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With Focus on the Functional Exocrine Pancreatic Disorders JOP. J Pancreas (Online) 2015 Jul 08; 16(4):365-368 MINI REVIEW Short Review of Our Work - “Chronic Metabolic Acidosis Destroys Pancreas” with Focus on the Functional Exocrine Pancreatic Disorders Peter Melamed, Felix Melamed Biotherapy Clinic of San Francisco. San Francisco, CA, USA Dear Editor of the Journal of the Pancreas (JOP), pancreatitis does not develop We deeply appreciate your publishing of our work - “Chronic attackThe final of stageacute ofpancreatitis chronic and pancreatic failure after metabolic acidosis destroys pancreas” in JOP (2014) [1]. chronicovernight. pancreatitis. There are usuallySimilar 8 to - 15disorders years between of many the other first We feel that our work can give the food for thought to many organs and systems, the pancreas initial diseased stage young researchers and health practitioners. A short review does not display any structural changes. However, after of our work may generate various questions and ideas this stage, long-standing biochemical, biomechanical, for further investigations. In our work, we have focused on negative affects of the chronic metabolic acidosis on pancreatic function including: changes of the pancreas (chronic pancreatitis) and toneurohumoral, lowering of and the inflammation exocrine pancreatic factors lead function to structural while Premature activation of the proteases within the developing many accompanying digestive diseases. pancreas However, when 90% of the pancreatic functional capacity • Diminishing the antimicrobial activity of the is depleted, the pancreatic failure occurs with steatorrhea pancreatic juice and malabsorption syndrome, resulting in a total crush of • the digestive system and consequently of the entire human pancreas organism. • Suppressing of the flushing out zymogens from the Precipitation of the aggressive bile acids The great numbers of the digestive problems are directly or indirectly related to the function of the pancreas. • Hence, a clinical diagnosis of gastrointestinal disorders Authors• Calcification believe that further research may provide more de facto supposes pancreatic involvement. Nowadays, causes chronic pancreatitis. We would like to share some exocrine pancreatic function. Taking into account that details of how the acidification destroys the pancreas and of our thoughts on this subject as follows: chronicthere is notmetabolic an efficient acidosis and safedestroys method the for pancreas boosting andthe entire digestion, might suggest another way to resolve the Descriptions of symptoms of chronic pancreatitis such as rampant gastrointestinal disorders and diseases. pain, malabsorption syndrome, steatorrhea, and weight loss are found in almost all medical books, textbooks, and articles. The medical literature refers to these conditions as makeThere senseare no and the are classifications getting practical of ifpancreatic they help diseasesprimary occur when only 10 % of the exocrine pancreatic function that may satisfy and unify all specialists. All classifications “pancreatic insufficiency”. It is known that these symptoms care physicians or medical practitioners to postpone the “failure” when the therapeutic opportunities are very limited.is left intact. This is not an “insufficiency.” It is a pancreatic the condition when medical approaches usually are narrowed,development and of possibilities the final stage for treatmentof the pancreatic are restricted. diseases, Taking into account that the pancreas is a key digestive Received March 28th, 2015 – Accepted May 23rd, 2015 organ, the authors attempt to propose a practical, functional Keywords Acidosis; Digestive System; Pancreatic Juice; Pancreatitis which can involve most of the gastrointestinal disorders Correspondence Peter Melamed clinical classification of exocrine pancreatic disorders, Biotherapy Clinic of San Francisco assist primary care physicians, gastroenterologists and 2215 Post Street, Suite 1 and diseases. This functional clinical classification may San Francisco, CA 94115 many health professionals in their everyday practice. This USA Phone: +1-415.377.6643 suffering from gastrointestinal disorders to get help in Fax: +1-415.409.3909 eitherclinical the classification early or compensated may help a largestages number of their of condition patients E-mail: [email protected] to avoid pancreatic failure [2]. JOP. Journal of the Pancreas - http://www.serena.unina.it/index.php/jop - Vol. 16 No. 4 – Jul 2015. [ISSN 1590-8577] 365 JOP. J Pancreas (Online) 2015 Jul 08; 16(4):365-368 The Functional Clinical Classification of Exocrine Smith et al. (1991) reported abnormal Lundh tests in 27% Pancreatic Disorders Subdivides Digestive Disorders and Diseases into Three Groups: dyspepsia.” They concluded, “Pancreatic disease may explainof patients the where symptoms conditions of some were patie classifiednts with as “functional non-ulcer 1. Acidic pancreas and bile dyspepsia” [10]. It is clear that dyspepsia and functional dyspepsia, in particular, are common conditions globally, affecting 2.3. Pancreatic deficiencyfailure most populations, regardless of location.”