Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up. PANCR-EVOL Study

Gastroenterol Hepatol. 2018 Feb;41(2):77-86. doi: 10.1016/j.gastrohep.2017.08.002. Epub 2017 Sep 19.
[Article in English, Spanish]

Abstract

Background/objectives: Exocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL).

Methods: This was a cross-sectional, multicenter Spanish study. CP patients without follow-up by a gastroenterologist or surgeon in at least 2 years were included. EPI was defined as fecal elastase test <200mcg/g. For nutritional assessment, laboratory and anthropometric data were obtained. QoL was investigated using the EORTC QLQ-C30 questionnaire.

Results: 64 patients (mean age 58.8±10.3 years, 85.9% men) from 10 centers were included. Median time since diagnosis of CP was 58.7 months [37.7-95.4]. Forty-one patients (64.1%) had EPI. Regarding nutritional status, the following differences were observed (EPI vs. Non-EPI): BMI (23.9±3.5kg/m2 vs. 25.7±2.5, p=0.03); glucose (121 [96-189] mg/dL vs. 98 [90-116], p=0.006); HbA1c 6.6% [6.0-8.4] vs. 5.5 [5.3-6.0], p=0.0005); Vitamin A (0.44mg/L [0.35-0.57] vs. 0.53 [0.47-0.63], p=0.048) and Vitamin E (11.2±5.0μg/ml vs. 14.4±4.3, p=0.03). EPI group showed a worse EORTC QLQ-C30 score on physical (93.3 [66.7-100] vs. 100 [93.3-100], p=0.048) and cognitive function (100 [83.3-100] vs. 100 [100-100], p=0.04).

Conclusions: Prevalence of EPI is high in patients with CP without follow-up. EPI group had higher levels of glucose, lower levels of vitamins A and E and worse QoL.

Keywords: Calidad De Vida; Chronic pancreatitis; Complicaciones; Complications; Elastasa Fecal; Estado Nutricional; Exocrine pancreatic insufficiency; Fecal elastase-1; Follow-up; Insuficiencia Pancreática Exocrina; Nutritional status; Pancreatitis Crónica; Quality of life; Seguimiento.

Publication types

  • Multicenter Study

MeSH terms

  • Aftercare / standards
  • Aged
  • Anthropometry
  • Cross-Sectional Studies
  • Exocrine Pancreatic Insufficiency / epidemiology
  • Exocrine Pancreatic Insufficiency / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nutritional Status
  • Pancreatitis, Chronic / complications*
  • Prevalence
  • Quality of Life
  • Spain / epidemiology
  • Surveys and Questionnaires