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The changing face of the exocrine pancreas in cystic fibrosis: the correlation between pancreatic status, pancreatitis and cystic fibrosis genotype

Augarten, Ariea; Tov, Amir Bena; Madgar, Igalb; Barak, Ashera; Akons, Hannaa; Laufer, Josepha; Efrati, Oria; Aviram, Michac; Bentur, Lead; Blau, Hannahe; Paret, Gideona; Wilschanski, Michaelf; Kerem, Bat-Shevag; Yahav, Yaakova

European Journal of Gastroenterology & Hepatology: March 2008 - Volume 20 - Issue 3 - p 164-168
doi: 10.1097/MEG.0b013e3282f36d04
Original Articles: Cystic Fibrosis
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Objectives The aims of this study were to determine the current pancreatic status of the entire cystic fibrosis (CF) population of Israel, to analyze the clinical characteristics of the pancreatic sufficient (PS) patients, and to characterize the correlation between pancreatic status, pancreatitis, and CF genotype.

Methods The Israeli CF database includes 505 patients. These patients were defined as being PS or insufficient according to their fecal pancreatic elastase level or by coefficient fat absorption findings. Mutations were categorized as severe (ΔF508, W1282X, G542X, S549R, N1303K, Q359K/T360K, 405+1G, and 1717) or mild/variable (3849+10 kb, D1152H, G85E, I1234V, R334W, and 5T) based on disease severity in patients carrying these mutations. Age at diagnosis, presenting symptoms, sweat–chloride concentrations, occurrence of pancreatitis, presence of diabetes, and liver disease were recorded.

Results One hundred and thirty-nine (27.5%) of the CF patients were PS. None carried two mutations associated with severe disease. Over one third (34%) had normal or borderline sweat tests; 20 of these 139 patients had pancreatitis (14.3%) but none of the 366 pancreatic insufficient patients had it. Four initially PS patients became pancreatic insufficient: conversion followed several events of pancreatitis in three of them. Nasal potential differences were all pathological in 35 tested PS patients. None had either diabetes or liver disease.

Conclusions A substantial number of CF patients are PS. All of them carry at least one mild mutation enabling production of a sufficient amount of normal mRNA to maintain exocrine pancreatic function. Pancreatitis occurs only in CF patients who are PS. These patients are at risk of progressing to pancreatic insufficiency.

aCF Center, Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University

bDepartment of Urology, Chaim Sheba Medical Center, Tel-Hashomer

cCF Center, Soroka Medical Center, Be'er Sheba

dCF Center, Rambam Medical Center, Haifa

eGraub CF Center, Schneider Children's Medical Center of Israel, Petach Tikva

fCF Center, Hadassah Medical Center

gDepartment of Genetics, The Hebrew University, Jerusalem, Israel

Correspondence to Arie Augarten, MD, National CF Center, The Chaim Sheba Medical Center, Tel-Hashomer, Israel 52621

Tel: +972 3 5303054; fax: +972 3 5305939;

e-mail: augarten@post.tau.ac.il

Received 30 January 2007 Accepted 15 June 2007

© 2008 Lippincott Williams & Wilkins, Inc.