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| 1 | Challenges in the management of pancreatic exocrine insufficiency显示文摘Pancreatic exocrine insufficiency(PEI) occurs when the insufficient secretion or function of pancreatic enzymes leads to maldigestion, most commonly as a result of chronic pancreatitis and pancreatic cancer. The condition is associated with significant morbidity and reductions in quality of life, even in milder forms. The challenges in approaching this condition include the non-specific presentation of mild to moderate PEI, and the lack of a convenient, accurate diagnostic test in this cohort. Classical symptoms appear late in the disease, and the diagnosis should be considered before steatorrhoea develops. Direct pancreatic function tests are the reference standard for diagnosis, but are invasive and not widely available. The faecal elastase-1(FE-1) stool test is widely available and has been shown to be as effective as the 13 C-mixed triglyceride breath test in more advanced disease. We recommend a pragmatic diagnostic approach that combines clinical history, assessment of nutritional status and measurement of FE-1. The critical first step is to consider the diagnosis. Once the diagnosis is confirmed, pancreatic enzyme replacement therapy should be initiated. The variety of enzyme preparations and recommended dosing regimens can present a challenge when selecting an adequate initial dose. Non-response should be actively sought and addressed in a systematic manner. This article discusses these challenges, and presents a practical approach to the diagnosis and management of PEI. | Benjamin Myles Shandro Rani Nagarajah Andrew Poullis | 2018 | World Journal of Gastrointestinal Pharmacology and Therapeutics2018，9，5： | 5 |
| 2 | Alcohol and risk of mortality in patients with traumatic brain injury显示文摘 | Shandro JR Rivara FP Wang J | 2009 | J Trauma2009，66，6： | 1 |
| 3 | Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation显示文摘 | Ryan EA Shandro T Green K Paty BW Senior PA Bigam D | | 0，，： | 1 |
| 4 | A pilot study of recovery room bypass ( 'fast-track protocol ) in a community hospital显示文摘 | Duncan PG Shandro J Bachand R | 2001 | Can J Anaesth2001，48，7： | 1 |
| 5 | Fluoroquinolone resis-tance in renal isolates of Mycobacterium tuberculosis显示文摘 | Webster D Long R Shandro C | 2010 | Int JTuberc Lung Dis2010，14，2： | 1 |
| 6 | Assessment of tile severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation显示文摘 | Ryan E A Shandro T Green K | 2004 | Diabetes2004，53，4： | 1 |
| 7 | Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation显示文摘 | Ryan EA Shandro T Green K | 2004 | Diabetes2004，53，4： | 1 |
| 8 | 查看详情显示文摘 | Lanni E.L Bosscher M.A Ooms B.D Shandro C.A Ellsworth B.A Anderson C.E | | 0，，： | 1 |
| 9 | A pilot study of recovery room bypass (fast-track protocolS) in a com- munity hospital显示文摘 | Duncan P G Shandro J Bachand R | 2001 | Can J Anaesth2001，48，7： | 1 |
| 10 | Asseasment of the severity of hypoglycemia and giyeemic lability in type I diabetic subjects undergoing islet transplantation显示文摘 | Ryan EA Shandro T Green K | 2004 | Diabetes2004，53，4： | 1 |
| 11 | A pilot study of recovery room bypass ('fast-track protocol') in a community hospital 显示文摘 | G Duncan J Shandro R Bachand | 2001 | Canadian Journal of Anesthesia2001，48，： | 1 |
| 12 | Associations with pancreatic exocrine insufficiency:An United Kingdom single-centre study显示文摘BACKGROUND Pancreatic exocrine insufficiency(PEI)is said to be associated with numerous conditions both within and outside the gastrointestinal(GI)system.The majority of research has been concerned with conditions that reduce the volume of functioning pancreatic tissue or prevent adequate drainage to the small bowel,such as chronic pancreatitis,cystic fibrosis,pancreatic cancer and pancreatic resection.However,the evidence base supporting an association with extrapancreatic conditions,such as coeliac disease,diabetes mellitus and congestive cardiac failure,is heterogeneous.AIM To strengthen the evidence base by studying all previously reported associations with PEI in a large cohort of outpatients.METHODS A single-centre retrospective study was performed.General gastroenterology outpatients tested for PEI with faecal elastase-1(FE1)were identified and information retrieved from the electronic patient record.PEI was defined as FE1<200μg/g.Patients already taking pancreatic enzyme replacement therapy were excluded.Multiple imputation was used to handle missing data.Univariable logistic regression was used to study which presenting symptoms predicted PEI.Multivariable logistic regression was used to explore the relationship between all previously reported associations and PEI.RESULTS Of 1027 patients were included.182 patients(17.7%)were diagnosed with PEI.Steatorrhoea[odds ratios(OR):2.51,95%confidence intervals(CI):1.58-3.98]and weight loss(OR:1.49,95%CI:1.08-2.06)were the only presenting symptoms that predicted PEI.Chronic pancreatitis(OR:7.98,95%CI:3.95-16.15),pancreatic cancer(OR:6.58,95%CI:1.67-25.98),upper GI surgery(OR:2.62,95%CI:1.32-5.19),type 2 diabetes(OR:1.84,95%CI:1.18-2.87),proton pump inhibitor therapy(OR:1.87,95%CI:1.25-2.80)and Asian ethnicity(OR:2.11,95%CI:1.30-3.42)were significantly associated with PEI in the multivariable analysis.None of the other historically reported associations with PEI were significant after adjustment for the other variables included in our multivariable analysis.CONCLUSION PEI is common in patients with chronic pancreatitis,pancreatic cancer,upper GI surgery and type 2 diabetes.Proton pump inhibitor therapy may also be associated with PEI or a false positive FE1. | Benjamin M Shandro Joshua Chen Jennifer Ritehnia Andrew Poullis | 2021 | World Journal of Clinical Cases2021，9，31： | 0 |
| 13 | Optical imaging technology in colonoscopy:Is there a role for photometric stereo?显示文摘Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer.However,up to a third of adenomas may be missed at colonoscopy,and the majority of post-colonoscopy colorectal cancers are thought to arise from these.Adenomas have three-dimensional surface topographic features that differentiate them from adjacent normal mucosa.However,these topographic features are not enhanced by white light colonoscopy,and the endoscopist must infer these from two-dimensional cues.This may contribute to the number of missed lesions.A variety of optical imaging technologies have been developed commercially to enhance surface topography.However,existing techniques enhance surface topography indirectly,and in two dimensions,and the evidence does not wholly support their use in routine clinical practice.In this narrative review,co-authored by gastroenterologists and engineers,we summarise the evidence for the impact of established optical imaging technologies on adenoma detection rate,and review the development of photometric stereo(PS)for colonoscopy.PS is a machine vision technique able to capture a dense array of surface normals to render three-dimensional reconstructions of surface topography.This imaging technique has several potential clinical applications in colonoscopy,including adenoma detection,polyp classification,and facilitating polypectomy,an inherently three-dimensional task.However,the development of PS for colonoscopy is at an early stage.We consider the progress that has been made with PS to date and identify the obstacles that need to be overcome prior to clinical application. | Benjamin M Shandro Khemraj Emrith Gregory Slabaugh Andrew Poullis Melvyn L Smith | 2020 | World Journal of Gastrointestinal Endoscopy2020，12，5： | 0 |
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