PMCID: PMC9001534 DOI: 10.1007/s00464-021-08573-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. PATIENTS AND METHODS We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male-female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient's performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. RESULTS PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79-20.56), clinical progression (OR 7.62; CI 2.64-22.05) and the need for emergency CCY (OR 14.75; CI 3.07-70.81) were mostly determined by AC severity grade. CONCLUSION PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.
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Affiliation(s)
- Szabolcs Ábrahám
- Department of Surgery, University of Szeged, Szeged, Hungary.
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Centre, Semmelweis u. 8., 6725, Szeged, Hungary.
| | - Illés Tóth
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
- Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary
- Central Pharmacy Department, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
- Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary
| | | | - Zita Morvay
- Radiology Department, University of Szeged, Szeged, Hungary
| | - András Nagy
- Radiology Department, University of Szeged, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - András Négyessy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - András Petri
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
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21
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Fasullo M, Omer E, Kaspar M. Sarcopenia in Chronic Pancreatitis - Prevalence, Diagnosis, Mechanisms and Potential Therapies. Curr Gastroenterol Rep 2022; 24:53-63. [PMID: 35167003 DOI: 10.1007/s11894-022-00837-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE OF REVIEW To investigate the prevalence, pathogenesis, diagnosis, clinical sequelae, and management of sarcopenia to improve mortality and quality of life in those with Chronic Pancreatitis. RECENT FINDINGS Sarcopenia is prevalent in chronic pancreatitis and can significantly affect clinical outcomes. Sarcopenia is prevalent in chronic pancreatitis. While effects on some clinical outcomes is has been shown, there is a significant gap in knowledge regarding effects on outcomes, pathophysiology, and options for management.
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Affiliation(s)
- Matthew Fasullo
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University (VCU), Richmond, VA, USA
| | - Endashaw Omer
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, USA
| | - Matthew Kaspar
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University (VCU), Richmond, VA, USA.
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22
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Chianca V, Albano D, Messina C, Gitto S, Ruffo G, Guarino S, Del Grande F, Sconfienza LM. Sarcopenia: imaging assessment and clinical application. Abdom Radiol (NY) 2022; 47:3205-3216. [PMID: 34687326 PMCID: PMC8536908 DOI: 10.1007/s00261-021-03294-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023]
Abstract
Sarcopenia is a progressive, generalized skeletal muscle disorder characterized by reduction of muscle mass and strength. It is associated with increased adverse outcomes including falls, fractures, physical disability, and mortality, particularly, in elderly patients. Nowadays, sarcopenia has become a specific imaging biomarker able to predict clinical outcomes of patients. Muscle fibre reduction has shown to be an unfavourable pre-operative predictive factor in patients with cancer, and is associated with worse clinical outcomes in terms of postoperative complications, morbidity, mortality, and lower tolerance of chemoradiation therapy. Several imaging modalities, including dual-energy X-ray absorptiometry, CT, MRI, and US can be used to estimate muscle mass and quality to reach the diagnosis of sarcopenia. This article reviews the clinical implications of sarcopenia, how this condition can be assessed through different imaging modalities, and future perspectives of imaging of sarcopenia.
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Affiliation(s)
- Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland ,Ospedale Evangelico Betania, Napoli, Italy
| | - Domenico Albano
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Milano, Italy ,grid.10776.370000 0004 1762 5517Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Carmelo Messina
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Salvatore Gitto
- grid.4708.b0000 0004 1757 2822Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Gaetano Ruffo
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
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23
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Ul Ain Q, Bashir Y, Kelleher L, Bourne DM, Egan SM, McMahon J, Keaskin L, Griffin OM, Conlon KC, Duggan SN. Dietary intake in patients with chronic pancreatitis: A systematic review and meta-analysis. World J Gastroenterol 2021; 27:5775-5792. [PMID: 34629801 PMCID: PMC8473599 DOI: 10.3748/wjg.v27.i34.5775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/26/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A progressive reduction in the secretion of pancreatic enzymes in patients with chronic pancreatitis (CP) results in malabsorption and ultimate malnutrition. However, the pathogenesis of malnutrition is multifactorial and other factors such as chronic inflammation, alcohol excess and poor dietary intake all contribute. Patients may restrict their dietary intake due to poor appetite or to avoid gastrointestinal symptoms and abdominal pain. Whilst up to half of patients with chronic pancreatitis are reportedly malnourished, the dietary intake of patients with CP is relatively understudied and has not been systematically reviewed to date.
AIM To perform a systematic review and meta-analysis of the dietary intakes of patients with CP compared to healthy controls, and to compare the dietary intake of patients with alcohol-related CP and non-alcohol-related CP.
