Huang Chung-Tsui, Lee Tzong-Hsi, Lin Cheng-Kuan, Chen Chao-Yi, Yang Yi-Feng, Liang Yao-Jen
Graduate Institute of Applied Science and Engineering (ASE), College of Science and Engineering, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 242062, Taiwan.
Department of Internal Medicine, Division of Gasteroenterology and Hepatology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan.
Diagnostics (Basel). 2021 Jul 13;11(7):1252. doi: 10.3390/diagnostics11071252.
A new concept for the diagnosis and management of non-functional dyspepsia in guidelines was lacking in the past decade. Medical advancement has proven pancreatic fibrosis (essential image evidence of early chronic pancreatitis) to be a cause of dyspepsia and related to pancreatic exocrine dysfunction. This study aimed to analyze the clinical picture, biomarker, and percentage of pancreatic fibrosis in the dyspeptic population. A total of 141 consecutive patients were retrospectively enrolled. They were diagnosed with peptic ulcer disease, 9.2% ( = 13); pancreatic fibrosis, 17% ( = 24); pure Helicobacter pylori infection, 19.9% ( = 28); functional dyspepsia, 53.2% ( = 75); and chronic pancreatitis, 0.7% ( = 1). Among those with pancreatic fibrosis, ( = 24), 11 were diagnosed on the basis of a pancreatic acoustic radiation force impulse exceeding 1.4 m/s, and the remaining 13 were diagnosed with early chronic pancreatitis with at least three of the Japanese endoscopic ultrasonography criteria. The anatomic distribution of parenchymal criteria of early chronic pancreatitis was head, 53%; body, 38%; and tail, 9%. There were 17 cases (71%, 17/24) without Helicobacter pylori and whose dyspepsia improved after pancreatic enzyme replacement with a ratio of 82.3% (14/17). Of the 141 cases, 19 received gastric emptying scintigraphy and Western blot analysis of chromogranin-A in duodenal mucosa. Delayed gastric emptying was more common in functional dyspepsia and chromogranin-A was expressed more in pancreatic fibrosis. In conclusion, pancreatic fibrosis (including early chronic pancreatitis) outnumbered peptic ulcer disease in the dyspeptic population and pancreatic enzyme therapy was effective for 82% of cases. In early chronic pancreatitis, pancreatic fibrosis is dominant in the head location, and duodenum mucosa chromogranin-A is a potential biomarker with increased expression in an age-matched manner.
在过去十年中，指南中缺乏关于非功能性消化不良诊断和管理的新概念。医学进展已证实胰腺纤维化（早期慢性胰腺炎的重要影像证据）是消化不良的一个病因，且与胰腺外分泌功能障碍有关。本研究旨在分析消化不良人群的临床表现、生物标志物以及胰腺纤维化的比例。总共回顾性纳入了141例连续患者。他们被诊断为消化性溃疡病，9.2%（n = 13）；胰腺纤维化，17%（n = 24）；单纯幽门螺杆菌感染，19.9%（n = 28）；功能性消化不良，53.2%（n = 75）；以及慢性胰腺炎，0.7%（n = 1）。在胰腺纤维化患者（n = 24）中，11例是根据胰腺声辐射力脉冲超过1.4 m/s诊断的，其余13例是根据日本内镜超声检查标准中的至少三条诊断为早期慢性胰腺炎。早期慢性胰腺炎实质标准的解剖分布为：胰头，53%；胰体，38%；胰尾，9%。有17例（71%，17/24）无幽门螺杆菌感染，其消化不良在胰腺酶替代治疗后改善，改善率为82.3%（14/17）。在141例患者中，19例接受了胃排空闪烁扫描和十二指肠黏膜嗜铬粒蛋白A的蛋白质印迹分析。胃排空延迟在功能性消化不良中更常见，嗜铬粒蛋白A在胰腺纤维化中表达更多。总之，在消化不良人群中，胰腺纤维化（包括早期慢性胰腺炎）的病例数超过消化性溃疡病，胰腺酶治疗对82%的病例有效。在早期慢性胰腺炎中，胰腺纤维化在胰头部位占主导，十二指肠黏膜嗜铬粒蛋白A是一种潜在的生物标志物，其表达随年龄增长而增加。
