Change of Both Endocrine and Exocrine Insufficiencies After Acute Pancreatitis in Non-Diabetic Patients

Abstract

Acute pancreatitis (AP) is the most common pancreatic disease and consists of an acute inflammation of the pancreas. AP can contribute to endocrine and exocrine insufficiencies in survivors as a result of the key role of the pancreas in both glucose metabolism and nutritional digestion. The aim of this population-based study was to determine the endocrine or exocrine insufficiencies in patients after initial AP with biliary or alcohol-associated causes.We conducted a nationwide cohort study using data from Taiwan's National Health Insurance Research Database collected between 2001 and 2010. A total of 12,284 patients with AP were identified.Alcohol-associated AP (odds ratio, 1.894; 95% CI, 1.520–2.268; P < 0.001) and ≥2 admissions for AP (odds ratio, 1.937; 95% CI, 1.483–2.391; P < 0.001) were significantly associated with newly diagnosed diabetes mellitus after AP. Further, only alcohol-associated AP (odds ratio, 1.215; 95% CI, 1.133–1.297; P < 0.001) was significantly associated with pancreatic exocrine insufficiency after AP. Additionally, alcohol-associated AP (odds ratio, 1.804; 95% CI, 1.345–2.263; P < 0.001) and ≥2 readmissions for AP (odds ratio, 3.190; 95% CI, 2.317–4.063; P < 0.001) were significantly associated with both exocrine and endocrine insufficiencies after AP.Our data showed that alcohol-associated AP, rather than a biliary cause, contributed to a higher extent to exocrine or endocrine insufficiencies. Furthermore, recurrent AP also led to endocrine insufficiency.

Potential for Screening for Pancreatic Exocrine Insufficiency Using the Fecal Elastase-1 Test

“…Recent studies have also indicated that PEI is much more common in acute pancreatitis (*21-29%) than previously thought, and that treatment with PERT can help to improve outcomes (reduced weight loss and flatulence, improved quality of life) [53,54]. Alcohol use and smoking are major factors in the development of acute pancreatitis and, together with the presence and extension of pancreatic necrosis, have been shown to correlate with the development of PEI [55]. PEI has been shown to be prevalent in approximately 87% of patients with autoimmune pancreatitis (AIP) [56].…”

Aspirin Protects against Acinar Cells Necrosis in Severe Acute Pancreatitis in Mice

“…A large number of clinical and experimental researches suggest that, after AP, especially after SAP, endocrine and exocrine function of the pancreas often suffer varying degrees of damage, even developing permanent sequelae of pancreatic dysfunction [7–9]. Therefore, protecting acinar cell against necrosis in the early phase of AP would play a vital role in the pathological processes of AP.…”

Chinese guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency (2018 edition)

“…During recovery from AP, pancreatic exocrine function is at a low level, causing PEI in some patients. PEI is commonly seen in alcoholic AP, severe acute pancreatitis (SAP), and AP with pseudocysts . About one‐third of the patients with SAP develop PEI, at a higher proportion compared with those with mild AP who develop PEI .…”