title: The changing face of the exocrine pancreas in cystic fibrosis: the correlation between pancreatic status, pancreatitis and cystic fibrosis genotype.
abstract: OBJECTIVE
  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 (DeltaF508, 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.
authors.affiliation: CF Center, Chaim Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Augarten
authors.forename: Amir
authors.initials: A
authors.lastname: Ben Tov
authors.forename: Igal
authors.initials: I
authors.lastname: Madgar
authors.forename: Asher
authors.initials: A
authors.lastname: Barak
authors.forename: Hanna
authors.initials: H
authors.lastname: Akons
authors.forename: Joseph
authors.initials: J
authors.lastname: Laufer
authors.forename: Ori
authors.initials: O
authors.lastname: Efrati
authors.forename: Micha
authors.initials: M
authors.lastname: Aviram
authors.forename: Lea
authors.initials: L
authors.lastname: Bentur
authors.forename: Hannah
authors.initials: H
authors.lastname: Blau
authors.forename: Gideon
authors.initials: G
authors.lastname: Paret
authors.forename: Michael
authors.initials: M
authors.lastname: Wilschanski
authors.forename: Bat-Sheva
authors.initials: BS
authors.lastname: Kerem
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Yahav
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002712:Chlorides / Q000032:analysis; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000150:complications / Q000235:genetics / Q000503:physiopathology*; D019005:Cystic Fibrosis Transmembrane Conductance Regulator / Q000235:genetics; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology; D005838:Genotype; D006579:Heterozygote; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D046790:Pancreas, Exocrine / Q000503:physiopathology*; D010195:Pancreatitis / Q000209:etiology*; D013542:Sweat / Q000737:chemistry
chemical_list: C505032:CFTR protein, human; D002712:Chlorides; D019005:Cystic Fibrosis Transmembrane Conductance Regulator