Pancreatic exocrine insufficiency following acute pancreatitis: Systematic review and study level meta-analysis.

Autor: Hollemans RA; Dept. of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Dept. of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands., Hallensleben NDL; Dept. of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands; Dept. of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands., Mager DJ; VU Medical Center, Amsterdam, The Netherlands., Kelder JC; Dept. of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands., Besselink MG; Dept. of Surgery, Academic Gastroenterology and Metabolism, Amsterdam, The Netherlands., Bruno MJ; Dept. of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands., Verdonk RC; Dept. of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands., van Santvoort HC; Dept. of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: h.van.santvoort@antoniusziekenhuis.nl.
Jazyk: angličtina
Zdroj: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] [Pancreatology] 2018 Apr; Vol. 18 (3), pp. 253-262. Date of Electronic Publication: 2018 Feb 20.
DOI: 10.1016/j.pan.2018.02.009
Abstrakt: Objectives: This study systematically explores the prevalence of pancreatic exocrine insufficiency (PEI) after acute pancreatitis in different subgroups of etiology (biliary/alcoholic/other), disease severity and follow-up time (<12, 12-36 and > 36 months after index admission).
Methods: PubMed and EMBASE databases were searched, 32 studies were included in this study level meta-analysis.
Results: In a total of 1495 patients with acute pancreatitis, tested at a mean of 36 months after index admission, the pooled prevalence of PEI was 27.1% (95%-confidence interval [CI]: 20.3%-35.1%). Patients from seven studies (n = 194) underwent direct tests with pooled prevalence of 41.7% [18.5%-69.2%]. Patients from 26 studies (n = 1305) underwent indirect tests with pooled prevalence of 24.4% [18.3%-31.8%]. In subgroup analyses on patients that underwent fecal elastase-1 tests, PEI occurred more often in alcoholic pancreatitis (22.7% [16.6%-30.1%]) than in biliary pancreatitis (10.2% [6.2%-16.4%]) or other etiology (13.4% [7.7%-22.4%]; P = 0.02). Pooled prevalence of PEI after mild and severe pancreatitis was 19.4% [8.6%-38.2%] and 33.4% [22.6%-46.3%] respectively in studies using fecal elaste-1 tests (P = 0.049). Similar results were seen in patients without (18.9% [9.3%-34.6%]) and with necrotizing pancreatitis (32.0% [18.2%-49.8%]; P = 0.053). Over time, the prevalence of PEI decreased in patients who underwent the fecal elastase-1 test and increased in patients who underwent the fecal fat analysis.
Conclusions: After acute pancreatitis, a quarter of all patients develop PEI during follow-up. Alcoholic etiology and severe and necrotizing pancreatitis are associated with higher risk of PEI. The prevalence of PEI may change as time of follow-up increases.
(Copyright © 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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