Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain

Nicholas J. Talley, Gerald Holtmann, Quoc Nam Nguyen, Peter Gibson, Peter Bampton, Martin Veysey, James Wong, Stephen Philcox, Natasha Koloski, Lisa Bunby, Michael Jones

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background and Aim: A previous UK study showed that 6.1% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) had evidence of severe pancreatic exocrine insufficiency (PEI), but these findings need replication. We aimed to identify the prevalence of PEI based on fecal elastase stool testing in consecutive outpatients presenting with chronic unexplained abdominal pain and/or diarrhea and/or IBS-D. Methods: Patients aged over 40 years presenting to hospital outpatient clinics from six sites within Australia with unexplained abdominal pain and/or diarrhea for at least 3 months and/or IBS-D were studied. Patients completed validated questionnaires and donated a stool sample in which elastase concentration was measured by ELISA. A concentration of < 100 mcg/g stool represented severe and < 200 mcg/g mild to moderate PEI. Patients whose fecal elastase was < 200 mcg/g underwent testing for pancreatic pathology with an endoscopic ultrasound or abdominal CT. Results: Two hundred eighteen patients (mean age of 60 years, 29.4% male) were studied. PEI was found in 4.6% (95% CI 2.2–8.3%) (n = 10), with five patients (2.3% (95% CI 0.8–5.3%) having severe PEI. Only male sex and heavy alcohol use were significantly associated with abnormal versus normal pancreatic functioning. Of seven patients who underwent endoscopic ultrasound or CT, two had features indicative of chronic pancreatitis. Conclusion: One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these. This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported.

LanguageEnglish
Pages1813-1817
Number of pages5
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume32
Issue number11
DOIs
Publication statusPublished - Nov 2017

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Exocrine Pancreatic Insufficiency
Chronic Pancreatitis
Abdominal Pain
Diarrhea
Pancreatic Elastase
Irritable Bowel Syndrome
Hospital Outpatient Clinics
Outpatients
Enzyme-Linked Immunosorbent Assay
Alcohols
Pathology

Keywords

  • diarrhea and malabsorption
  • functional disorders
  • pancreatic physiology

Cite this

Talley, Nicholas J. ; Holtmann, Gerald ; Nguyen, Quoc Nam ; Gibson, Peter ; Bampton, Peter ; Veysey, Martin ; Wong, James ; Philcox, Stephen ; Koloski, Natasha ; Bunby, Lisa ; Jones, Michael. / Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain. In: Journal of Gastroenterology and Hepatology (Australia). 2017 ; Vol. 32, No. 11. pp. 1813-1817.
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title = "Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain",
abstract = "Background and Aim: A previous UK study showed that 6.1{\%} of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) had evidence of severe pancreatic exocrine insufficiency (PEI), but these findings need replication. We aimed to identify the prevalence of PEI based on fecal elastase stool testing in consecutive outpatients presenting with chronic unexplained abdominal pain and/or diarrhea and/or IBS-D. Methods: Patients aged over 40 years presenting to hospital outpatient clinics from six sites within Australia with unexplained abdominal pain and/or diarrhea for at least 3 months and/or IBS-D were studied. Patients completed validated questionnaires and donated a stool sample in which elastase concentration was measured by ELISA. A concentration of < 100 mcg/g stool represented severe and < 200 mcg/g mild to moderate PEI. Patients whose fecal elastase was < 200 mcg/g underwent testing for pancreatic pathology with an endoscopic ultrasound or abdominal CT. Results: Two hundred eighteen patients (mean age of 60 years, 29.4{\%} male) were studied. PEI was found in 4.6{\%} (95{\%} CI 2.2–8.3{\%}) (n = 10), with five patients (2.3{\%} (95{\%} CI 0.8–5.3{\%}) having severe PEI. Only male sex and heavy alcohol use were significantly associated with abnormal versus normal pancreatic functioning. Of seven patients who underwent endoscopic ultrasound or CT, two had features indicative of chronic pancreatitis. Conclusion: One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these. This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported.",
keywords = "diarrhea and malabsorption, functional disorders, pancreatic physiology",
author = "Talley, {Nicholas J.} and Gerald Holtmann and Nguyen, {Quoc Nam} and Peter Gibson and Peter Bampton and Martin Veysey and James Wong and Stephen Philcox and Natasha Koloski and Lisa Bunby and Michael Jones",
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Talley, NJ, Holtmann, G, Nguyen, QN, Gibson, P, Bampton, P, Veysey, M, Wong, J, Philcox, S, Koloski, N, Bunby, L & Jones, M 2017, 'Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain', Journal of Gastroenterology and Hepatology (Australia), vol. 32, no. 11, pp. 1813-1817. https://doi.org/10.1111/jgh.13791

Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain. / Talley, Nicholas J.; Holtmann, Gerald; Nguyen, Quoc Nam; Gibson, Peter; Bampton, Peter; Veysey, Martin; Wong, James; Philcox, Stephen; Koloski, Natasha; Bunby, Lisa; Jones, Michael.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 32, No. 11, 11.2017, p. 1813-1817.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain

AU - Talley, Nicholas J.

AU - Holtmann, Gerald

AU - Nguyen, Quoc Nam

AU - Gibson, Peter

AU - Bampton, Peter

AU - Veysey, Martin

AU - Wong, James

AU - Philcox, Stephen

AU - Koloski, Natasha

AU - Bunby, Lisa

AU - Jones, Michael

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N2 - Background and Aim: A previous UK study showed that 6.1% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) had evidence of severe pancreatic exocrine insufficiency (PEI), but these findings need replication. We aimed to identify the prevalence of PEI based on fecal elastase stool testing in consecutive outpatients presenting with chronic unexplained abdominal pain and/or diarrhea and/or IBS-D. Methods: Patients aged over 40 years presenting to hospital outpatient clinics from six sites within Australia with unexplained abdominal pain and/or diarrhea for at least 3 months and/or IBS-D were studied. Patients completed validated questionnaires and donated a stool sample in which elastase concentration was measured by ELISA. A concentration of < 100 mcg/g stool represented severe and < 200 mcg/g mild to moderate PEI. Patients whose fecal elastase was < 200 mcg/g underwent testing for pancreatic pathology with an endoscopic ultrasound or abdominal CT. Results: Two hundred eighteen patients (mean age of 60 years, 29.4% male) were studied. PEI was found in 4.6% (95% CI 2.2–8.3%) (n = 10), with five patients (2.3% (95% CI 0.8–5.3%) having severe PEI. Only male sex and heavy alcohol use were significantly associated with abnormal versus normal pancreatic functioning. Of seven patients who underwent endoscopic ultrasound or CT, two had features indicative of chronic pancreatitis. Conclusion: One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these. This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported.

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