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Papers of the Week

2022 Jan 25

J Nippon Med Sch

Pancreatic dysfunction and duodenal inflammatory responses coordinate with refractory epigastric pain including functional dyspepsia “A narrative review”.


Functional dyspepsia (FD) in the past, has been found to be associated with patients with pancreatic enzyme abnormalities and chronic pancreatitis in a certain population of patients who suffered from this disease. Since 2009, when the idea of early chronic pancreatitis (ECP) first emerged, the utility of endoscopic ultrasonography (EUS) has gained our attention as it may play an important role in distinguishing ECP from dyspepsia patients. Although the symptoms of patients with pancreatic enzyme abnormalities and pancreatic dysfunction overlap with those of dyspepsia, there are no available data to explain the direct relationships and linkages between pancreatic dysfunction and dyspeptic symptoms. The disturbance of exocrine pancreatic enzyme function and the reduction of pancreatic endocrine levels, such as insulin, may be associated with dyspeptic symptoms through impaired gastric emptying and duodenal inflammation. Recently, some studies have focused on the role of duodenal pathophysiology in gastric motility, bicarbonate secretion, and digestion. Since the reduction of bicarbonate secretion by pancreatic dysfunction fails to neutralize gastric acid in the proximal part of the duodenum, impaired bicarbonate secretion by pancreatic dysfunction in turn fails to protect the duodenal mucosa against gastric acid influx, thereby inducing duodenal inflammation. In addition, it has been suggested that elevated trypsin levels might be partly associated in part with duodenal inflammatory responses through PAR2-related immunomodulatory cells. This article offers a review on how duodenal inflammation may play a role in the etiology of FD and demonstrates whether pancreatic dysfunction may be associated with FD through intestinal inflammation.