Department of Pediatric Gastroenterology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
Department of Pediatrics, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey.
Turk J Pediatr. 2021;63(1):102-108. doi: 10.24953/turkjped.2021.01.012.
Although the exact pathophysiology of functional gastrointestinal diseases remains unclear, numerous etiologies have been blamed, including visceral hypersensitivity, gastrointestinal motility disorders, psychological factors, intestinal mucosal inflammation, intestinal microbiota, and post-infectious syndromes. In the present study, we aimed to evaluate pancreatic insufficient patients diagnosed with functional abdominal pain-not otherwise specified (FAP-NOS) according to Rome IV criteria.
The study included a total of 110 patients aged 4-17 years who were diagnosed with FAP-NOS according to Rome IV criteria. The control group consisted of 80 patients with no gastrointestinal disorders and chronic diseases. Glucose, amylase, lipase, pancreatic amylase, immunoreactive trypsinogen (IRT) and fecal elastase (FE-1) levels were examined for each patient.
No significant difference was found between the two groups with regard to lipase, pancreatic amylase, IRT, and serum glucose levels. However, the amylase levels were significantly higher and the FE-1 levels were significantly lower in the study group compared to the control group (p=0.007 and p < 0.001). The cut-off value detected in in ROC analysis for the diagnostic value of FE-1 in predicting FAP-NOS was found to be 140.107 μg/g. Based on this value, the sensitivity, specificity, PPV, and NPV of FE-1 were 82.1%, 66.2%, 77%, 73%, respectively. Accordingly, the likelihood of FE-1 in providing a positive value in patients with FAP-NOS was almost 9 times higher than in individuals without FAP-NOS.
FE-1 levels were significantly lower in children diagnosed with FAP-NOS and we consider that this difference could be attributed to malabsorption secondary to dysbiosis as there is not enough data.
尽管功能性胃肠病的确切病理生理学仍不清楚，但已归咎于许多病因，包括内脏高敏性、胃肠动力障碍、心理因素、肠黏膜炎症、肠道微生物群和感染后综合征。在本研究中，我们旨在根据罗马 IV 标准评估诊断为功能性腹痛-未特指（FAP-NOS）的胰腺功能不全患者。
本研究共纳入 110 名年龄在 4-17 岁之间、根据罗马 IV 标准诊断为 FAP-NOS 的患者。对照组由 80 名无胃肠道疾病和慢性疾病的患者组成。对每位患者进行血糖、淀粉酶、脂肪酶、胰淀粉酶、免疫反应性胰蛋白酶原（IRT）和粪便弹性蛋白酶（FE-1）水平检测。
两组间脂肪酶、胰淀粉酶、IRT 和血清葡萄糖水平无显著差异。然而，与对照组相比，研究组的淀粉酶水平显著升高，FE-1 水平显著降低（p=0.007 和 p<0.001）。ROC 分析检测到 FE-1 预测 FAP-NOS 的诊断价值的截断值为 140.107μg/g。基于该值，FE-1 的敏感性、特异性、PPV 和 NPV 分别为 82.1%、66.2%、77%、73%。因此，FE-1 在 FAP-NOS 患者中呈阳性的可能性几乎是在无 FAP-NOS 个体中的 9 倍。
诊断为 FAP-NOS 的儿童的 FE-1 水平显著降低，我们认为这种差异可能归因于由于菌群失调导致的吸收不良，但目前尚无足够的数据支持这一结论。