[11] Okada R et al. (2009) considered that mild functional pancreatic Disorders takes the common digestive symptoms such disorders might trigger some cases with unexplainable The Functional Clinical Classification of Exocrine Pancreatic as pain, gas, fullness, heartburn, stool, appetite and food chronic dyspepsia [12]. sensitivity along with their frequency, quality and changes corelleted with a combination of common clinical medical Eva Lindström et al. (1990) suggested that altogether, 66% tests and diagnoses. of the patients with abdominal pain had morphological and functional evidence of pancreatic affection [13]. Acidic Pancreas and Bile Some researchers agree that differentiation between In everyday medical practice, the crowds of individuals functional dyspepsia and early chronic pancreatitis is with digestive symptoms consist of patients with the “acidic pancreas and bile” stage of exocrine pancreatic decreasing of exocrine pancreatic function are commonly disorders. Their tests are usually normal, and most of misdiagnosed.difficult [14]. Early stages of chronic pancreatitis and these patients receive palliative symptomatic therapy. “Early chronic pancreatitis remains a diagnostic challenge The authors consider that the acidifying of alkaline digestive as there is no gold standard for the diagnosis and glands (pancreas and liver) decreases the digestive pancreatic biopsy is risky and impractical. Reported data capacity of pancreatic juice and bile. Also acidifying makes on the incidence and prevalence of chronic pancreatitis are unreliable and highly variable. Chronic pancreatitis is clearly under – diagnosed” [15]. isthese collected fluids corrosiveand fermented and “aggressive”. inside the Inintestines. turn, it causesThen, thea large improperly number ofdigested pathological food refluxes. irritates Undigested the intestinal food The diagnosis of the beginning of the pancreatic disorders walls causing gas, belching, bloating, abdominal cramps might be missed in clinical practice because symptoms and pain, ulcers, constipation, etc. Nausea, vomiting, and of severe exocrine pancreatic deficiency (malabsorption poor digestion. stages of chronic pancreatitis. As a result, early chronic diarrhea are natural detoxification reactions of the body to pancreatitissyndrome and is maldigestion)rarely suspected are notwhen specific pain tois themild early or Possible diseases and conditions associated with acidic pancreas and bile stage: functional dyspepsia, biliary in the absence of steatorrhea. dyskinesia, GERD, Sphincter of Oddi Dysfunction type III, absent and when symptoms are unspecific (“dyspepsia”) IBS, Intestinal Dysbiosis (Candida-yeast overgrowth), etc. Pancreatic Deficiency Functional disorders of the pancreas are terra incognita Possible diseases and conditions associated with in conventional medicine; there is little attention on the acute pancreatitis, chronic pancreatitis, gastric ulcers, the pancreas being a key organ in normal digestion. In duodenalpancreatic ulcers, deficiency: duodenitis, clinical Sphincter or subclinical of Oddi Dysfunctionepisodes of 1987,functional H. Worningstage of exocrinefrom the pancreatic University deficiency of Copenhagen, despite Denmark wrote in Digestion that the prevalence of sludge, parasites), conditions after gallbladder removal pancreatic diseases as the cause of dyspepsia differs in andtype someII or III, surgeries gallbladder on thedisorders upper (inflammation,GI tract, considerable stones, clinical materials between 0 and 25-30%. In his view, pancreatic function and pancreatic disease are connected intestinal dysbiosis (Candida-yeast overgrowth, Small to different gastro-intestinal diseases [3]. Intestine Bacterial Overgrowth), IBD (Crohn’s Disease, Ulcerative Colitis), Celiac Diseases, Cystic Fibrosis (early The connection between impaired pancreatic function and stage), NIDDM- noninsulin-dependent diabetes mellitus, functional gastrointestinal disorders such as functional non-alcoholic fatty pancreas, etc. dyspepsia, SIBO-small intestinal bacteria overgrowth, IBS increasingly attracts the attention of researchers and In almost all these diseases, there is a constant pancreas doctors [4-6]. involvement that results in structural damage and Goepp J et al. (2014) found low pancreatic elastase diminished function including different severities of chronic pancreatitis. Nutritional scientists have found of the patients with IBS [7].
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