Pancreatic enzyme therapy in childhood celiac disease
Tóm tắt
The validity of pancreatic enzyme substitution therapy in the two months following diagnosis of celiac disease was investigated. Twenty patients (8 males, 12 females), mean age 14.2 months (group A) received an enzyme substitution preparation. The control group (group B) included 20 patients (9 males, 11 females), mean age 14.5 months, treated with placebo. Before starting treatment, we performed a stratification for age, weight-for-age at diagnosis, and degree of pancreatic insufficiency. The therapies were then administered randomly in double-blind fashion. On diagnosis and 30 and 60 days after commencement of a gluten-free diet with identical calorie intake in both groups, a series of anthropometric variables were determined. After 30 days weight increase in group A patients was significantly higher (in grams) than in group B: 1131±461 vs 732±399 (P<0.006). Weight-for-age increase also was greater in group A than in group B: 9.2±5.1% vs 5.0±4.0% (P<0.002). The increase in height Z score, weight-for-height, arm circumference, and subscapular and tricipital fold measurements were greater in group A patients than those in group B, but the difference was not significant. After 60 days of therapy none of the parameters considered were significantly different in the two groups. We concluded that pancreatic enzyme therapy is certainly useful in the first 30 days after diagnosis of celiac disease.
Tài liệu tham khảo
Zieve L, Silvis SE, Mulford B, Blackwood WD: Secretion of pancreatic enzymes. I Response to secretin and pancreozymin. Am J Dig Dis 11:671–684, 1966
Fernanez LB, De Paula A, Prizont R: Exocrine pancreas insufficiency secondary to gluten enteropathy. Am J Gastroentrol 53:464–469, 1960
Di Magno EP, Go VLW, Summerskill WHJ: Impaired cholecystokinin-pancreozymin secretion, intraluminal dilution, and maldigestion of fat in sprue. Gastroenterology 63:25–32, 1972
Regan PT, Di Magno EP: Exocrine pancreatic insufficiency in celiac sprue: a cause of treatment failure. Gastroenterology 78:484–487, 1980
Carroccio A, Iacono G, Montalto G, Cavataio F, Di Marco C, Balsamo V, Notarbartolo A: Exocrine pancreatic function in children with celiac disease before and after a gluten-free diet. Gut 32:796–799, 1991
Carroccio A, Iacono G, Montalto G, Cavataio F, Lorello D, Soresi M, Di Martino D, Notarbartolo A: Pancreatic insufficiency in celiac disease is not dependent on the nutritional status. Dig Dis Sci 39:2235–2242, 1994
Di Magno EP, Go VLW, Summerskill WHJ: Relations between pancreatic enzymes outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 288:813–815, 1973
Meuwisse GW: Diagnostic criteria in coeliac disease. Acta Paediatr Scand 59:461–463, 1970
Walker Smith JA, Guandalini S, Schimtz J, Shmerling DH, Visakorpi JK: Revised criteria for diagnosis of celiac disease: report of working group of ESPGAN. Arch Dis Child 65:909–911, 1990
Gullo L, Costa PL, Fontana G, Labò G: Investigation of exocrine pancreatic function by continuous infusion of cerulein and secretin in normal subjects and in chronic pancreatitis. Digestion 14:97–107, 1976
Taylor RH, Waterman S: Single intubation test for investigation of malabsorption and diarrhea. Gut 24:680–682, 1983
Sarles H, Taulier J, Figarella C: Dosage de la lipase dans le suc duodenal. Rev Franc Etud Clin Biol 8:706–707, 1963
Figarella C, Ribeiro T: The assay of human pancreatic phospholipase in pancreatic juice and duodenal contents. Scand J Gastroenterol 6:133–137, 1971
Figarella C, Souville, C, Quet O, et al: Problemes posés par le dosage des enzymes pancréatiques dans le suc duodenal. Vie Med 47:493–500, 1966
Capozzi G, Vitiello N, Granato L, Garguilo ML, Langella F, Greco L: Analisi dei fattori che influenzano la crescita staturale: Sono ancora necessari standard regionali di riferimento? Riv Ital Pediatr 14:384–389, 1988
Capozzi G, Vitiello N, Granato L, Gargiulo ML, Sabetti P, Greco L: Sviluppo del peso e del rapporto peso/altezza in un campione di scolari campani. Riv Ital Pediatr 15:429–436, 1989
Rhodes RA, Tai HH, Chey WY: Impairment of secretin release in celiac sprue. Dig Dis Sci 23:833–839, 1978
Maton PN, Selden AC, Fitzpatrick ML, Chadwick US: Defective gallbladder emptying and cholecystokinin release in celiac disease. Gastroenterology 88:391–396, 1985