Shafqet Muhammad, Sharzehi Kaveh
Gastroenterology and Hepatology, Temple University Hospital, Philadelphia, PA, USA.
Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L461, Portland, OR, 97239, USA.
Curr Treat Options Gastroenterol. 2017 Dec;15(4):508-519. doi: 10.1007/s11938-017-0163-x.
The emphasis of this review article is to bring to the forefront the spectrum of pancreatobiliary disorders and their association with diabetes. We hope to systematically discuss the link between diabetes and disorders of the pancreas including acute and chronic pancreatitis, as well as pancreatic cancer. We also hope to review and highlight the literature with respect to other cancers of the biliary tree including gallbladder and cholangiocarcinoma. Lastly, we discuss diabetes and biliary dyskinesia.
Newer cohort studies suggest the presence of diabetes to increase the severity and worsen outcomes in acute pancreatitis. Post pancreatitis diabetes is a novel disease entity being increasingly recognized. The use of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis may attenuate the risk of endocrine dysfunction. Pancreatic cancer may either be the consequence of diabetes or a presenting manifestation. The use of anti-diabetic medications may confer protection against development of pancreatic cancer. Gallbladder adenocarcinoma and cholangiocarcinoma risks are elevated in those with underlying diabetes. Diabetes can directly impact or deteriorate outcome of acute and chronic pancreatitis and well as pancreatobiliary malignancies. It could also occur as a result of loss of endocrine function after pancreatitis. Like many areas of the digestive tract, biliary motility could be impacted by diabetes.
本文献综述的重点是将胰腺疾病谱及其与糖尿病的关联置于前沿。我们希望系统地讨论糖尿病与胰腺疾病之间的联系，包括急性和慢性胰腺炎以及胰腺癌。我们还希望回顾并突出有关胆管其他癌症（包括胆囊癌和胆管癌）的文献。最后，我们讨论糖尿病与胆道运动障碍。
更新的队列研究表明，糖尿病的存在会增加急性胰腺炎的严重程度并使预后恶化。胰腺炎后糖尿病是一种越来越被认可的新型疾病实体。在慢性胰腺炎中使用胰酶替代疗法（PERT）可能会降低内分泌功能障碍的风险。胰腺癌可能是糖尿病的后果，也可能是首发表现。使用抗糖尿病药物可能对预防胰腺癌有保护作用。患有基础糖尿病的人群中胆囊腺癌和胆管癌的风险升高。糖尿病可直接影响急性和慢性胰腺炎以及胰腺胆道恶性肿瘤的预后或使其恶化。它也可能是胰腺炎后内分泌功能丧失的结果。与消化道的许多部位一样，糖尿病可能会影响胆道运动。
