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Incidence and severity of nutritional deficiency states in chronic exocrine pancreatic insufficiency: Comparison with nontropical sprue

Summary

Evidences of nutritional deficiencies were much less frequent in 90 patients with untreated or inadequately treated chronic exocrine pancreatic insufficiency, many with marked steatorrhea, than in a previous series of patients with nontropical sprue. Hemorrhage due to prothrombin deficiency and osteomalacia associated with bone pain or hypocalcemic tetany, common in patients with nontropical sprue, were not encountered in the patients with exocrine pancreatic insufficiency. Furthermore, no patient in the series had a blood hemoglobin concentration below 10.gm./100 ml., whereas 21% of patients with nontropical sprue had values below this level. Two patients had anemia due to Vitamin B12 deficiency but none had anemia due to iron or folic acid deficiency. Factors possibly responsible for these findings include shorter duration of exocrine pancreatic insufficiency than nontropical sprue, small-bowel mucosal damage characteristic of nontropical sprue but absent in exocrine pancreatic insufficiency, and increased food intake in exocrine pancreatic insufficiency.

Absence of severe nutritional deficiency states may help differentiate exocrine pancreatic insufficiency from other malabsorption states. Also diagnostically helpful is passage by rectum of gross oil separate from the rest of the fecal bulk, common in exocrine pancreatic insufficiency but apparently not occurring in malabsorption syndromes having other causes.

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References

  1. 1.

    Comfort, M. W. Syndrome of progressive destruction of the pancreas.Med Rec Ann 43:855, 1949.

    Google Scholar 

  2. 2.

    Gambill, E. E., andPugh, D. G. Pancreatic calcification: Study of clinical and roentgenologic data on thirty-nine cases.Arch Int Med 81:301, 1948.

    Google Scholar 

  3. 3.

    Gross, J. B., andComfort, M. W. Chronic pancreatitis.Amer J Med 21:596, 1956.

    PubMed  Google Scholar 

  4. 4.

    Douglas, G. J., Jr., Reinauer, A. J., Brooks, W. C, andPratt, J. H. The effect on digestion and absorption of excluding the pancreatic juice from the intestine.Gastroenterology 23:452, 1953.

    PubMed  Google Scholar 

  5. 5.

    Pratt, J. H. Study of steatorrhea, with special reference to its occurrence in pancreatic disease and sprue.Amer J Med Sci 187:222, 1934.

    Google Scholar 

  6. 6.

    Dornberger, G. R., Comfort, M. W., Wollaeger, E. E., andPower, M. H. Total fecal solids, fat and nitrogen: Study of patients with chronic relapsing pancreatitis.Gastroenterology 11:691, 1948.

    Google Scholar 

  7. 7.

    Wollaeger, E. E., Comfort, M. W., Claggett, O. T., andOsterberg, A. E. Efficiency of gastrointestinal tract after resection of head of pancreas.JAMA 137:838, 1948.

    Google Scholar 

  8. 8.

    Bartholomew, L. G., Baggenstoss, A. H., Morlock, C. G., andComfort, M. W. Primary atrophy and lipomatosis of the pancreas.Gastroenterology 36:563, 1959.

    PubMed  Google Scholar 

  9. 9.

    Christiansen, P. A., Kirsner, J. B., andAblaza, J. D-xylose and its use in the diagnosis of malabsorptive states.Amer J Med 27:443, 1959.

    PubMed  Google Scholar 

  10. 10.

    Fordtran, J. S., Clodi, P. H., Soergel, K. H., andIngelfinger, F. J. Sugar absorption tests, with special reference to 3-0-methyl-d-glucose and d-xylose.Ann Int Med 57:883, 1962.

    PubMed  Google Scholar 

  11. 11.

    Kalser, M. H. Tests of malassimilation useful in the differential diagnosis of the malabsorption syndromes.Med Clin N Amer 41:1553, 1957.

    PubMed  Google Scholar 

  12. 12.

    Green, P. A., andWollaeger, E. E. The clinical behavior of sprue in the United States.Gastroenterology 38:399, 1960.

    PubMed  Google Scholar 

  13. 13.

