Relationship between Pain and Plasma Amino Acid Levels in Chronic Pancreatitis
Abstract
Objective Our aim was to investigate the relationship between imbalances of plasma amino acids and pain in chronic pancreatitis (CP). Methods Thirty patients with alcoholic CP in an exocrine-insufficient state were examined. We divided them between diet and control group. Diet group ingested 80g/300kcal of the elemental diet "Elental®". This diet of 300 kcal/day was administered for two months. Selected clinical and laboratory values were compared between both groups before and after diet. Pain was observed and compared using a visual analog scale (VAS). Results There was no significant difference in the BMI between both groups before and after diet. The serum albumin level in diet group after diet was significantly higher than in control group (P=0.036). There was no significant difference in HbA1c between both groups before and after diet. The total amino acid concentration was significantly higher in diet group after diet than in control group (P=0.033). The concentrations of serum histidine and methionine in diet group after diet were significantly higher than in control group (histidine, P=0.022; methionine, P=0.026). The concentration of serum glutamate in diet group after diet was significantly lower than in control group (P=0.027). The balance of amino acids in diet group was normalized after the Elental® was ingested. The VAS score was significantly lower in diet group after diet than in control group (P=0.018). Conclusion These amino acid levels and pancreatic pain were improved by the elemental diet. The pancreatic pain may be related to these amino acid imbalances.
Image: Tokai University Hospital. Isehara, Japan
Downloads
References
Kawaguchi Y, Ogawa M, Ito H, Mine T. Alterations in plasma amino acid levels in alcoholic chronic pancreatitis in Japanese. Digestion 2012; 86: 155-160. [PMID: 22889918]
American Gastroenterological Association Medical Position Statement: treatment of pain in chronic pancreatitis. Gastroenterology 1998; 115:763-4. [PMID: 9721174]
Otsuki M. Chronic pancreatitis in Japan: epidemiology, prognosis, diagnostic criteria, and future problems. J Gastroenterol 2003; 38:315-26. [PMID: 12743770]
Ito T, Otsuki M, Itoi T, Shimosegawa T, Funakoshi A, Shiratori K, et al. Pancreatic diabetes in a follow-up survey of chronic pancreatitis in Japan. J Gastroenterol 2007; 42:291-7. [PMID: 17464458]
Shimosegawa T, Kataoka K, Kamisawa T, Miyakawa H, Ohara H, Ito T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol 2010; 45:584-91. [PMID: 20422433]
Ito T, Igarashi H, Niina Y, Hijioka M, Matsuo S, Shimokawa Y, Yonekura M, Nakamura K, Takayanagi R. Management of pain in chronic pancreatitis with home elemental diet ingestion. JOP 2010; 11: 648-649. [PMID: 21068507]
Abou-Assi S, Craig K, O'Keefe SJ. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol 2002; 97: 2255-62. [PMID: 12358242]
Hirota M, Takada T, Kitamura N, Ito T, Hirata K, Yoshida M, et al. Fundamental and intensive care of acute pancreatitis. J Hepatobiliary Pancreat Sci 2010; 17: 45-52. [PMID: 20012652]
Antal S. Treatment of protein malnutrition and uncontrollable diarrhea following biliopancreatic diversion with pancreas extract viokase. Obes Surg 1993; 3: 279-283.
Polge A, Bancel E, Bellet H, Strubel D, Poirey S, Peray P, Carlet C, Magnan de Bornier B. Plasma amino acid concentrations in elderly patients with protein energy malnutrition. Age Ageing 1997; 26: 457-462. [PMID: 9466296]
Schrader H, Menge BA, Belyaev O, Uhl W, Schmidt WE, Meier JJ. Amino acid malnutrition in patients with chronic pancreatitis and pancreatic carcinoma. Pancreas 2009; 38: 416-21. [PMID: 19169171]
Homma T. Criteria for pancreatic disease diagnosis in Japan: diagnostic criteria for chronic pancreatitis. Pancreas 1998; 16: 250-254. [PMID: 9548663]
Smith HW, Finkelstein N, Aliminosa L, Crawford B, and Graber F. The renal clearance of substituted hippuric acid derivatives and other aromatic acids in dog and man. J Clin Invest 1945; 28:1110-1115. [PMC: 435470]
Sun DC, Shay H. Pancreozymin-secretin test: The combined study of serum and duodenal contents in the diagnosis of pancreatic disease. Gastroenterology 1960; 38: 570-581. [PMID: 13835699]
Shimbo K, Kubo S, Harada Y, Oonuki T, Yokokura T, Yoshida H, Amao M, Nakamura M, Kageyama N, Yamazaki J, et al. Automated precolumn derivatization system for analyzing physiological amino acids by liquid chromatography/mass spectrometry. Biomed Chromatogr. 2010; 24: 683-91. [PMID: 19830681]
Adrych K, Smoczynski M, Stojek M, Sledzinski T, Slominska E, Goyke E, et al. Decreased serum essential and aromatic amino acids in patients with chronic pancreatitis. World J Gastroenterol 2010; 16: 4422-7. [PMID: 20845509]
Girish BN, Rajesh G, Vaidvanathan K, Balakrishnan V. Alterations in plasma amino acid levels in chronic pancreatitis. JOP 2011; 12: 11-18. [PMID: 21206095]
Andou A, Hisamatsu T, Okamoto S, Chinen H, Kamada N, Kobayashi T, Hashimoto, M, Okutsu T, Shimbo K, et al. Dietary histidine ameliorates murine colitis by inhibition of proinflammatory cytokine production from macrophages. Gastroenterology 2009; 136: 564-574.e2. [PMID: 19027739]
Gilliland L, Steer ML. Effects of ethionine on digestive enzyme synthesis and discharge by mouse pancreas. Am J Physiol 1980; 239:G418-26. [PMID: 6159794]
Farber E, Popper H. Production of acute pancreatitis with ethionine and its prevention by methionine. Proc Soc Exp Biol Med 1950; 74:838-40. [PMID: 14781196]
Sandstrom P, Trulsson L, Gasslander T, Sundqvist T, von Dobeln U, Svanvik J. Serum amino acid profile in patients with acute pancreatitis. Amino Acids 2008; 35: 225-231. [PMID: 17520324]
Hirota M, Takada T, Kitamura N, Ito T, Hirata K, Yoshida M, et al. Fundamental and intensive care of acute pancreatitis. J Hepatobiliary Pancreat Sci 2010; 17:45-52. [PMID: 20012652]
American Gastroenterological Association Medical Position Statement: Treatment of pain in chronic pancreatitis. Gastroenterology 1998; 115:763-4. [PMID: 9721174]
Gachago C, Draganov PV. Pain management in chronic pancreatitis. World J Gastroenterol 2008; 14:3137-48. [PMC: 2712844]
Copyright (c) 2015 Yoshiaki Kawaguchi, Jung-Chun Lin, Yohei Kawashima, Atsuko Maruno, Hiroyuki Ito, Masami Ogawa, Tetsuya Mine
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.