Role of Exocrine and Endocrine Insufficiency in the Management of Patients with Chronic Pancreatitis

Role of Exocrine and Endocrine Insufficiency in the Management of Patients with Chronic Pancreatitis

Carmelo Diéguez-Castillo;Cristina Jiménez-Luna;Jose Luis Martín-Ruiz;Joaquina Martínez-Galán;José Prados;Carolina Torres;Amanda Rocío González-Ramírez;Octavio Caba;Diéguez-Castillo, Carmelo;Jiménez-Luna, Cristina;Martín-Ruiz, Jose Luis;Martínez-Galán, Joaquina;Prados, José;Torres, Carolina;González-Ramírez, Amanda Rocío;Caba, Octavio;
journal of clinical medicine 2020 Vol. 9 pp. 2014-
202
diéguez-castillo2020journalrole

Abstract

Background: Exocrine pancreatic insufficiency results from the destruction of the pancreatic parenchyma and is diagnosed by using direct or indirect tests, both of which have shortcomings. Chronic pancreatitis is the most frequent cause of this pathology in adults. Methods: Patients meeting radiological or histological diagnostic criteria of chronic pancreatitis are enrolled and the stool elastase test is conducted, considering fecal elastase levels >200 µg/g to represent normal pancreatic function, and levels <200 μg/g to indicate the presence of exocrine pancreatic insufficiency. Additionally, we determine the body mass index of the patients and study their nutritional status and main biochemical and hematological variables, including their glucose and hemoglobin A1c (HbA1c) levels. Results: Exocrine pancreatic insufficiency is detected in 60% of the patients. Among these, 83.3% are severe cases, and 72% of the latter also are diagnosed with endocrine pancreatic insufficiency (diabetes mellitus). During the nutritional status study, HbA1c levels are significantly higher, and magnesium and prealbumin levels are significantly lower in patients with exocrine pancreatic insufficiency than in those without this disease. Conclusions: Exocrine and endocrine pancreatic insufficiency are highly prevalent among patients with chronic pancreatitis and an early diagnosis of these diseases is vital to improve the clinical management of these patients and reduce their risk of mortality.

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