Upper GI 06

Abstract

Aims: To assess pancreatic exocrine function in patients recovering from first attack of acute pancreatitis, and to evaluate its relationship to severity of attack and the development of local pancreatic complications and endocrine pancreatic insufficiency. Methods: Between December 2000 and November 2001, 23 patients were prospectively evaluated. Pancreatic exocrine function was measured by the faecal elastase-1 test. Attacks were classified as mild (n = 16) or severe (n = 7) according to the Atlanta criteria. Results: Pancreatic exocrine insufficiency was significantly more frequent in patients recovering from severe attacks than mild (n = 6, 86 per cent versus n = 2, 13 per cent; P = 0.002), and in those who developed pancreatic necrosis or pseudocyst than those who did not [6 of 7 patients versus 2 of 16 patients, and 5 of 5 patients versus 3 of 18 patients, respectively; P = 0.002]. The development of exocrine insufficiency correlated strongly (P < 0.001) with the presence of pancreatic necrosis and pseudocyst formation, but not with pancreatic endocrine insufficiency (n = 4, P = 0.07). ‘Severe’ exocrine insufficiency (n = 7) occurred in all six patients with pancreatic necrosis involving more than one-third of the gland. Exocrine insufficiency persisted during follow-up (median 3 months) in patients with severe disease. Conclusions: Pancreatic exocrine insufficiency is a common occurrence in patients recovering from severe acute pancreatitis, and its severity relates to the extent of pancreatic necrosis. A follow-up study is required to evaluate the long-term potential for recovery, and the duration of therapy with pancreatic enzyme supplementation.