Endocrine and exocrine pancreatic insufficiency after acute pancreatitis: long-term follow-up study

Abstract

BackgroundPatients could develop endocrine and exocrine pancreatic insufficiency after acute pancreatitis (AP), but the morbidity, risk factors and outcome remain unclear. The aim of the present study was to evaluate the incidence of endocrine and exocrine pancreatic insufficiency after AP and the risk factors of endocrine pancreatic insufficiency through a long-term follow-up investigation.MethodsFollow-up assessment of the endocrine and exocrine function was conducted for the discharged patients with AP episodes. Oral Glucose Tolerance Test (OGTT) and faecal elastase-1(FE-1) test were used as primary parameters. Fasting blood-glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin HBA1c, 2-h postprandial blood glucose (2hPG), Homa beta cell function index (HOMA-β), homeostasis model assessment of insulin resistance (HOMA-IR) and FE-1 were collected. Abdominal contrast-enhanced computed tomography (CECT) was performed to investigate the pancreatic morphology and the other related data during hospitalization was also collected.ResultsOne hundred thirteen patients were included in this study and 34 of whom (30.1%) developed diabetes mellitus (DM), 33 (29.2%) suffered impaired glucose tolerance (IGT). Moreover, 33 patients (29.2%) developed mild to moderate exocrine pancreatic insufficiency with 100μg/g<FE-1<200μg/g and 7 patients (6.2%) were diagnosed with severe exocrine pancreatic insufficiency with FE-1<100μg/g. The morbidity of DM and IGT in patients with pancreatic necrosis was significant higher than that in the non-pancreatic necrosis group (X 2 = 13.442,P = 0.001). The multiple logistic regression analysis showed that extent of pancreatic necrosis<30% (P = 0.012, OR = 0.061) were the protective factors of endocrine pancreatic insufficiency. HOMA-IR (P = 0.002, OR = 6.626), Wall-off necrosis (WON) (P = 0.013, OR = 184.772) were the risk factors.ConclusionThe integrated morbidity of DM and IGT after AP was 59.25%, which was higher than exocrine pancreatic insufficiency. 6.2% and 29.2% of patients developed severe and mild to moderate exocrine pancreatic insufficiency, respectively. The extent of pancreatic necrosis>50%, WON and insulin resistance were the independent risk factors of new onset diabetes after AP.Electronic supplementary materialThe online version of this article (10.1186/s12876-017-0663-0) contains supplementary material, which is available to authorized users.

Acute Abdomen in Diabetic Patients - What Should We Do?

“…After the treatment of the acute episode, the blood glucose should soon return to normal. However, some of these patients may not fully recover from the hyperglycemia and their blood glucose could rise again after a short term recovery; afterwards, they may develop diabetes mellitus and need treatment with antidiabetic medication or insulin in their rest of lives (19). There has been described a type 3c diabetes mellitus, which is determined by pancreatic destruction during one or more episodes of acute pancreatitis.…”

New-Onset Diabetes Mellitus After the First Attack of Acute Pancreatitis: A Systematic Review and Meta-Analysis

“…The search retrieved a total number of 4834 studies of which, 65 relevant papers were included in the assessment. Finally, 12 studies were used in the analysis (Figure 1) (16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Cohen's kappa coefficient was 0.773 (95% CI: 0.610 -0.936), which indicates a strong consistency.…”

“…All the studies performed prospective cohorts. Eight studies (16,27,29,30,(32)(33)(34)(35) were conducted in Europe, three (25,26,31) in Asia, and one (28) in South America. All studies were conducted in single centers.…”

“…The pooled prevalence of prediabetes was 31% (95% CI: 11% to 90%) and heterogeneity between the studies did not decrease (I 2 = 77%). Sensitivity analysis involved studies that used the 1999 WHO definitions (21), including three studies (25,26,33) with 415 patients. The pooled prevalence was 28% (95% CI: 24% to 33%), with no statistical heterogeneity between studies (I 2 = 0%).…”

Evaluation of ultrasound-guided Freka-Trelumina enteral nutrition tube placement in the treatment of acute pancreatitis

“…Severe acute pancreatitis often occurs suddenly and progresses rapidly with numerous complications that can even lead to multiple-organ dysfunction, resulting in high mortality. Evidence-based medical evidence indicates that early enteral nutrition can preserve intestinal mucosal barrier function in patients with severe acute pancreatitis and reduce endotoxin translocation, pancreatic infection, the organ failure rate, and mortality [1][2][3][4][5][6][7][8][9]. Therefore, the guidelines for the diagnosis and treatment of acute pancreatitis recommend enteral nutrition as an important treatment, which should be implemented as early as possible in patients with moderate to severe acute pancreatitis [1][2][3][4][5][6][7][8][9].…”