THU261 Etiologic Factors, Contributors, And Associations For Exocrine Pancreatic Insufficiency

Abstract

Abstract Disclosure: K.G. Romo: None. A. Noor: None. A. Zia: None. S. Shu: None. S. Bhamre: None. W.A. West: None. B.M. Hoard: None. G.I. Uwaifo: None. Introduction: Exocrine pancreatic insufficiency (EPI) is a clinical condition which though presumed to be uncommon has grown in prominence and recognition in recent years. The fact that pancreatic enzyme replacement therapy (PERT) is available to ameliorate many of the metabolic and gastrointestinal sequelae of EPI makes its early recognition, diagnosis, and treatment very important. Since EPI appears uncommon, improved quantification of its prevalence and identification of associated etiologic factors could inform targeted screening in select patient populations. Our study is a retrospective chart analysis of a large multi-specialty, multi-institutional practice group covering much of Louisiana and seeks to provide needed information regarding EPI prevalence and etiologic factors. Methods: A retrospective review of the entire 1.3 million patient-practice of the Ochsner Health system in Louisiana was performed to cover the period from January 2017 to January 2020. All cases of documented EPI and patients on PERT were identified—these were then further interrogated including individual chart review to identify etiologic factors and obtain relevant cardiometabolic, demographic, vital sign data, and clinical course information. Results: A total of 677 EPI patients were identified with a prevalence of 0.525% among patients with diabetes (DM) and 0.051% in the general outpatient population. EPI, though uncommon, is thus ∼ 10x more prevalent among DM patients. The identified etiologic factors were Type 2 diabetes (T2DM) (44.6% of cases), general cancer (15.9%), secondary diabetes (11.5%), cystic fibrosis (12.9%), Type 1 diabetes (T1DM) (9.6%), pancreatic cancer (6.6%), idiopathic (6.2%), pancreatitis (5%), pancreatic surgery (2.95%), hemochromatosis-hemosiderosis (0.44%), and alpha-1 antitrypsin deficiency (0.15%). Several patients in the cohort had multiple identified etiologic factors. Discussion and Conclusions: While EPI is uncommon in the general population it is at least 10x more prevalent among DM patients. Etiologic factors provide a clinical pathway for targeted clinical and lab screening to enable early diagnosis and treatment. Since T2DM is the most common etiologic factor for EPI in our cohort and other reported series, there is need for further in-depth study to identify potentially modifiable factors and possible predictors in the progression of DM to EPI and whether PERT can ameliorate associated cardio-metabolic and ASCVD risk surrogates. Presentation: Thursday, June 15, 2023