Exocrine Pancreatic Insufficiency Following Acute Pancreatitis: Systematic Review and Meta-Analysis

• Published in: Digestive diseases and sciences Vol. 64; no. 7; pp. 1985 - 2005
• Main Authors: Huang, Wei, de la Iglesia-García, Daniel, Baston-Rey, Iria, Calviño-Suarez, Cristina, Lariño-Noia, Jose, Iglesias-Garcia, Julio, Shi, Na, Zhang, Xiaoying, Cai, Wenhao, Deng, Lihui, Moore, Danielle, Singh, Vikesh K., Xia, Qing, Windsor, John A., Domínguez-Muñoz, J. Enrique, Sutton, Robert
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2019; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biochemistry; Development and progression; Diabetes; Enzyme Replacement Therapy; Enzymes; Epidemiology; Exocrine Pancreatic Insufficiency - diagnosis; Exocrine Pancreatic Insufficiency - drug therapy; Exocrine Pancreatic Insufficiency - enzymology; Exocrine Pancreatic Insufficiency - epidemiology; Female; Gastroenterology; Hepatology; Humans; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Meta-analysis; Middle Aged; Observational Studies as Topic; Oncology; Original; Original Article; Pancreatic insufficiency; Pancreatitis; Pancreatitis - diagnosis; Pancreatitis - epidemiology; Prevalence; Randomized Controlled Trials as Topic; Risk Factors; Systematic review; Transplant Surgery; Treatment Outcome; Acute pancreatitis; Severe pancreatitis; Exocrine pancreatic insufficiency; Pancreatic enzyme replacement therapy; Necrotizing pancreatitis
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05568-9

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.