METHODS A systematic literature search was performed using EMBASE, MEDLINE, and Cochrane review on studies published between 1946 and August 30th, 2019. Adult subjects with a diagnosis of CP who had undergone dietary assessment were included in the systematic review (qualitative analysis). Studies on patients with other pancreatic diseases or who had undergone pancreatic surgery were not included. Studies comparing the dietary intake of patients with CP to that of healthy controls were included in the meta-analysis (quantitative analysis). Meta-analysis was performed using Review Manager 5.3. Newcastle Ottawa Scale (NOS) was used to assess quality of studies.
RESULTS Of 6715 studies retrieved in the search, 23 were eligible for qualitative analysis while 12 were eligible for quantitative analysis. In the meta-analysis, the total energy (calorie) intake of patients with CP was similar to that of healthy controls [mean difference (MD): 171.3; 95% confidence interval (CI): -226.01, 568.5; P = 0.4], however patients with CP consumed significantly fewer non-alcohol calories than controls [MD: -694.1; 95%CI: -1256.1, (-132.1); P = 0.02]. CP patients consumed more protein, but carbohydrate and fat intakes did not differ significantly. Those with alcohol-related CP consumed more mean (standard deviation) calories than CP patients with a non-alcohol aetiology [2642 (1090) kcal and 1372 (394) kcal, respectively, P = 0.046], as well as more protein, fat, but not carbohydrate.
CONCLUSION Although patients with CP had similar calorie intake to controls, studies that analysed the contribution of alcohol to energy intake showed that patients with CP consumed fewer non-alcohol calories than healthy controls. A high calorie intake, made up to a large degree by alcohol, may in part contribute to poor nutritional status in CP.
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Affiliation(s)
- Qurat Ul Ain
- Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Dublin 24 D24 NR0A, Ireland
| | - Yasir Bashir
- Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Dublin 24 D24 NR0A, Ireland
| | - Linda Kelleher
- Department of Nutrition and Dietetics, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland
| | - David M Bourne
- Department of Newcastle Nutrition, Freeman Hospital, Newcastle Upon Tyne NE77DN, United Kingdom
| | - Suzanne M Egan
- Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Dublin 24 D24 NR0A, Ireland
| | - Jean McMahon
- Library and Information Services Tallaght, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland
| | - Laura Keaskin
- Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Dublin 24 D24 NR0A, Ireland
| | - Oonagh M Griffin
- Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Dublin 24 D24 NR0A, Ireland
- Department of Nutrition and Dietetics, St. Vincent’s University Hospital, Dublin 4 D04 T6F4, Ireland
| | - Kevin C Conlon
- Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Dublin 24 D24 NR0A, Ireland
| | - Sinead N Duggan
- Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Dublin 24 D24 NR0A, Ireland
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24
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Furbetta N, Comandatore A, Gianardi D, Palmeri M, Di Franco G, Guadagni S, Caprili G, Bianchini M, Fatucchi LM, Picchi M, Bastiani L, Biancofiore G, Di Candio G, Morelli L. Perioperative Nutritional Aspects in Total Pancreatectomy: A Comprehensive Review of the Literature. Nutrients 2021; 13:1765. [PMID: 34067286 PMCID: PMC8224756 DOI: 10.3390/nu13061765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 02/05/2023] Open
Abstract
Total pancreatectomy (TP) is a highly invasive procedure often performed in patients affected by anorexia, malabsorption, cachexia, and malnutrition, which are risk factors for bad surgical outcome and even may cause enhanced toxicity to chemo-radiotherapy. The role of nutritional therapies and the association between nutritional aspects and the outcome of patients who have undergone TP is described in some studies. The aim of this comprehensive review is to summarize the available recent evidence about the influence of nutritional factors in TP. Preoperative nutritional and metabolic assessment, but also intra-operative and post-operative nutritional therapies and their consequences, are analyzed in order to identify the aspects that can influence the outcome of patients undergoing TP. The results of this review show that preoperative nutritional status, sarcopenia, BMI and serum albumin are prognostic factors both in TP for pancreatic cancer to support chemotherapy, prevent recurrence and prolong survival, and in TP with islet auto-transplantation for chronic pancreatitis to improve postoperative glycemic control and obtain better outcomes. When it is possible, enteral nutrition is always preferable to parenteral nutrition, with the aim to prevent or reduce cachexia. Nowadays, the nutritional consequences of TP, including diabetes control, are improved and become more manageable.
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Affiliation(s)
- Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Annalisa Comandatore
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Desirée Gianardi
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Giovanni Caprili
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Matteo Bianchini
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Lorenzo Maria Fatucchi
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Martina Picchi
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Luca Bastiani
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy;
| | | | - Giulio Di Candio
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.)
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