Department of Surgery,Trinity College Dublin, Trinity Centre for Health Sciences,Tallaght Hospital,Dublin 24,Ireland.
Proc Nutr Soc. 2017 Nov;76(4):484-494. doi: 10.1017/S0029665117001045. Epub 2017 Jul 24.
Chronic pancreatitis is a chronic inflammatory disease of the pancreas characterised by irreversible morphological change and typically causing pain and/or permanent loss of function. This progressive, irreversible disease results in destruction of healthy pancreatic tissue and the development of fibrous scar tissue. Gradual loss of exocrine and endocrine function follows, along with clinical manifestations such as steatorrhoea, abdominal pain and diabetes. Nutrition in chronic pancreatitis has been described as a problem area and, until recently, there was little research on the topic. It is often asserted that >90 % of the pancreas must be damaged before exocrine insufficiency occurs; however, an exploration of the original studies from the 1970s found that the data do not support this assertion. The management of steatorrhoea with pancreatic enzyme replacement therapy is the mainstay of nutritional management, and early identification and treatment is a key. The presence of steatorrhoea, coupled with poor dietary intake (due to intractable abdominal pain, gastrointestinal side effects and often alcoholism) renders the chronic pancreatitis patients at considerable risk for undernutrition, muscle depletion and fat-soluble vitamin deficiency. Premature osteoporosis/osteopenia afflicts two-thirds of patients as a consequence of poor dietary intake of calcium and vitamin D, low physical activity, low sunlight exposure, heavy smoking, as well as chronic low-grade inflammation. Bone metabolism studies show increased bone formation as well as bone resorption in chronic pancreatitis, indicating that bone turnover is abnormally high. Loss of the pancreatic islet cells occurs later in the disease process as the endocrine cells are diffusely distributed throughout the pancreatic parenchyma. Patients may develop type 3c (pancreatogenic) diabetes, which is complicated by concurrent decreased glucagon secretion, and hence an increased risk of hypoglycaemia. Diabetes control is further complicated by poor diet, malabsorption and (for some) alcoholism, and therefore those with type 3c diabetes have clinical characteristics and therapeutic goals that are different from that of type 1 and type 2 diabetes patients. This review describes emerging research and clinical guidelines for nutrition in chronic pancreatitis.
慢性胰腺炎是一种胰腺的慢性炎症性疾病，其特征为不可逆转的形态学改变，通常导致疼痛和/或永久性功能丧失。这种进行性、不可逆的疾病会导致健康胰腺组织的破坏和纤维瘢痕组织的发展。随后逐渐出现外分泌和内分泌功能丧失，并出现脂肪泻、腹痛和糖尿病等临床表现。慢性胰腺炎的营养问题一直以来都被认为是一个难题，直到最近，针对这一课题的研究才刚刚起步。人们常说，只有当胰腺的 90%以上受到损伤时才会出现外分泌功能不全；然而，对 20 世纪 70 年代的原始研究进行探讨后发现，这些数据并不能支持这一说法。使用胰酶替代疗法治疗脂肪泻是营养管理的主要方法，早期发现和治疗是关键。脂肪泻的存在，加上由于难以控制的腹痛、胃肠道副作用以及经常饮酒导致的不良饮食摄入，使慢性胰腺炎患者面临严重的营养不足、肌肉消耗和脂溶性维生素缺乏的风险。由于钙和维生素 D 摄入不足、低体力活动、低日照、大量吸烟以及慢性低度炎症等原因，骨质疏松症/骨量减少在三分之二的患者中过早发生。骨代谢研究表明，慢性胰腺炎中骨形成和骨吸收均增加，表明骨转换异常升高。随着疾病的发展，胰岛细胞逐渐丧失，因为内分泌细胞广泛分布在胰腺实质中。患者可能会患上 3 型（胰源性）糖尿病，这种糖尿病同时伴有胰高血糖素分泌减少，因此低血糖的风险增加。糖尿病的控制还因不良饮食、吸收不良以及（对某些人而言）饮酒而变得更加复杂，因此，3 型糖尿病患者具有与 1 型和 2 型糖尿病患者不同的临床特征和治疗目标。本综述描述了慢性胰腺炎营养方面的新研究和临床指南。
