Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2017; 23(12): 2217-2222
Published online Mar 28, 2017. doi: 10.3748/wjg.v23.i12.2217
Comparing acid steatocrit and faecal elastase estimations for use in M-ANNHEIM staging for pancreatitis
M Ganesh Kamath, C Ganesh Pai, Asha Kamath, Annamma Kurien
M Ganesh Kamath, Department of Physiology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
C Ganesh Pai, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, India
Asha Kamath, Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal 576104, India
Annamma Kurien, Department of Pathology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
Author contributions: Pai CG proposed the study; Kamath MG and Pai CG wrote the first draft; Kamath MG and Kurien A performed the research; Kamath MG and Pai CG analysed the lab parameters; Kamath MG and Pai CG collected the data and assisted Kamath A, who performed the statistical analysis; all authors contributed to the design and interpretation of the study and to further drafts; Pai CG is the guarantor.
Supported by Indian Council of Medical Research, New Delhi, India.
Institutional review board statement: The study protocol was reviewed and approved by University Ethics Committee of Manipal University.
Informed consent statement: All study participants or their legal guardians provided written informed consent prior to study enrolment.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: C Ganesh Pai, MD, DM, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, India. cgpai@yahoo.co.in
Telephone: +91-820-2922192 Fax: +91-820-2571934
Received: December 9, 2016
Peer-review started: December 11, 2016
First decision: January 9, 2017
Revised: February 14, 2017
Accepted: March 4, 2017
Article in press: March 4, 2017
Published online: March 28, 2017
Abstract
AIM

To compare two tests for exocrine pancreatic function (EPF) for use in M-ANNHEIM staging for pancreatitis.

METHODS

One hundred and ninety four consecutive patients with acute pancreatitis (AP; n = 13), recurrent acute pancreatitis (RAP; n = 65) and chronic pancreatitis (CP; n = 116) were enrolled. EPF was assessed by faecal elastase-1 (FE-1) estimation and stool fat excretion by the acid steatocrit method. Patients were classified as per M-ANNHEIM stages separately based on the results of the two tests for comparison. Independent Student’s t-test, χ2 test, Kruskal-Wallis test, Mann-Whitney U test and McNemar’s test were used as appropriate.

RESULTS

Sixty-one (52.5%) patients with CP had steatorrhoea when assessed by the acid steatocrit method; 79 (68.1%) with CP had exocrine insufficiency by the FE-1 test (χ2 test, P < 0.001). The results of acid steatocrit and FE-1 showed a significant negative correlation (Spearman’s rho = -0.376, P < 0.001). A statistically significant difference was seen between the M-ANNHEIM stages as classified separately by acid steatocrit and the FE-1. Thirteen (6.7%), 87 (44.8%), 89 (45.8%) and 5 (2.5%) patients were placed in M-ANNHEIM stages 0, I, II, and III respectively, with the use of acid steatocrit as against 13 (6.7%), 85 (43.8%), 75 (38.6%), and 21 (10.8%) respectively by FE-1 in stages 0, I, II, and III thereby altering the stage in 28 (14.4%) patients (P < 0.001, McNemar’s test).

CONCLUSION

FE-1 estimation performed better than the acid steatocrit test for use in the staging of pancreatitis by the M-ANNHEIM classification since it diagnosed a higher proportion of patients with exocrine insufficiency.

Keywords: Chronic pancreatitis, Pancreatic function tests, Pancreatic elastase, Staging, Steatorrhoea

Core tip: Patients with acute, recurrent acute and chronic pancreatitis were classified as per M-ANNHEIM stages, separately based on the results of two exocrine function tests (acid steatocrit method and faecal elastase test) for comparison. A statistically significant difference was seen between the M-ANNHEIM stages as classified separately by the two tests. Faecal elastase-1 estimation performed better than the acid steatocrit test for use in the staging of pancreatitis by the M-ANNHEIM classification since it diagnosed a higher proportion of patients with exocrine dysfunction.