Gastrointestinal symptoms before and after total pancreatectomy with islet autotransplantation: the role of pancreatic enzyme dosing and adherence.
Gastrointestinal symptoms before and after total pancreatectomy with islet autotransplantation: the role of pancreatic enzyme dosing and adherence.
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DOI：
10.1097/mpa.0000000000000266
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发表时间：
2015-04
期刊：
影响因子：
2.9
通讯作者：
Schwarzenberg SJ
中科院分区：
文献类型：
--
作者：
Crosby J;Bellin MD;Radosevich DM;Chinnakotla S;Dunn TB;Pruett TL;Freeman ML;Beilman GJ;Schwarzenberg SJ
在一大群接受胰岛自体移植全胰腺切除术 (TPIAT) 的受试者中，我们评估了手术前后胃肠道症状的患病率和持续时间，并确定酶依从性对胃肠道症状的影响。从 2008 年至 2011 年间在明尼苏达大学接受 TPIAT 的 184 名年龄在 5 岁至 66 岁之间的受试者中收集了 356 份术前和术后问卷。对问卷进行了自我报告的胃肠道症状的频率和严重程度、胰酶的使用和血糖变异指数（GVI）的分析。手术后，患者报告的脂肪泻增加；便秘减少。尽管酶依从性很高，但 44-69% 的受试者在手术前后胃肠道症状干扰了日常活动。术后，≥79% 的受试者报告在所有餐食中均一致使用酶。胃肠道症状的存在并不随依从性而变化。与 GVI 0 相比，GVI 2 的脂肪泻几率增加 2.8 倍（95% 置信区间 1.1-7.0）。TPIAT 后胃肠道症状很常见；需要持续的管理。在该队列中，不遵守酶并不是导致腹泻/脂肪泻的主要原因。血糖变异性与脂肪泻密切相关。对酶替代反应不佳可能会使糖尿病管理复杂化。
In a large cohort of subjects undergoing total pancreatectomy with islet autotransplantation (TPIAT), we assessed the prevalence and duration of gastrointestinal symptoms before and after the procedure and to determine the impact of enzyme adherence on gastrointestinal symptoms. 356 pre- and post-operative questionnaires were collected from 184 subjects between ages of 5 and 66 years who underwent TPIAT between 2008 and 2011 at University of Minnesota. Questionnaires were analyzed for self-reported frequency and severity of gastrointestinal symptoms, pancreatic enzyme usage, and glycemic variability index (GVI). After surgery, patient-reported steatorrhea increased; constipation decreased. Gastrointestinal symptoms interfered with daily activity in 44–69% of subjects, before and after surgery, despite high reported enzyme adherence. Post-operatively, ≥79% of subjects reported consistent use of enzymes at all meals. Presence of gastrointestinal symptoms did not vary with adherence. GVI of 2 had a 2.8 fold increased odds of steatorrhea (95% confidence interval 1.1– 7.0) compared to GVI of 0. Gastrointestinal symptoms were common after TPIAT; ongoing management is needed. Enzyme non-adherence was not a major contributor to diarrhea/steatorrhea in this cohort. Glycemic variability was closely associated with steatorrhea; poor response to enzyme replacement may complicate diabetes management.