Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18432
Revised: June 22, 2014
Accepted: August 13, 2014
Published online: December 28, 2014
AIM: To investigate impairment and clinical significance of exocrine and endocrine pancreatic function in patients after acute pancreatitis (AP).
METHODS: Patients with AP were invited to participate in the study. Severity of AP was determined by the Atlanta classification and definitions revised in 2012. Pancreatic exocrine insufficiency (PEI) was diagnosed by the concentration of fecal elastase-1. An additional work-up, including laboratory testing of serum nutritional markers for determination of malnutrition, was offered to all patients with low levels of fecal elastase-1 FE. Hemoglobin A1c or oral glucose tolerance tests were also performed in patients without prior diabetes mellitus, and type 3c diabetes mellitus (T3cDM) was diagnosed according to American Diabetes Association criteria.
RESULTS: One hundred patients were included in the study: 75% (75/100) of patients had one attack of AP and 25% (25/100) had two or more attacks. The most common etiology was alcohol. Mild, moderately severe and severe AP were present in 67, 15 and 18% of patients, respectively. The mean time from attack of AP to inclusion in the study was 2.7 years. PEI was diagnosed in 21% (21/100) of patients and T3cDM in 14% (14/100) of patients. In all patients with PEI, at least one serologic nutritional marker was below the lower limit of normal. T3cDM was more frequently present in patients with severe AP (P = 0.031), but was also present in some patients with mild and moderately severe AP. PEI was present in all degrees of severity of AP. There were no statistically significantly differences according to gender, etiology and number of AP attacks.
CONCLUSION: As exocrine and endocrine pancreatic insufficiency can develop after AP, routine follow-up of patients is necessary, for which serum nutritional panel measurements can be useful.
Core tip: Endocrine and exocrine pancreatic insufficiency can develop after acute pancreatitis regardless of the severity, etiology, age, gender and number of attacks. In all patients with pancreatic exocrine insufficiency (PEI), at least one serum nutritional marker was below the lower limit of normal regardless of the presence of classical clinical symptoms of PEI. Routine follow-up of patients with acute pancreatitis at least 24 mo after discharge from the hospital is necessary with special emphasis on diabetes detection. Measurement of serum nutritional markers regardless of the presence of other clinical symptoms of PEI can be of clinical importance.