Introduction: Chronic pancreatitis is a heterogeneous and complex syndrome that, in most cases, causes pain as a cardinal symptom and affects both the morphology and function of the pancreas, leading to several serious complications. Areas covered: The present review, based on a non-systematic PubMed search updated to June 2023, aims to present the current available evidence on the role of gastroenterologists in the diagnosis and treatment of both local and systemic complications by either endoscopic or medical treatments. Expert opinion: At diagnosis and during chronic pancreatitis follow-up, particular care is needed to consider not only the clinically manifest signs and symptoms of the disease, such as pain, jaundice, gastrointestinal obstruction, and pseudocysts, which require multidisciplinary discussion to establish the best treatment option (endoscopic or surgical), but also less evident systemic complications. Pancreatic exocrine and endocrine insufficiency, together with chronic inflammation, addiction, and dysbiosis, contribute to malnutrition, sarcopenia, and osteopathy. These complications, in turn, increase the risk of infection, thromboembolic events, and death. Patients with chronic pancreatitis also have an increased risk of psychiatric disorders and pancreatic cancer onset. Overall, patients with chronic pancreatitis should receive a holistic evaluation, considering all these aspects, possibly through multidisciplinary care in dedicated expert centers.

Head and neck cancer (HNC) represents the sixth most common neoplasm worldwide, accounting for 800,000 new cases and 400,000 deaths globally every year. The locally advanced HNC (LAHNC) requires chemotherapy with high dose cisplatin, a nephrotoxic agent able to damage renal function both in acute and chronic asset. Moreover, this necessary aggressive oncological regimen increases the rate of malnutrition, catabolism and sarcopenia in the majority of patients, making the nutritional therapy an essential cornerstone of the multidisciplinary approach in the management of LA-HNC.

697 Background: Impaired nutritional status is often associated with Pancreatic Ductal Adenocarcinoma (PDAC) and poor prognosis. Little is known on the prognostic role of nutritional variables in PDAC patients (pts) receiving chemotherapy (CT). Methods: Locally advanced or metastatic PDAC pts enrolled at our Institute in a prospective observational study (PAC-MAIN) and treated with 1st-line CT between April 2019 and July 2021 were included in the analysis. Clinical and nutritional variables entailed biohumoral parameters, bioimpedance vector analysis (BIVA)- and Computed Tomography-derived body composition. Progression-free and Overall survival (PFS and OS) were calculated from CT start to progression or death. A Multivariate Cox proportional-hazards model for PFS prediction was generated by backward selection of features with a p-value (p) ≤ 0.06. The resultant index, named PANCIN, was calculated as linear combination of the covariates (Xi are the N) and the b Cox coefficients (bi), according to the formula: PANCIN = ∑Ni=1 bi Xi Kaplan–Meier test was performed to assess the ability of PANCIN to stratify pts according to its median value for PFS and OS prediction. Results: 74 pts were included in the study. The variables retained in the model were: serum Vitamin B12 (pg/ml) [Hazard Ratio (HR)= 1.001, 95% Confidence Interval (CI) 1.0004-1.0016, p=0.002]; BIVA-derived Body Cell Mass (%) [HR= 0.94, 95% CI 0.887-1.002, p=0.058]; ECOG Performance Status (0 vs 1-2) [HR= 3.25, 95% CI 1.048-10.077, p=0.041]; Albumin (g/L) [HR= 0.91, 95% CI 0.86-0.97, p=0.002]; FAACT Score [HR= 1.041, 95% CI 1.006-1.077, p=0.022]. Median PFS was 15.3 (95% CI 7.6-21.8) and 5.8 months (95% CI 2.7-9.0) for pts with PANCIN < or ≥ -1.7768 median value respectively [HR= 3.7, 95% CI 1.9-7.0, p=0.0001]. Median OS was 23.8 (95% CI 12.6-33.3) and 10.0 months (95% CI 5.7-12.7) for pts with PANCIN < or ≥ -1.7768 respectively [HR= 4.1, 95% CI 2.1-7.9, p<0.0001]. Conclusions: PANCIN is a novel nutritional-clinical index able to predict outcome of advanced PDAC pts receiving CT. If furtherly validated, it may represent a stratification tool both in clinical practice and in prospective trials. Our findings also support the relevance of a baseline comprehensive nutritional assessment, to define tailored nutritional interventions.[Table: see text]

