RESUMO
Patients with chronic pancreatitis may have abnormal gastrointestinal transit, but the factors underlying these abnormalities are poorly understood. Gastrointestinal transit was assessed, in 40 male outpatients with alcohol-related chronic pancreatitis and 18 controls, by scintigraphy after a liquid meal labeled with (99m)technetium-phytate. Blood and urinary glucose, fecal fat excretion, nutritional status, and cardiovascular autonomic function were determined in all patients. The influence of diabetes mellitus, malabsorption, malnutrition, and autonomic neuropathy on abnormal gastrointestinal transit was assessed by univariate analysis and Bayesian multiple regression analysis. Accelerated gastrointestinal transit was found in 11 patients who showed abnormally rapid arrival of the meal marker to the cecum. Univariate and Bayesian analysis showed that diabetes mellitus and autonomic neuropathy had significant influences on rapid transit, which was not associated with either malabsorption or malnutrition. In conclusion, rapid gastrointestinal transit in patients with alcohol-related chronic pancreatitis is related to diabetes mellitus and autonomic neuropathy.
Assuntos
Trânsito Gastrointestinal/fisiologia , Intestino Delgado/fisiopatologia , Pancreatite Alcoólica/fisiopatologia , Pancreatite Crônica/fisiopatologia , Adulto , Doenças do Sistema Nervoso Autônomo/diagnóstico por imagem , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Teorema de Bayes , Índice de Massa Corporal , Ceco/diagnóstico por imagem , Ceco/fisiopatologia , Neuropatias Diabéticas/diagnóstico por imagem , Neuropatias Diabéticas/fisiopatologia , Humanos , Síndromes de Malabsorção/diagnóstico por imagem , Síndromes de Malabsorção/fisiopatologia , Masculino , Pessoa de Meia-Idade , Compostos de Organotecnécio , Pancreatite Alcoólica/diagnóstico por imagem , Pancreatite Crônica/diagnóstico por imagem , Ácido Fítico , Cintilografia , Esteatorreia/diagnóstico por imagem , Esteatorreia/fisiopatologiaRESUMO
BACKGROUND: Patients with alcohol-related chronic pancreatitis (ARCP) may present with abnormal gastric emptying (GE), which has been ascribed mainly to nutrient maldigestion. Nevertheless, many patients also have diabetes with autonomic dysfunction and malnutrition and the role of these factors on abnormal GE has not been investigated. GOALS: To determine the influences of malabsorption, diabetes, malnutrition, and autonomic dysfunction on GE abnormalities in patients with ARCP. STUDY: Forty ARCP outpatients and 18 healthy controls were studied. GE was measured by scintigraphy after a standard, liquid, nutrient meal labeled with Technetium-phytate. Autonomic function was evaluated by cardiovascular tests. The influence of each factor on abnormal GE was assessed by Bayesian multiple regression analysis. RESULTS: In the ARCP group, GE was abnormal in 19 patients (47.5%), who showed either accelerated (N=12) or delayed emptying (N=7). Diabetes was highly prevalent (P<0.01) in ARCP patients with either rapid or delayed GE (18/19). Multiple regression analysis showed that not only diabetes, but also autonomic dysfunction has significant effects on abnormal GE, whereas malabsorption and malnutrition seemed not to be associated to abnormal emptying. CONCLUSIONS: A substantial proportion of patients with ARCP may have abnormal GE. Either delayed or accelerated GE seem to be related to underlying diabetes mellitus and autonomic neuropathy rather than to nutrient malabsorption and malnutrition.
Assuntos
Esvaziamento Gástrico , Pancreatite Alcoólica/fisiopatologia , Adulto , Doenças do Sistema Nervoso Autônomo/epidemiologia , Diabetes Mellitus/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Alcoólica/complicações , Cintilografia , Fatores de Risco , Estômago/diagnóstico por imagem , TecnécioRESUMO
Ascite pancreática (AP) é considerada causa incomum de ascite e consiste em acúmulo de fluído intraperitoneal exsudativo e rico em amilase, resultante da ruptura de pseudocisto ou ducto pancreático. Relatamos um caso de AP em paciente com pancreatite crônica alcoólica tratado de maneira conservadora, e revisamos aspectos acerca da fisiopatologia, diagnóstico e tratamento desta condiçäo clínica.
Assuntos
Humanos , Masculino , Adulto , Ascite , Pseudocisto Pancreático , Pancreatite Alcoólica/diagnóstico , Pancreatite Alcoólica/fisiopatologia , Pancreatite Alcoólica/terapiaRESUMO
Patients with alcohol-related chronic pancreatitis (ARCP) often have peripheral neuropathy, but no data on the occurrence of autonomic neuropathy (AN) are available for this condition. To assess the autonomic function and the significance of its abnormalities for the prognosis of ARCP, 18 patients with ARCP and associated diabetes mellitus (P-DM group), 10 with ARCP without evidence of diabetes mellitus (P group), 17 patients with insulin-dependent diabetes mellitus (IDDM group), and 18 healthy controls answered a structured questionnaire and underwent three standardized cardiovascular (CV) tests that yielded six different parameters for autonomic nerve function. Patients with at least one symptom plus two abnormal results on CV tests were regarded as having AN. ARCP patients were followed up for 48 months and mortality rates were recorded. The proportions of patients with AN were 66.6% in the P-DM group, 30.0% in the P group, and 29.4% in IDDM patients. Seven of 15 ARCP patients with AN died during follow-up, compared with one of 13 of those without AN (p < 0.037). In conclusion, AN is commonly found in ARCP patients and carries an ominous prognosis.