Brief Article
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World J Gastroenterol. Nov 28, 2013; 19(44): 8065-8070
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.8065
Effects of disease severity and necrosis on pancreatic dysfunction after acute pancreatitis
Gokhan Garip, Emre Sarandöl, Ekrem Kaya
Gokhan Garip, Ekrem Kaya, Department of Surgery, Uludag University School of Medicine, 16059 Gorukle-Bursa, Turkey
Emre Sarandöl, Department of Biochemistry, Uludag University School of Medicine, 16059 Gorukle-Bursa, Turkey
Author contributions: Garip G and Kaya E contributed equally to this work and wrote the paper; Sarandöl E analyzed the blood samples and laboratory data.
Supported by Uludag University Resources Committee
Correspondence to: Ekrem Kaya, MD, Department of Surgery, Uludag University School of Medicine, HPB Unit, 16059 Gorukle-Bursa, Turkey. ekremkaya@uludag.edu.tr
Telephone: +90-224-4428398 Fax: +90-224-4428398
Received: March 28, 2013
Revised: August 21, 2013
Accepted: September 16, 2013
Published online: November 28, 2013
Processing time: 257 Days and 20.1 Hours
Abstract

AIM: To evaluate the effects of disease severity and necrosis on organ dysfunctions in acute pancreatitis (AP).

METHODS: One hundred and nine patients treated as AP between March 2003 and September 2007 with at least 6 mo follow-up were included. Patients were classified according to severity of the disease, necrosis ratio and localization. Subjective clinical evaluation and fecal pancreatic elastase-I (FPE-I) were used for exocrine dysfunction evaluation, and oral glucose tolerance test was completed for endocrine dysfunction. The correlation of disease severity, necrosis ratio and localization with exocrine and endocrine dysfunction were investigated.

RESULTS: There were 58 male and 51 female patients, and mean age was 56.5 ± 15.7. Of the patients, 35.8% had severe AP (SAP) and 27.5% had pancreatic necrosis. Exocrine dysfunction was identified in 13.7% of the patients [17.9% were in SAP, 11.4% were in mild AP (MAP)] and 34.7% of all of the patients had endocrine dysfunction (56.4% in SAP and 23.2% in MAP). In patients with SAP and necrotizing AP (NAP), FPE-Ilevels were lower than the others (P < 0.05 and 0.001 respectively) and in patients having pancreatic head necrosis or near total necrosis, FPE-1 levels were lower than 200 μg/g stool. Forty percent of the patients who had undergone necrosectomy developed exocrine dysfunction. Endocrine dysfunction was more significant in patients with SAP and NAP (P < 0.001). All of the patients in the necrosectomy group had endocrine dysfunction.

CONCLUSION: Patients with SAP, NAP, pancreatic head necrosis and necrosectomy should be followed for pancreatic functions.

Keywords: Acute pancreatitis; Exocrine dysfunction; Endocrine dysfunction; Pancreas function test; Pancreatic necrosis

Core tip: The aim of this study was to evaluate the effects of disease severity and necrosis on organ dysfunctions in acute pancreatitis (AP). Exocrine and endocrne dysfunctions were investigated according to disease severity and necrosis ratio after acute pancreatitis. Exocrine dysfunction was identified in 13.7% of the patients [17.9% were in severe AP (SAP), 11.4% were in mild AP (MAP) and 34.7% of all of the patients had endocrine dysfunction (56.4% in SAP and 23.2% in MAP)]. Forty percent of the patients who had undergone necrosectomy developed exocrine dysfunction. Endocrine dysfunction was more significant in patients with SAP and NAP. All of the patients in the necrosectomy group had endocrine dysfunction. Patients with SAP, NAP, pancreatic head necrosis and necrosectomy should be followed for pancreatic functions.