Introduction Pancreatic Ductal Adenocarcinoma (PDAC) is an aggressive disease with poor outcomes. One of the reasons for the dismal prognosis resides in its impressive ability to alter the nutritional status of patients who develop malnutrition, cachexia, anorexia, and sarcopenia in most cases. The ideal way to measure such changes in PDAC patients, in order to readily identify them and avoid complications or discontinuations of treatment is a relatively unexplored area. In addition, most PDAC patients experience pancreatic exocrine insufficiency (PEI) that contributes to the complex puzzle of malnutrition and that can be treated with Pancreatic Enzyme Replacement Therapy (PERT). Areas covered We review current knowledge on the impact of nutritional status on both surgical and medical treatments for PDAC, reporting available data on the causes of malnutrition, characteristics, and advantages of different tools to investigate nutritional status and possible strategies to improve patient outcomes. Expert opinion All PDAC patients should receive a careful nutritional assessment at diagnosis, and this should be repeated alongside their treatment path. Screening tools and biochemical variables or scores are associated with prognosis, but bioimpedance vector analysis (BIVA) and radiological assessment of body composition seem more accurate in predicting clinical outcomes and postoperative complications.

Several immunotherapy agents are the standard of care of many solid malignancies. Nevertheless, the majority of patients do not benefit from the currently available immunotherapies. It is therefore of paramount importance to identify the prognostic and predictive factors of tumor response/resistance and to design effective therapeutic strategies to overcome primary resistance and improve the efficacy of immunotherapy. The aim of this review is to underline the influence of the tumor and host metabolism on the antitumor immune response and to discuss possible strategies to improve the efficacy of available treatments by targeting the specific metabolic pathways in tumors or immune cells and by modifying patients' nutritional statuses. A systematic search of the Medline and EMBASE databases was carried out to identify scientific papers published until February 2020, which reported original research articles on the influence of tumor or host metabolism on antitumor immune response. The literature data showed the key role of glycolysis and mitochondrial oxidative phosphorylation, arginine, tryptophan, glutamine, lipid metabolism and microbiome on immune cell function. Moreover, specific nutritional behaviors, such as a low dietary intake of vitamin C, low glycemic index and alpha-linolenic acid, eicosapentenoic acid, docosahexaenoic acid, ornithine ketoglutarate, tryptophan and probiotic supplementation were associated with the potential clinical benefits from the currently available immunotherapies.

BACKGROUND & AIMS:Coronavirus disease 2019 (COVID-19) may associate with clinical manifestations, ranging from alterations in smell and taste to severe respiratory distress requiring intensive care, that might associate with weight loss and malnutrition. We aimed to assess the incidence of unintentional weight loss and malnutrition in COVID-19 survivors. METHODS:In this post-hoc analysis of a prospective observational cohort study, we enrolled all adult (age ≥18 years) patients with a confirmed diagnosis of COVID-19 who had been discharged home from either a medical ward or the Emergency Department of San Raffaele University Hospital, and were re-evaluated after remission at the Outpatient COVID-19 Follow-Up Clinic of the same Institution from April 7, 2020, to May 11, 2020. Demographic, anthropometric, clinical and biochemical parameters upon admission were prospectively collected. At follow-up, anthropometrics, the mini nutritional assessment screening and a visual analogue scale for appetite were assessed. RESULTS:A total of 213 patients were included in the analysis (33% females, median age 59.0 [49.5-67.9] years, 70% overweight/obese upon initial assessment, 73% hospitalised). Sixty-one patients (29% of the total, and 31% of hospitalised patients vs. 21% of patients managed at home, p = 0.14) had lost >5% of initial body weight (median weight loss 6.5 [5.0-9.0] kg, or 8.1 [6.1-10.9]%). Patients who lost weight had greater systemic inflammation (C-reactive protein 62.9 [29.0-129.5] vs.48.7 [16.1-96.3] mg/dL; p = 0.02), impaired renal function (23.7% vs. 8.7% of patients; p = 0.003) and longer disease duration (32 [27-41] vs. 24 [21-30] days; p = 0.047) as compared with those who did not lose weight. At multivariate logistic regression analysis, only disease duration independently predicted weight loss (OR 1.05 [1.01-1.10] p = 0.022). CONCLUSIONS:COVID-19 might negatively impact body weight and nutritional status. In COVID-19 patients, nutritional evaluation, counselling and treatment should be implemented at initial assessment, throughout the course of disease, and after clinical remission. CLINICALTRIALS. GOV REGISTRATION:NCT04318366.