Dóra Illés

Analysis of research activity in gastroenterology: Pancreatitis is in real danger

Objective Biomedical investment trends in 2015 show a huge decrease of investment in gastroenterology. Since academic research usually provides the basis for industrial research and development (R&D), our aim was to understand research trends in the field of gastroenterology over the last 50 years and identify the most endangered areas. Methods We searched for PubMed hits for gastrointestinal (GI) diseases for the 1965–2015 period. Overall, 1,554,325 articles were analyzed. Since pancreatology was identified as the most endangered field of research within gastroenterology, we carried out a detailed evaluation of research activity in pancreatology. Results In 1965, among the major benign GI disorders, 51.9% of the research was performed on hepatitis, 25.7% on pancreatitis, 21.7% on upper GI diseases and only 0.7% on the lower GI disorders. Half a century later, in 2015, research on hepatitis and upper GI diseases had not changed significantly; however, studies on pancreatitis had dropped to 10.7%, while work on the lower GI disorders had risen to 23.4%. With regard to the malignant disorders (including liver, gastric, colon, pancreatic and oesophageal cancer), no such large-scale changes were observed in the last 50 years. Detailed analyses revealed that besides the drop in research activity in pancreatitis, there are serious problems with the quality of the studies as well. Only 6.8% of clinical trials on pancreatitis were registered and only 5.5% of these registered trials were multicentre and multinational (more than five centres and nations), i.e., the kind that provides the highest level of impact and evidence level. Conclusions There has been a clear drop in research activity in pancreatitis. New international networks and far more academic R&D activities should be established in order to find the first therapy specifically for acute pancreatitis.

Exocrine pancreatic insufficiency in type 1 and type 2 diabetes mellitus: do we need to treat it? A systematic review

The exocrine and endocrine pancreata are very closely linked both anatomically and physiologically. Abdominal symptoms such as nausea, bloating, diarrhea, steatorrhea, and weight loss can often occur in diabetic patients. Impairments of the exocrine pancreatic function seem to be a frequent complication of diabetes mellitus; however, they are largely overlooked. The aim of this paper is to provide an overview of the current concepts of exocrine pancreatic insufficiency (PEI) in diabetes mellitus. The prevalence and symptoms of PEI in diabetes mellitus, the pathomechanism, and difficulties of diagnosis and therapy of PEI are summarized in this systematic review.

Pancreatic Diabetes Mellitus and Heavy Drinking are Risk Factors for the Development of Liver Fibrosis in Alcoholic Chronic Pancreatitis

Objective: The coincidence of chronic pancreatitis and liver cirrhosis in alcoholic patients is comparatively rare. Our aim was to assess liver fibrosis in patients with alcoholic chronic pancreatitis (ACP) by measuring noninvasive fibrosis scores and liver stiffness. Methods: Fifty-five patients with ACP were enrolled in the study. Eight healthy volunteers served as controls. Noninvasive fibrosis scoring systems, including the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 score (FIB-4), were determined and transient elastography (TE) was performed. Results: Mild (F1 or F2) and severe (F3 or F4) fibrosis was revealed by TE in 15 and 6 patients (38.2%), respectively. However, the levels of the liver enzymes were elevated in only 12 patients. The APRI and FIB-4 scores jointly revealed fibrosis of the liver in two patient. ACP patients with liver fibrosis drank significantly more amount of alcohol and had diabetes more frequently than ACP patients without liver fibrosis. Conclusion: Liver fibrosis was revealed by TE in one-fourth of the ACP patients. Liver enzymes are not reliable parameters with which to diagnose liver fibrosis. The quantity of consumed alcohol and the presence of DM are risk factors for the development of liver fibrosis in ACP.

Pancreatic Carcinoma and Diabetes Mellitus

The prognosis for PaC is extremely poor: it has the lowest five-year survival of all cancers, only 6% [6], and this rate has not changed during the last 40 years [7]. It depends on the late diagnosis of the disease: in the presence of the aspecific symptoms, PaC is often in an advanced stage, which means that the possibility of a curative surgical intervention is low. Screening PaC in an asymptomatic stage is recommended for a better outcome [8]. Population-wide screening is not feasible because the lifetime prevalence of PaC is low, only 1.39% [9]. In fact, screening of individuals under 70 who have a lifetime risk of PaC of 16% or greater is cost-effective [10].