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Findings clarify between diabetic exocrine pancreatopathy, chronic pancreatitis

SAN DIEGO —  A blinded histopathology review of pancreatic tissue from 16 deceased individuals highlighted differences between diabetic exocrine pancreatopathy and chronic pancreatitis, according to a presenter at DDW 2016.

Shounak Majumder, MD, of the department of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn., and colleagues aimed to determine if diabetic exocrine pancreatopathy is histopathologically different from chronic pancreatitis. “Looking at some earlier data, it is evident that diabetes mellitus is associated with pancreatic volume loss,” Majumder said. “It has also been shown that fibrosis of exocrine pancreatitis is present in nearly a third of people with diabetes mellitus.”

The researchers identified patients from the Mayo Clinic Autopsy database. The current analysis included nine patients with type 2 diabetes without a known history of pancreatic disease who had moderate-to-severe fibrosis in the exocrine pancreas, and seven individuals with chronic pancreatitis. Five national and international experts in pancreas pathology reviewed the autopsy slides on an electronic platform and rated their confidence in the diagnoses. The researchers considered a definitive diagnosis to be one in which the pathologist had more than 75% confidence. They used the Mayo diagnosis as the standard by which the results were measured. The pathologists assessed 12 histological features, including fibrosis, inflammation, acinar atrophy and ductal distortion

All cases of chronic pancreatitis were diagnosed correctly, according to Majumder. Specifically, the features that were predictors of a case not being chronic pancreatitis were paucity of the following features: stromal inflammation, ductal epithelial attenuation, intraductal protein plugs, ductal distortion and interlobular fibrosis. “There was good statistical agreement in these top five features,” Majumder said. “The presence of islet amyloid favored a diagnosis of diabetic exocrine pancreatopathy.”

The researchers concluded that diabetic exocrine pancreatopathy is a distinct histopathologic entity. However, they suggested that the pathophysiology and clinical implications of this diagnosis should be more thoroughly investigated.

Reference:

Majumder S, et al. Abstract #959. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego. 

Disclosures: Majumder reports no relevant financial disclosures.

Editor's Note: This item has been updated with clarifications from the presenter.

SAN DIEGO —  A blinded histopathology review of pancreatic tissue from 16 deceased individuals highlighted differences between diabetic exocrine pancreatopathy and chronic pancreatitis, according to a presenter at DDW 2016.

Shounak Majumder, MD, of the department of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn., and colleagues aimed to determine if diabetic exocrine pancreatopathy is histopathologically different from chronic pancreatitis. “Looking at some earlier data, it is evident that diabetes mellitus is associated with pancreatic volume loss,” Majumder said. “It has also been shown that fibrosis of exocrine pancreatitis is present in nearly a third of people with diabetes mellitus.”

The researchers identified patients from the Mayo Clinic Autopsy database. The current analysis included nine patients with type 2 diabetes without a known history of pancreatic disease who had moderate-to-severe fibrosis in the exocrine pancreas, and seven individuals with chronic pancreatitis. Five national and international experts in pancreas pathology reviewed the autopsy slides on an electronic platform and rated their confidence in the diagnoses. The researchers considered a definitive diagnosis to be one in which the pathologist had more than 75% confidence. They used the Mayo diagnosis as the standard by which the results were measured. The pathologists assessed 12 histological features, including fibrosis, inflammation, acinar atrophy and ductal distortion

All cases of chronic pancreatitis were diagnosed correctly, according to Majumder. Specifically, the features that were predictors of a case not being chronic pancreatitis were paucity of the following features: stromal inflammation, ductal epithelial attenuation, intraductal protein plugs, ductal distortion and interlobular fibrosis. “There was good statistical agreement in these top five features,” Majumder said. “The presence of islet amyloid favored a diagnosis of diabetic exocrine pancreatopathy.”

The researchers concluded that diabetic exocrine pancreatopathy is a distinct histopathologic entity. However, they suggested that the pathophysiology and clinical implications of this diagnosis should be more thoroughly investigated.

Reference:

Majumder S, et al. Abstract #959. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego. 

Disclosures: Majumder reports no relevant financial disclosures.

Editor's Note: This item has been updated with clarifications from the presenter.

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