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Introduction

Chronic pancreatitis is a fibro-inflammatory syndrome of the pancreas with mixed etiology, multifactorial pathogenesis and persistent pathological response to parenchymal damage, characterized by chronic inflammation, endocrine dysregulation, malnutrition and malabsorption. These factors represent secondary causes of sarcopenia, a progressive and generalized skeletal muscle disease associated with an increased risk of adverse events including falls, fractures, physics disabilities and death.

Aims & Methods

This study aimed to evaluate the prevalence of sarcopenia in patients affected by chronic pancreatitis (eventually complicated by exocrine pancreatic insufficiency), to compare parameters of body composition, muscular strength and ultrasound muscle thickness between sarcopenic and non-sarcopenic patients, and to clarify the role of ultrasound in the diagnosis of sarcopenia compared to gold standard imaging (CT or MRI). 29 patients with diagnosis of chronic pancreatitis (according to the UEG criteria) were prospectively enrolled between February 2023 and September 2023. Data about anthropometric parameters, blood chemistry tests, fecal elastase, Body Indipendence Assessment (BIA), Hand Grip Strength and Sit To Stand test were collected. The presence of sarcopenia was assessed by CT or MRI at the third level lumbar vertebra, through the quantitative analysis of various muscles. Patients underwent muscle ultrasound to evaluate the echogenicity, thickness and length of different muscular fibers.

Results

The prevalence of radiologically defined sarcopenia was 34.5% (10/29). Among patients without exocrine pancreatic insufficiency, the prevalence of sarcopenia was 28.6%, resulting lower than the prevalence of sarcopenia among patients with exocrine pancreatic insufficiency treated with pancreatic enzyme replacement therapy (PERT) (37.5%) and without exocrine pancreatic insufficiency treated with PERT (40%). Evaluation of BMI did not show significant differences in the sarcopenic group compared to the non-sarcopenic group (21.5 vs 23.4 – p = 0.08). Sarcopenic patients showed significantly lower values of phase angle (4.85° vs 6.4°, p = 0.004), free fat mass (46.3 kg vs 56.6 kg, p = 0.02), body cell mass (22.9 kg vs 30.4 kg, p = 0.001), body cell mass index (7.8 vs 10.7, p = 0.004), total body water (32.2 L vs 41.4 L, p = 0.03) and a lower performance both in terms of strength at HGS (24.7 kg vs 38.4 kg, p = 0.003) and average power at STS test (33.3 W vs 102.2 W, p = 0.002). The rectus abdominis muscle and the left radial muscular compartment showed a statistically significant difference in terms of thickness between non-sarcopenic and sarcopenic patients (8.4 mm vs 6.9 mm - p = 0.003; 18.5 mm vs 15.7 mm - p = 0.004), with high accuracy in distinguishing the two groups (respectively AUC of 84% and 83%).

Conclusion

Sarcopenia is a highly prevalent comorbidity in patients suffering from chronic pancreatitis with or without exocrine pancreatic insufficiency, with an increasing prevalence of this condition along with the progression of the pancreatic disease. BMI does not represent a valid tool for assessing and monitoring the nutritional state. Muscle ultrasound has shown good diagnostic accuracy in diagnosis of sarcopenia compared with the radiological gold standard, when specific muscle groups are considered.

SARCOPENIA IN PATIENTS WITH CHRONIC PANCREATITIS: SARCOPAN STUDY PRELIMINARY RESULTS

Federica Vitale 1, Mattia Paratore 1, Alberto Nicoletti 1, Marcantonio Negri 1, Maria Elena Ainora 1, Gabriele Pulcini 1, Marco Cintoni 1, Emanuele Rinninella 1, Enza Genco 1, Maria Gabriella Brizi 1, Maria Cristina Mele 1, Enrico Celestino Nista 1, Antonio Gasbarrini 1, Lorenzo Zileri Dal Verme 1, Maria Assunta Zocco 1

1 UCSC - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

Chronic pancreatitis (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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The future of immunotherapy → are surgeons obsolete soon? with Jeroen Dekervel

Jeroen Dekervel, Pradeep Mundre

Topics

Digestive Oncology

Published

2026

UEG Presentation

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Endoscopic resection of duodenal polyps: Is there any limit?

Michael John Bourke 1

1 Westmead Hospital Sydney, Westmead, Australia

Event

UEG Week Vienna 2024

Topics

Digestive Oncology Endoscopy Primary Care Small Intestine & Nutrition Stomach & H. Pylori Surgery

Session

The guilty genes in hereditary GI syndromes

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Presentation

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IMPACT OF TRANSGLUTAMINASE 2 INHIBITOR ZED1227 ON SYSTEMIC LIPIDOMIC RESPONSES IN CELIAC DISEASE: A GLUTEN CHALLENGE STUDY

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Introduction

Celiac disease (CeD) is an autoimmune disease triggered by dietary gluten in genetically predisposed individuals. This study aimed to explore the systemic plasma lipidomic biomarkers in treated CeD patients undergoing a gluten challenge and to assess the effect of the transglutaminase 2 inhibitor, ZED1227.

