Pancreatic exocrine insufficiency, diabetes mellitus and serum nutritional markers after acute pancreatitis

Table 1 Characteristics of patients with exocrine pancreatic insufficiency

Gender	Age (yr)	Etiology	No. of attacks	Severity of AP	FE (μg/g)	T3cDM
Male	30	Alcohol	1	Moderately Severe	7	No
Male	63	Alcohol	1	Moderately Severe	101	No
Male	59	Gallstone	1	Severe	19	Yes
Female	63	Gallstone	1	Severe	63	No
Male	52	Alcohol	1	Mild	46	No
Male	43	Alcohol	2	Moderately Severe	134	No
Male	66	Gallstone	2	Mild	5	Yes
Female	53	Alcohol	1	Mild	4	No
Male	47	Alcohol	2	Mild	156	No
Male	58	Unknown	8	Mild	176	Yes
Male	63	Alcohol	9	Mild	9	No
Male	59	Alcohol	2	Mild	37	No
Female	73	Gallstone	1	Mild	137	No
Male	64	Alcohol	1	Severe	151	Yes
Male	83	Gallstone	1	Mild	191	Yes
Male	63	Alcohol	2	Mild	163	No
Female	52	Drug-induced	1	Mild	94	No
Male	63	Unknown	1	Severe	89	No
Male	40	Alcohol	1	Severe	119	No
Male	53	Alcohol	1	Severe	198	Yes
Male	57	Alcohol	1	Severe	117	No

AP: Acute pancreatitis; FE: Fecal elastase-1; T3cDM: Type 3 diabetes mellitus.

Table 2 Nutritional parameters in patients with pancreatic exocrine insufficiency n (%)

Parameter	Valid cases (n)	Below lower limit of normal
Vitamin D	16	11 (68.8)
Vitamin A	16	1 (6.3)
Vitamin E	16	0
Vitamin B12	16	3 (18.8)
Folic acid	16	3 (18.8)
Iron	16	5 (31.2)
Magnesium	16	0

Reference values: folic acid, 7.0-39.7 nmol/L; iron, 10.7-28.6 μmol/L; magnesium, 0.65-1.05 mmol/L; vitamin A, 1.05-2.80 μmol/L; vitamin B12, 160-800 pg/mL; vitamin D, 65-165 nmol/L; vitamin E, 12-42 μmol/L.

Table 3 Prevalence of exocrine and endocrine pancreatic insufficiency after acute pancreatitis

Ref.	Year	Follow-up	n	Etiology	Methods	Exocrine insufficiency	Endocrine insufficiency
Glasbrenner et al[27]	1992	Acute phase and after 1 mo	29 oedematous AP	Alcohol, gallstone	FDL serum test, fecal chymotrypsin	FDL abnormal: 79% in acute phase and 10% after 1 mochymotrypsin abnormal: 69% in acute phase and 3% after 1 mo	Has not been determined
Seidensticker et al[26]	1995	34 mo	38	Alcohol, gallstone, unexplained	SPT, fecal fat analysis, ERCP	50% had one or more abnormal tests	Has not been determined
Bozkurt et al[8]	1995	4 wk-18 mo	53all severe AP	Alcohol, gallstone	Lundh test meal with measurement of duodenal secretion and enzyme activity	6%-84% of all patients; 6%-26% marked and 74%-81% moderate	Has not been determined
Tsiotos et al[7]	1998	5 yr	44severe AP	Alcohol, gallstone, post-ERCP, hereditary	Fecal fat excretion, fasting plasma glucose	25%	36.4%
Appelros et al[6]	2001	Mean 7 yr	26all severe AP	Alcohol, gallstone, post-ERCP, hyperlipidemia, unexplained	Triolein test, fasting plasma glucose, HbA1c	69.2% with pathologic triolein test	43%
Boreham et al[2]	2003	Acute phase and after 3 mo	2316 mild, 7 severe AP	Alcohol, gallstone, post-ERCP, hyperlipidemia, unexplained	Fecal elastase-1, fasting plasma glucose	34.8% of all patients; 26.1% after severe and 8.7% after mild AP	17.4% of all patients; 13.0% after severe and 4.4% after mild AP
Connor et al[3]	2005	29 mo	63after necrosectomy	Alcohol, gallstone	Clinical symptoms of steatorrhea, OGTT	25%	33%
Symersky et al[1]	2006	4.6 yr	3422 mild, 12 severe AP	Gallstone, post-ERCP	PABA test, OGTT, PP secretion, fecal fat analysis	64.7% of all patients; 29.4% after severe and 35.3% after mild AP	35%
Pezzilli et al[4]	2009	Acute phase (on the day of refeeding)	7560 mild, 15 severe AP	Alcohol, gallstone, hyperlipidemia	Fecal elastase-1	12% of all patients; 2.7% after severe and 9.3% after mild AP	Has not been determined
Gupta et al[5]	2009	Mean 31 mo	3021 with necrosis	Alcohol, gallstone, unexplained	Fecal fat excretion, urinary D-xylose excretion, OGTT	40%	40%
Present study	2013	Mean 2.7 yr	10017 with necrosis	Alchohol, gallstone, hyperlipidemia, unexplained, drug-induced,	Fecal elastase-1, OGTT	21%	14%

AP: Acute pancreatitis; ERCP: Endoscopic retrograde cholangiopancreatography; FDL: Fluorescein dilaurate; HbA1c: Glycated hemoglobin; OGTT: Oral glucose tolerance test; PABA: 4-aminobenzoic acid; PP: Pancreatic polypeptide; SPT: Secretin-pancreozymin test.