title: Pancreatic congestion in liver cirrhosis correlates with impaired insulin secretion.
abstract: BACKGROUND
  Although impaired glucose tolerance is common in cirrhosis, this condition's pathogenesis remains undefined. This study aimed to clarify pathogenesis related to the pancreas in cirrhotic patients, and to evaluate associations between insulin secretion and pancreatic congestion due to portal hypertension.
  
  
  METHODS
  Pancreatic perfusion parameters were analyzed by dynamic contrast-enhanced ultrasound (CE-US) in 41 patients (20 cirrhotic, 21 non-cirrhotic; age, 67.9 ± 13.3; female, 19), and prospectively compared to delta C-peptide immunoreactivity (ΔCPR). In a separate study, a retrospective chart review with human autopsy specimens was conducted, and vessels and islets of the pancreas were analyzed in 43 patients (20 cirrhotic, 23 controls; age, 71.5 ± 11.6; female, 15).
  
  
  RESULTS
  In the CE-US study, the clinical characteristics indicative of portal hypertension (e.g., ascites and varices) had significantly higher incidences in the cirrhotic group than in the control group. Pancreatic drainage times were greater in the cirrhotic group (p < 0.0001), and had a significant negative correlation with ΔCPR (R = 0.42, p = 0.0069). In the histopathological study, the islets were enlarged in the cirrhotic group (p < 0.0001). However, the percentage of insulin-positive area per islet was decreased in the cirrhotic group (p < 0.0001), and had a significant negative correlation with the wall thickness of the pancreatic vein (R = 0.63, p < 0.0001).
  
  
  CONCLUSIONS
  Pancreatic congestion was present in cirrhotic patients. Moreover, pancreatic congestion and insulin secretion were significantly correlated. This pathogenesis could be a key factor underlying the development of hepatogenous diabetes in cirrhotic patients.
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Taira
authors.initials: T
authors.lastname: Kuroda
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Koizumi
authors.forename: Hironori
authors.initials: H
authors.lastname: Ochi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Hisano
authors.forename: Kenji
authors.initials: K
authors.lastname: Bando
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D007328:Insulin