Systematic Reviews
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2014; 20(45): 17196-17205
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17196
Relationship between the exocrine and endocrine pancreas after acute pancreatitis
Stephanie L M Das, James I C Kennedy, Rinki Murphy, Anthony R J Phillips, John A Windsor, Maxim S Petrov
Stephanie L M Das, James I C Kennedy, Anthony R J Phillips, John A Windsor, Maxim S Petrov, Department of Surgery, University of Auckland, Auckland 1142, New Zealand
Rinki Murphy, Department of Medicine, University of Auckland, Auckland 1142, New Zealand
Author contributions: Das SLM acquired data and drafted the manuscript; Kennedy JIC acquired data, carried out data analysis, and drafted the manuscript; Murphy R, Phillips ARJ and Windsor JA contributed to interpretation of data and critically reviewed the manuscript; and Petrov MS conceived and supervised the study.
Correspondence to: Maxim S Petrov, MD, MPH, PhD, Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. max.petrov@gmail.com
Telephone: +64-9-9232776 Fax: +64-9-3779656
Received: March 19, 2014
Revised: July 9, 2014
Accepted: July 29, 2014
Published online: December 7, 2014
Processing time: 265 Days and 21.7 Hours
Abstract

AIM: To determine the prevalence and time course of pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis.

METHODS: Relevant literature cited in three major biomedical journal databases (EMBASE, MEDLINE, and Scopus) was reviewed independently by two authors. There were no language constraints but the search was limited to human studies. Studies included were cohort studies of adult patients who were discharged after an attack of acute pancreatitis. Patients were excluded if they were under 18 years of age or had a previous diagnosis of prediabetes or diabetes mellitus, pancreatic exocrine insufficiency, or chronic pancreatitis. The main outcome measure was the prevalence of concomitant pancreatic exocrine insufficiency in patients who were diagnosed with prediabetes and diabetes mellitus after an attack of acute pancreatitis. Subgroup analysis was conducted for patients who were diagnosed with prediabetes only and those who were diagnosed with diabetes mellitus only. Subgroup analysis looking at the time course of concomitant pancreatic exocrine and endocrine insufficiency was also conducted. Pooled prevalence and corresponding 95% confidence intervals were calculated for all outcome measures and P-values < 0.05 were deemed statistically significant.

RESULTS: Eight clinical studies comprising of 234 patients met all eligibility criteria. The pooled prevalence of newly diagnosed prediabetes or diabetes in individuals after acute pancreatitis was 43% (95%CI: 30%-56%). The pooled prevalence of pancreatic exocrine insufficiency in individuals after acute pancreatitis was 29% (95%CI: 19%-39%). The prevalence of concomitant pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes was 40% (95%CI: 25%-55%). The prevalence of concomitant pancreatic exocrine insufficiency among individuals with prediabetes alone and diabetes mellitus alone was 41% (95%CI: 12%-75%) and 39% (95%CI: 28%-51%), respectively. Further analysis showed that the prevalence of concomitant pancreatic exocrine insufficiency in individuals with prediabetes or diabetes decreases over time after an attack of acute pancreatitis.

CONCLUSION: Pancreatic exocrine insufficiency occurs in 40% of individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis. Further studies are needed to investigate the pathogenesis of diabetes in this setting.

Keywords: Pancreatogenic diabetes; Pancreatic exocrine insufficiency; Acute pancreatitis; Endocrine insufficiency

Core tip: Diabetes mellitus and pancreatic exocrine insufficiency are common after acute pancreatitis. Concomitant pancreatic exocrine insufficiency occurs in 40% of patients with prediabetes or diabetes and its prevalence decreases with time. Purposefully designed clinical studies are required to elucidate the pathogenesis of pancreatogenic diabetes.