Elevated Serum Chromogranin-A and Characteristic Duodenal Enteroendocrine Cell Distribution in Pancreatic Fibrosis and Chronic Pancreatitis Compared with Other Dyspeptic Disorders: A Case Series Study

Duodenal enteroendocrine cells (EECs) play a crucial role in regulating gastrointestinal function through the secretion of gut hormones. Chromogranin-A (CgA) is a cell marker for EECs. While the spatial distribution of EEECs can determine the pathogenesis of gastrointestinal diseases, the association between serum CgA levels and EEC distribution patterns in dyspeptic diseases remains unclear. This cross-sectional case series included 15 patients with various dyspeptic diseases, including duodenal ulcers (n=2), both with Helicobacter pylori infection, chronic pancreatic fibrosis (n=3), alcoholic chronic pancreatitis (n=1), functional dyspepsia (n=5), gallstones (n=4), and post-cholecystectomy (n=2). Two cases presented with overlapping conditions: one with both pancreatic fibrosis and post-cholecystectomy, and another with duodenal ulcer and gallstones. Serum CgA levels were categorized into low (< 50 ng/mL, n=4) and high (> 50 ng/mL, n= 11) groups. Patients in the high CgA group were generally older (52-68 years) than those in the low CgA group (37-55 years). The high CgA group showed a centralized and adjacent EEC distribution, particularly in patients with pancreatic fibrosis and chronic pancreatitis. In contrast, the low CgA group showed a peripheral and discrete EEC distribution, especially in patients with duodenal ulcers (p < 0.01). Serum CgA levels vary significantly with age and underlying dyspeptic disease. A centralized EEC distribution pattern is commonly associated with pancreatic pathologies, while a peripheral pattern is typical of duodenal ulcers. Hence, serum CgA could be a potential serologic marker for chronic pancreatic disorders.