Regan P T, DiMagno E P
Gastroenterology. 1980 Mar;78(3):484-7.
The coexistence of nontropical sprue and advanced pancreatic insufficiency is uncommon. The purposes of this report are to: (a) describe 3 patients with non-tropical spruc and severe pancreatic insufficiency, (b) determine the frequency, magnitude, and clinical importance of diminished pancreatic secretion in nontropical sprue, and (c) assess whether patients with pancreatic insufficency secondary to chronic pancreatitis or pancreatic cancer have jejunal mucosal histologic abnormalities. In each of 3 patients with nontropical sprue and associated severe exocrine pancreatic insufficiency, an optimal clinical response required the appropriate treatment of both causes of malabsorption. Of 31 subjects with proved nontropical sprue, cholecystokinin-stimulated duodenal tryptic activity or lipolytic activity (or both) was reduced in 13 (42%) but severely reduced in only the three case reports (10%). The morphologic structure of the small bowel was normal in 21 patients with primary pancreatic insufficiency secondary to chronic pancreatitis or pancreatic cancer. Mild-to-moderate exocrine pancreatic insufficiency is a frequent finding in untreated nontropical sprue, is presumably reversible, and rarely contributes to the development of steatorrhea. However, if patients with nontropical sprue fail to respond to a gluten-free diet, coexistent severe pancreatic insufficiency is a possible cause for treatment failure.
非热带性口炎性腹泻与严重胰腺功能不全并存的情况并不常见。本报告的目的是：(a) 描述3例患有非热带性口炎性腹泻和严重胰腺功能不全的患者；(b) 确定非热带性口炎性腹泻中胰腺分泌减少的频率、程度及临床重要性；(c) 评估继发于慢性胰腺炎或胰腺癌的胰腺功能不全患者空肠黏膜组织学是否存在异常。在3例患有非热带性口炎性腹泻并伴有严重外分泌性胰腺功能不全的患者中，每例患者要获得最佳临床疗效都需要对两种吸收不良病因进行恰当治疗。在31例已证实患有非热带性口炎性腹泻的受试者中，13例（42%）的胆囊收缩素刺激后的十二指肠胰蛋白酶活性或脂肪分解活性（或两者）降低，但仅在3例病例报告（10%）中严重降低。在21例继发于慢性胰腺炎或胰腺癌的原发性胰腺功能不全患者中，小肠的形态结构正常。轻度至中度外分泌性胰腺功能不全在未经治疗的非热带性口炎性腹泻中很常见，大概是可逆的，很少导致脂肪泻的发生。然而，如果非热带性口炎性腹泻患者对无麸质饮食无反应，并存的严重胰腺功能不全可能是治疗失败的原因。