Aims & Methods

Mass spectrometry–based lipidomic profiling was applied to plasma samples obtained from 47 CeD patients. The samples were collected at baseline (gluten-free diet, GFD) and post-gluten challenge (PGC). Patients underwent a 6-week gluten challenge and were randomly divided into 2 groups: the placebo drug group (PGCp, n = 19) and the group with a daily oral administration of 100mg ZED1227 (PGCd, n = 28). Comparative analyses were performed between the groups, with adjustments for BMI, age, sex, and country of origin.

Results

Significantly different gluten-induced serum lipid profiles between GFD vs. PGCp and between GFD vs. PGCd were detected, as 46 lipids were differentially expressed in the first and six in the latter comparison. Additionally, kidney function, measured as glomerular filtration rate and plasma creatinine, decreased significantly in gluten challenge. This correlated with alterations in medium-chain fatty acylcarnitines (CARs), and the function was restored by ZED1227. This suggests that specific carnitines could be early biomarkers for the systemic effects of gluten ingestion in CeD patients.

Conclusion

This study highlights the potential of lipidomic analysis as a tool for early detection of systemic responses to gluten in CeD. The differential lipidomic profiles between the drug and placebo groups suggest that ZED1227 attenuates gluten-induced lipidomic alterations.

Disclosure

B.T., T.Z. and R.M. are employees of Dr. Falk Pharma GmbH. M.M. s the founder, owner and Chair of Board at Maki HealthTech Ltd (MHT). MHT receives Management/Advisory Affiliation fees from Dr. Falk Pharma, Topas Therapeutics, Calypso Biotech, Vaccitech, ImmunogenX, Equillium, and Immunic; holds patent licensed to Labsystems Diagnostics from where MHT receives royalties via Tampere University Hospital.

IMPACT OF TRANSGLUTAMINASE 2 INHIBITOR ZED1227 ON SYSTEMIC LIPIDOMIC RESPONSES IN CELIAC DISEASE: A GLUTEN CHALLENGE STUDY

Valeriia Dotsenko 1, Alex Dickens 2, Tuulia Hyötyläinen 3, Bernhard Tewes 4, Timo Zimmermann 4, Ralf Mohrbacher 4, Matej Oresic 5, Markku Mäki 1, Keijo Viiri 1

1 Tampere University and Tampere University hospital, Tampere, Finland

2 University of Turku and Åbo Akademi University, Turku, Finland

3 Örebro University, Örebro, Sweden

4 Dr. Falk Pharma GmbH, Freiburg, Germany

5 University of Turku and Åbo Akademi University, Turku, Finland|||Örebro University, Örebro, Sweden

Event

UEG Week Vienna 2024

Topics

Immunology Small Intestine & Nutrition

Submission format

Abstract

Session

Coeliac disease

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Introduction

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, but diagnosis at an early stage can improve the prognosis. Focal parenchymal atrophy and main pancreatic duct (MPD) dilatation have been identified as early signs of PDAC through imaging studies. However, limited evidence exists regarding their temporal progression due to previous study limitations with restricted case numbers.

Aims & Methods

We aimed to ascertain a more precise frequency assessment of suspicious PDAC findings as well as delineate the temporal progression of them. A multicenter retrospective study was conducted on patients diagnosed with PDAC between 2015 and 2021. We included patients who had undergone at least one computed tomography (CT) scan ≥6 months before diagnosing PDAC. The temporal progression of suspicious PDAC findings on CT was investigated. As an additional relatively small control group analysis, we reviewed the CT findings of each 30 consecutive patients with chronic pancreatitis and autoimmune pancreatitis at our hospital between 2022 and 2023.

Results

Out of 1832 patients diagnosed with PDAC at 17 facilities, 320 had a previous CT before their diagnosis. Suspicious PDAC findings were detected in 153 cases (47.8%), with focal parenchymal atrophy being the most common (26.6%), followed by MPD dilatation (11.3%), pancreatic swelling or mass (6.9%), retention cysts (5.0%), pancreatic inflammation (3.8%), and MPD stricture (1.9%). Focal parenchymal atrophy was the earliest detectable sign among all suspicious findings and became visible on average 2.7 years before diagnosis, and the next most common, MPD dilatation, 1.1 years before diagnosis. Other findings were less frequent and appeared around 1 year before diagnosis. Focal parenchymal atrophy followed by MPD dilatation was observed in 10 patients but not in reverse order. Focal parenchymal atrophy was more frequently detected in the pancreatic body/tail. No significant relationship was found between the pathological PDAC differentiation or tumor stage and the time course of the CT findings. All cases of focal parenchymal atrophy progressed just prior to diagnosis, and the atrophic area was occupied by tumor at diagnosis. Main pancreatic duct dilatation continued to progress until diagnosis. In the study of the control group, among the patients with chronic pancreatitis, 96.7% (29/30) exhibited diffuse pancreatic atrophy, while focal pancreatic atrophy was observed in 3.3% (1/30) in the body of the pancreas. There was no significant progression of focal pancreatic atrophy observed in chronic pancreatitis patient. Among the patients with autoimmune pancreatitis, pancreatic atrophy was identified in 90% (27/30), and all instances of atrophy observed in diffuse pancreatic parenchyma.

Conclusion

This large-scale study revealed that the temporal progression of focal parenchymal atrophy is the earliest detectable sign indicating PDAC. The morphology of the atrophy and whether it is progressive or not are important factors in distinguishing pancreatic atrophy with malignancy from that with benign lesion. These results provide crucial insights for early PDAC detection.