Journal of the Pancreas Open Access

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Is Pancreatic Exocrine Insufficiency A Result of Decreased Splanchnic Circulation in Patients with Chronic Heart Failure?

Vujasinovic Miroslav, Tretjak Martin, Tepes Bojan, Marolt Apolon, Slemenik Pusnik Cirila, Kotnik Kerbev Mateja, Rudolf Sasa

Introduction Pancreatic exocrine insufficiency is associated with various pancreatic illnesses and could be associated with extra pancreatic diseases. In chronic heart failure patients, the splanchnic circulation is decreased. If the reduced circulation is prolonged, tissue damage to the splanchnic organs is possible. The aim of our study was to determine the prevalence of pancreatic exocrine insufficiency in chronic heart failure patients as well as its clinical importance. Patients and Methods Patients with known chronic heart failure were selected from the outpatient cardiology clinic, and chronic heart failure was classified according to the New York Health Association criteria. Pancreatic exocrine insufficiency was diagnosed by the faecal elastase-1 concentration. Levels of >200 μg/g, 100-200 μg/g and <100 μg/g were considered as normal exocrine pancreatic function, mild pancreatic exocrine insufficiency and severe pancreatic exocrine insufficiency, respectively. In patients with low FE, additional serum laboratory testing was performed. Results In total, 87 patients were included in the study, and 56 (64.4%) were male and 31 (35.6%) were female; the mean age was 74.7±8.9 years (range 48-90).There were 54 patients with NYHA II and 33 patients with NYHA III chronic heart failure. The mean time from the confirmation of chronic heart failure to inclusion in the study was 4.0±3.3 years. Pancreatic exocrine insufficiency was diagnosed in six (6.9%) patients as follows: severe pancreatic exocrine insufficiency was diagnosed in three (3.45%) patients, and mild pancreatic exocrine insufficiency in three (3.45%) patients. In all of the tested pancreatic exocrine insufficiency patients, nutritional serum markers were decreased (vitamin D, selenium, phosphorus, zinc, folic acid and prealbumin). Conclusions Pancreatic exocrine insufficiency could develop in a low percentage of chronic heart failure patients. Decreased values of serum nutritional markers are present in all of the patients with pancreatic exocrine insufficiency and chronic heart failure.