Reşat DABAK, Engin Ersin ŞİMŞEK, Sabah TÜZÜN, Can ÖNER, İsmet TAMER, Ekrem ORBAY, Oya BAYRAMİÇLİ

Effects of Pancreatin therapy on Gastrointestinal Symptoms in Patients with Type 2 Diabetes Mellitus

Objectives: Gastrointestinal symptoms (GIS) are more common in individuals with type 2 diabetes mellitus(DM) in comparison to normal population. This study aimed to evaluate the effects of the pancreatin therapyon the GIS in patients with type 2 DM.Methods: This study included patients with type 2 DM admitted to the Gastroenterology Department between February to July 2017. Age, HbA1c, level of C-peptide, triglyceride, antidiabetic treatments, fecal elastase levels were evaluated in the files of all patients. The GIS of the patients, who were considered to sufferfrom the exocrine pancreatic insufficiency, including abdominal pain, bloating, constipation and diarrhea wereevaluated before and after the 25000 IU pancreatin therapy.Results: The study included 35 patients with type 2 DM, the mean age was 59.1±7.6 years, and 24 (68.6%) ofthe patients were female. The exocrine pancreatic insufficiency was detected in 1 (2.9%) of the patients. Priorto the pancreatin therapy, 33 (94.3%) of the patients were determined to have abdominal pain, 34 (97.1%) hadbloating, 33 (94.3%) had constipation and 32 (91.4%) had diarrhea. After the therapy, 29 (82.9%) of the patientswere found to have abdominal pain, 31 (88.6%) had bloating, 31 (88.6%) had constipation and 29 (82.9%) haddiarrhea. GIS including abdominal pain, bloating, constipation and diarrhea were decreased after pancreatintreatment (p=0.015, p

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1. Du YT, Rayner CK, Jones KL, Talley NJ, Horowitz M. Gastrointestinal Symptoms in Diabetes: Prevalence, Assessment, Pathogenesis, and Management. Diabetes Care 2018;41(3):627–37.

2. Hardt PD, Krauss A, Bretz L, Porsch-Ozcürümez M, SchnellKretschmer H, Mäser E, et al. Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus. Acta Diabetol 2000;37(3):105–10.

3. Andriulli A, Ippolito AM, Festa V, Valvano MR, Merla A, Bossa F, et al. Exocrine Pancreatic Insufficiency, as Assessed by Fecal Elastase-1 Levels, in Diabetic Patients: An Estimate of Prevalence in Prospective Studies. J Diabetes Metab 2014;5(6):1000379.

4. Yılmaztepe A, Ulukaya E, Ersoy C, Yılmaz M, Tokullugil HA. Investigation of fecal pancreatic elastase-1 levels in type 2 diabetic patients. Turk J Gastroenterol 2005;16(2):75–80.

5. Ewald N, Bretzel RG, Fantus IG, Hollenhorst M, Kloer HU, Hardt PD. Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. Results of a prospective multi-centre trial. Diabetes Metab Res Rev 2007;23(5):386–91.

6. Bouchoucha M, Uzzan B, Cohen R. Metformin and digestive disorders Metformine et troubles digestifs. Diabetes Metab 2011;37(2):90–6.

7. Davidson J, Howlett H. New prolonged-release metformin improves gastrointestinal tolerability. The British Journal of Diabetes & Vascular Disease 2004;4(4):273–7.

8. Rathmann W, Haastert B, Icks A, Giani G, Hennings S, Mitchell J, et al. Low Faecal Elastase 1 Concentrations in Type 2 Diabetes Mellitus. Scand J Gastroenterol 2001;36(10):1056–61.

9. Shivaprasad C, Pulikkal AA, Kumar KMP. Pancreatic exocrine insufficiency in type 1 and type 2 diabetics of Indian origin. Pancreatology 2015;15(6):616–9.

10. Vujasinovic M, Zaletel J, Tepes B, Popic B, Makuc J, EpsekLenart M, et al. Low prevalence of exocrine pancreatic insufficiency in patients with diabetes mellitus. Pancreatology 2013;13(4):343–6.

11. Herzig KH, Purhonen AK, Räsänen KM, Idziak J, Juvonen P, Phillps R, et al. Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus. BMC Geriatr 2011;11:4.

12. Larger E, Philippe MF, Barbot-Trystram L, Radu A, Rotariu M, Nobécourt E, et al. Pancreatic exocrine function in patients with diabetes. Diabet Med 2012;29(8):1047–54.

13. Cavalot F, Bonomo K, Fiora E, Gaia E, Trovati M. Pancreatic elastase-1 in stools, a marker of exocrine pancreas function, correlates with both residual b-cell secretion and metabolic control in type 1 diabetic subject. Diabetes Care 2004;27(8):2052–4.

14. Ewald N, Raspe A, Kaufmann C, Bretzel RG, Kloer HU, Hardt PD. Determinants of exocrine pancreatic function as measured by fecal elastase-1 concentrations (FEC) in patients with diabetes mellitus. Eur J Med Res 2009;14(3):118–22.

15. Gullo L, Ventrucci M, Naldoni P, Pezzilli R. Aging and exocrine pancreatic function. J Am Geriatr Soc 1986;34(11):790–2.

16. Gullo L, Simoni P, Migliori M, Lucrezio L, Bassi M, Frau F, et al. A study of pancreatic function among subjects over ninety years of age. Pancreatology 2009;9(3):240–4.

17. Rathmann W, Haastert B, Oscarsson J, Berglind N, Lindkvist B, Wareham NJ. Association of faecal elastase 1 with non-fasting triglycerides in type 2 diabetes. Pancreatology 2016;16(4):563–9.

18. Krishnan B, Babu S, Walker J, Walker AB, Pappachan JM. Gastrointestinal complications of diabetes mellitus. World J Diabetes 2013;4(3):51–63.