    Wollaeger, E. E., andScribner, B. H. Delayed excretion of water with regular nocturnal diuresis in patients with nontropical sprue (idiopathic steatorrhea).Gastroenterology 19:224, 1951.

    PubMed  Google Scholar 

  14. 14.

    Comfort, M. W., Wollaeger, E. E., Taylor, A. B., andPower, M. H. Nontropical sprue: Observations on absorption and metabolism.Gastroenterology 23: 155, 1953.

    PubMed  Google Scholar 

  15. 15.

    Marks, I. N., Bank, S., andAirth, E. M. Pancreatic replacement therapy in the treatment of pancreatic steatorrhea.Gut 4:217, 1963.

    Google Scholar 

  16. 16.

    Handelsman, M. B., Golden, L. A., andPratt, J. H. The effect of variations in the diet on the absorption of food in the absence of pancreatic digestion.J Nutr 8: 479, 1934.

    Google Scholar 

  17. 17.

    Coffey, R. J., Mann, F. C, andBollman, J. L. Influence of pancreas on utilization of foodstuff.Amer J Dig Dis 7:144, 1940.

    Google Scholar 

  18. 18.

    Wolstenholme, G. E. W., and Cameron, M. P. Ciba Foundation Study Group No. 14: Intestinal Biopsy. Little, Boston, 1962, p. 120.

    Google Scholar 

  19. 19.

    Comfort, M. W., andWollaeger, E. E. Nontropical sprue: Pathologic physiology, diagnosis, and therapy.AMA Arch Int Med 98:807, 1956.

    Google Scholar 

  20. 20.

    Higgins, J. A., Lee, P. R., Scholer, J. F., Reitemeier, R. J., Code, C. F., Wollaeger, E. E. Absorption of water and sodium from the small intestine of patients with nontropical sprue.J Clin Invest 36:265, 1957.

    PubMed  Google Scholar 

  21. 21.

    Rubin, C. Quoted by Sleisenger, M. H.: Panel on malabsorption.Gastroenterology 47:452, 1964.

    PubMed  Google Scholar 

  22. 22.

    Madanagopalan, N., Shiner, M., andRowe, B. Measurements of small intestinal mucosa obtained by peroral biopsy.Amer J Med 38:42, 1965.

    PubMed  Google Scholar 

  23. 23.

    Davis, A. E., andBadenoch, J. Iron absorption in pancreatic disease.Lancet 2:6, 1962.

    Google Scholar 

  24. 24.

    Deller, D. J. Iron53 absorption measurements by whole-body counting: Studies in alcoholic cirrhosis, hemochromatosis, and pancreatitis.Amer J Dig Dis 10: 249, 1965.

    PubMed  Google Scholar 

  25. 25.

    Veeger, W., Abels, J., Hellemans, N., andNieweg, H. O. Effect of sodium bicarbonate and pancreatin on the absorption of Vitamin B12 and fat in pancreatic insufficiency.New Engl J Med 267:1341, 1962.

    PubMed  Google Scholar 

  26. 26.

    Wollaeger, E. E., andScudamore, H. H. Spectrum of diseases causing steatorrhea.Arch Int Med 113:819, 1964.

    Google Scholar 

  27. 27.

    Green, P. A., Wollaeger, E. E., Sprague, R. G., andBrown, A. L., Jr. Diabetes mellitus associated with nontropical sprue: Report of four cases.Diabetes 11: 388, 1962.

    PubMed  Google Scholar 

  28. 28.

    Berge, K. G., Wollaeger, E. E., Scholz, D. A., Rooke, E. D., andSprague, R. G. Steatorrhea complicating diabetes mellitus with neuropathy: Report of cases without apparent external pancreatic insufficiency.Diabetes 5:25, 1956.

    PubMed  Google Scholar 

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Evans, W.B., Wollaeger, E.E. Incidence and severity of nutritional deficiency states in chronic exocrine pancreatic insufficiency: Comparison with nontropical sprue. Digest Dis Sci 11, 594–606 (1966). https://doi.org/10.1007/BF02233507

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Keywords

  • Folic Acid
  • Osteomalacia
  • Folic Acid Deficiency
  • Increase Food Intake
  • Steatorrhea