Effects of disease severity and necrosis on pancreatic dysfunction after acute pancreatitis

World J Gastroenterol. 2013 Nov 28;19(44):8065-70. doi: 10.3748/wjg.v19.i44.8065.

Abstract

Aim: To evaluate the effects of disease severity and necrosis on organ dysfunctions in acute pancreatitis (AP).

Methods: One hundred and nine patients treated as AP between March 2003 and September 2007 with at least 6 mo follow-up were included. Patients were classified according to severity of the disease, necrosis ratio and localization. Subjective clinical evaluation and fecal pancreatic elastase-I (FPE-I) were used for exocrine dysfunction evaluation, and oral glucose tolerance test was completed for endocrine dysfunction. The correlation of disease severity, necrosis ratio and localization with exocrine and endocrine dysfunction were investigated.

Results: There were 58 male and 51 female patients, and mean age was 56.5 ± 15.7. Of the patients, 35.8% had severe AP (SAP) and 27.5% had pancreatic necrosis. Exocrine dysfunction was identified in 13.7% of the patients [17.9% were in SAP, 11.4% were in mild AP (MAP)] and 34.7% of all of the patients had endocrine dysfunction (56.4% in SAP and 23.2% in MAP). In patients with SAP and necrotizing AP (NAP), FPE-Ilevels were lower than the others (P < 0.05 and 0.001 respectively) and in patients having pancreatic head necrosis or near total necrosis, FPE-1 levels were lower than 200 μg/g stool. Forty percent of the patients who had undergone necrosectomy developed exocrine dysfunction. Endocrine dysfunction was more significant in patients with SAP and NAP (P < 0.001). All of the patients in the necrosectomy group had endocrine dysfunction.

Conclusion: Patients with SAP, NAP, pancreatic head necrosis and necrosectomy should be followed for pancreatic functions.

Keywords: Acute pancreatitis; Endocrine dysfunction; Exocrine dysfunction; Pancreas function test; Pancreatic necrosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carrier Proteins / metabolism
  • Clinical Enzyme Tests
  • Exocrine Pancreatic Insufficiency / complications
  • Exocrine Pancreatic Insufficiency / diagnosis
  • Feces / chemistry
  • Female
  • Glucose Tolerance Test
  • Humans
  • Male
  • Middle Aged
  • Necrosis
  • Pancreas / diagnostic imaging
  • Pancreas / metabolism
  • Pancreas / pathology*
  • Pancreas / surgery
  • Pancreatectomy / adverse effects
  • Pancreatic Elastase
  • Pancreatic Function Tests
  • Pancreatitis, Acute Necrotizing / diagnosis*
  • Pancreatitis, Acute Necrotizing / metabolism
  • Pancreatitis, Acute Necrotizing / pathology
  • Pancreatitis, Acute Necrotizing / surgery
  • Predictive Value of Tests
  • Severity of Illness Index
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult

Substances

  • Carrier Proteins
  • Pancreatic Elastase
  • cholesterol-binding protein