Observational Study
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World J Gastroenterol. Dec 28, 2014; 20(48): 18432-18438
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18432
Pancreatic exocrine insufficiency, diabetes mellitus and serum nutritional markers after acute pancreatitis
Miroslav Vujasinovic, Bojan Tepes, Jana Makuc, Sasa Rudolf, Jelka Zaletel, Tjasa Vidmar, Maja Seruga, Bostjan Birsa
Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia
Bojan Tepes, Abakus Medico Diagnostic Centre, Rogaska Slatina 3250, Slovenia
Sasa Rudolf, Department of Radiology, University Medical Centre Maribor, Maribor 2000, Slovenia
Jelka Zaletel, Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
Maja Seruga, Department of Internal Medicine, Murska Sobota General Hospital, Murska Sobota 9001, Slovenia
Bostjan Birsa, Department of Internal Medicine, Celje General Hospital, Celje 3000, Slovenia
Author contributions: Vujasinovic M and Tepes B designed the study and drafted the manuscript; Vujasinovic M, Vidmar T, Seruga M and Birsa B recruited the patients; Rudolf S performed magnetic resonance imaging; Vujasinovic M, Tepes B, Makuc J, and Zaletel J wrote the manuscript.
Correspondence to: Miroslav Vujasinovic, MD, MSc, Department of Internal Medicine, Slovenj Gradec General Hospital, Gosposvetska 1, Slovenj Gradec 2380, Slovenia. mvujas@gmail.com
Telephone: +386-2-8823448 Fax: +386-2-8823505
Received: April 25, 2014
Revised: June 22, 2014
Accepted: August 13, 2014
Published online: December 28, 2014
Processing time: 256 Days and 2.6 Hours
Abstract

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.

Keywords: Acute pancreatitis; Diabetes mellitus; Pancreatic exocrine insufficiency; Serum nutritional markers

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.