TY - JOUR
T1 - Exocrine Pancreatic Insufficiency Following Acute Pancreatitis
T2 - Systematic Review and Meta-Analysis
AU - Huang, Wei
AU - de la Iglesia-García, Daniel
AU - Baston-Rey, Iria
AU - Calviño-Suarez, Cristina
AU - Lariño-Noia, Jose
AU - Iglesias-Garcia, Julio
AU - Shi, Na
AU - Zhang, Xiaoying
AU - Cai, Wenhao
AU - Deng, Lihui
AU - Moore, Danielle
AU - Singh, Vikesh K.
AU - Xia, Qing
AU - Windsor, John A.
AU - Domínguez-Muñoz, J. Enrique
AU - Sutton, Robert
N1 - Funding Information:
The authors are grateful to Dr. Michael Chvanov, PhD, of the Department of Cellular and Molecular Physiology at the University of Liverpool for the translation of Russian into English to enable completion of this study. This study was partially supported by the Key Technology R&D Program of Sichuan Provincial Department of Science and Technology (grant no. 2015SZ0229; QX) and NZ-China Strategic Research Alliance 2016 Award (China: 2016YFE0101800, QX, WH and LD.; New Zealand: JAW); the Liverpool China Scholarships Council (XZ); the University Hospital of Santiago de Compostela funds, Spain (DdlIG, IB-R, CC-S, JL-N, JI-G and JED-M); the Biomedical Research Unit Funding Scheme of the National Institute for Health Research (NIHR; WH and RS); the NIHR Senior Investigator Scheme (RS).
Funding Information:
Acknowledgments The authors are grateful to Dr. Michael Chvanov, PhD, of the Department of Cellular and Molecular Physiology at the University of Liverpool for the translation of Russian into English to enable completion of this study. This study was partially supported by the Key Technology R&D Program of Sichuan Provincial Department of Science and Technology (grant no. 2015SZ0229; QX) and NZ-China Strategic Research Alliance 2016 Award (China: 2016YFE0101800, QX, WH and LD.; New Zealand: JAW); the Liverpool China Scholarships Council (XZ); the University Hospital of Santiago de Compostela funds, Spain (DdlIG, IB-R, CC-S, JL-N, JI-G and JED-M); the Biomedical Research Unit Funding Scheme of the National Institute for Health Research (NIHR; WH and RS); the NIHR Senior Investigator Scheme (RS).
Funding Information:
Conflict of interest JED-M has provided consultancy to and received financial support from Abbott (Mylan) for lecture fees and travel ex- penses outside of the submitted work; RS has provided consultancy to Abbott (Mylan); no further support from any organization for the submitted work; no the financial relationships with any organizations that might have had an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/7/15
Y1 - 2019/7/15
N2 - Background/Objectives: The epidemiology of exocrine pancreatic insufficiency (EPI) after acute pancreatitis (AP) is uncertain. We sought to determine the prevalence, progression, etiology and pancreatic enzyme replacement therapy (PERT) requirements for EPI during follow-up of AP by systematic review and meta-analysis. Methods: Scopus, Medline and Embase were searched for prospective observational studies or randomized clinical trials (RCTs) of PERT reporting EPI during the first admission (between the start of oral refeeding and before discharge) or follow-up (≥ 1 month of discharge) for AP in adults. EPI was diagnosed by direct and/or indirect laboratory exocrine pancreatic function tests. Results: Quantitative data were analyzed from 370 patients studied during admission (10 studies) and 1795 patients during follow-up (39 studies). The pooled prevalence of EPI during admission was 62% (95% confidence interval: 39–82%), decreasing significantly during follow-up to 35% (27–43%; risk difference: − 0.34, − 0.53 to − 0.14). There was a two-fold increase in the prevalence of EPI with severe compared with mild AP, and it was higher in patients with pancreatic necrosis and those with an alcohol etiology. The prevalence decreased during recovery, but persisted in a third of patients. There was no statistically significant difference between EPI and new-onset pre-diabetes/diabetes (risk difference: 0.8, 0.7–1.1, P = 0.33) in studies reporting both. Sensitivity analysis showed fecal elastase-1 assay detected significantly fewer patients with EPI than other tests. Conclusions: The prevalence of EPI during admission and follow-up is substantial in patients with a first attack of AP. Unanswered questions remain about the way this is managed, and further RCTs are indicated.
AB - Background/Objectives: The epidemiology of exocrine pancreatic insufficiency (EPI) after acute pancreatitis (AP) is uncertain. We sought to determine the prevalence, progression, etiology and pancreatic enzyme replacement therapy (PERT) requirements for EPI during follow-up of AP by systematic review and meta-analysis. Methods: Scopus, Medline and Embase were searched for prospective observational studies or randomized clinical trials (RCTs) of PERT reporting EPI during the first admission (between the start of oral refeeding and before discharge) or follow-up (≥ 1 month of discharge) for AP in adults. EPI was diagnosed by direct and/or indirect laboratory exocrine pancreatic function tests. Results: Quantitative data were analyzed from 370 patients studied during admission (10 studies) and 1795 patients during follow-up (39 studies). The pooled prevalence of EPI during admission was 62% (95% confidence interval: 39–82%), decreasing significantly during follow-up to 35% (27–43%; risk difference: − 0.34, − 0.53 to − 0.14). There was a two-fold increase in the prevalence of EPI with severe compared with mild AP, and it was higher in patients with pancreatic necrosis and those with an alcohol etiology. The prevalence decreased during recovery, but persisted in a third of patients. There was no statistically significant difference between EPI and new-onset pre-diabetes/diabetes (risk difference: 0.8, 0.7–1.1, P = 0.33) in studies reporting both. Sensitivity analysis showed fecal elastase-1 assay detected significantly fewer patients with EPI than other tests. Conclusions: The prevalence of EPI during admission and follow-up is substantial in patients with a first attack of AP. Unanswered questions remain about the way this is managed, and further RCTs are indicated.
KW - Acute pancreatitis
KW - Exocrine pancreatic insufficiency
KW - Necrotizing pancreatitis
KW - Pancreatic enzyme replacement therapy
KW - Severe pancreatitis
UR - http://www.scopus.com/inward/record.url?scp=85065724109&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065724109&partnerID=8YFLogxK
U2 - 10.1007/s10620-019-05568-9
DO - 10.1007/s10620-019-05568-9
M3 - Article
C2 - 31161524
AN - SCOPUS:85065724109
VL - 64
SP - 1985
EP - 2005
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
SN - 0163-2116
IS - 7
ER -