Table 3.
Pancreatic function at baseline and follow-up
| Study | Patients enrolled (analyzed for EPI) | Pre-existing DM (%) | Pancreatic intervention (%)a | EPI diagnostic criteria | EPI (%)b | Use of PERT | RAP (%) | New prediabetes and/or DM (%) | Pancreatic morphology changes (%) | Health status |
|---|---|---|---|---|---|---|---|---|---|---|
| Braganza et al. | 12 (12) | NR | 0 (0) | SCT < lower reference rangec | 1 (0.8) | NR | NR | NR | NR | NR |
| Seligson et al. | 10 (10) | 1 (10) | NR | Lundh meal test < lower reference ranged | 7 (70) | 2 (20) | NR | 5 (50) | 6 (60) | NR |
| Mitchell et al. | 30 (30) | NR | 0 (0) | NBT-PABA test with urinary PABA recovery < 57% | 7/15 (47); Index admission: 30 (100) | NR | NR | NR | NR | NR |
| Angelini et al. | 27 (20) | NR | 27 (100)e | SCT < lower reference rangec | 8/20 (40) | NR | NR | 12 (44)e | 13 (48)e | NR |
| Arenas et al. | 26 (26) | NR | NR | NBT-PABA test with urinary PABA recovery < 45% | 2/11 (18) Index admission: 12 (46) | NR | NR | NR | NR | NR |
| Büchler et al. | 79 (79) | NR | 52 (65.8) | SCT < lower reference rangec; urine or serum fluorescein-dilaurate test < lower reference range (NR) | 42 (53) | NR | NR | 19 (24) | 34 (43) | NR |
| Garnacho Montero et al. | 19 (19) | NR | NR | NBT-PABA test with urinary PABA recovery < 45% | 8 (42); Index admission: 19 (100) | NR | NR | NR | NR | NR |
| Airey et al. | 59 (41) | NR | 0 (0) | NBT-PABA test with urinary PABA recovery < 55% | 29 (71); Index admission: 26 (63) | 20 (49)f | NR | NR | NR | NR |
| Glasbrenner et al. | 29 (29) | NR | 0 (0) | Fluorescein dilaurate test with peak serum fluorescein < 4.5 µg/ml; fecal chymotrypsin < 3 U/g | Index admission: 23 (79) | 0 (0) | NR | NR | NR | NR |
| Bozkurt et al. | 89 (53) | NR | 42 (47)d | Lundh meal test < lower reference ranged | 45 (85) | NR | NR | NR | NR | NR |
| Seidensticker et al. | 38 (38) | NR | 1 (3) | SCT < lower reference rangec | 5 (13) | NR | 0 (0) | NR | 7 (18) | NR |
| Malecka-Panas et al. (a) | 47 (47) | NR | 0 (0) | SCT < lower reference rangec | 30 (64) | 6 (13) | NR | 14 (30) | 30 (64) | NR |
| Malecka-Panas et al. (b) | 30 (30) | NR | NR | SCT < lower reference rangec | 19 (63) | NR | NR | NR | 4 (13) | NR |
| John et al. | 50 (36) | NR | NR | Fecal chymotrypsin level < 3 U/g | 11 (31) | NR | NR | NR | 9 (18) | NR |
| Tsiotos et al. | 72 (44) | NR | 44 (100) | FFE > 7 g/d with or without fecal weight > 20% | 11 (25) | 11 (25) | 2 (5) | 16 (36) | NR | ECOG score |
| Appelros et al. | 79 (26) | 1 (1) | 31 (39) | Pathologic triolein breath test (1 point) with weight loss > 10% (1 point), low level of serum amylase (1 point), low fat diet to avoid diarrhea (1 point); ≥ 2 | 18 (69) | NR | 12 (34) | 19 (73) | NR | Working capacity |
| Ibars et al. | 63 (61) | NR | 0 (0) | FFE > 7 g/d; SCT < lower reference rangec; urinary pancreolauryl test < 25%; fecal chymotrypsin < 3 U/g | 2 (3) | NR | NR | 13 (21) | NR | NR |
| Boreham et al. | 23 (23) | 0 (0) | 0 (0) | FE-1 < 200 µg/gg | 6 (26); Index admission: 8 (35) | NR | NR | 4 (17) | NR | NR |
| Napolitano et al. | 35 (35) | NR | 0 (0) | FE-1 < 200 µg/g | 4 (11) | NR | NR | 2 (6) | NR | NR |
| Sabater et al. | 39 (27) | NR | 12 (44) | FFE > 7 g/d for 3 days; fecal chymotrypsin < 6 U/g; SCT < lower reference rangec | 9 (33) | NR | NR | 13 (48) | NR | NR |
| Migliori et al. | 75 (75) | NR | 0 (0) | SCT with bicarbonate < 15 mmol, lipase < 150 U × 103; chymotrypsin < 160 U × 102; AACT < 14% | 41 (55) | NR | NR | NR | NR | NR |
| Bavare et al. | 18 (18) | NR | 18 (100) | FFE > 7 g/d with or without steatorrhea and use of PERT | 9 (50); index admission: 13 (72) | 2 (11) | 3 (17) | 13 (72) | 16 (89) | Back to work |
| Symersky et al. | 34 (34) | NR | 6 (18) | FFE > 7 g/d for 2 days; NBT-PABA test with urinary PABA < 50% | 22 (65) | 10 (29) | 0 (0) | 12 (35) | NR | GIQLI |
| Reszetow et al. | 28 (28) | 0 (0) | 28 (100) | FE-1 < 200 µg/gg | 4 (14) | NR | NR | 22 (79) | 12 (42) | Core FACIT scale |
| Reddy et al. | 10 (10) | 0 (0) | 10 (100) | FFE > 7 g/d | 8 (80) | NR | NR | 5 (50) | 7 (70) | Back to work |
| Pelli et al. | 54 (54) | 8 (15) | NR | FE-1 < 200 µg/g with or without plasma fat-soluble vitamin A < 1 µmol/l or vitamin E < 12 µmol/l | 5 (9); index admission 21 (39) | NR | 10 (19) | 17 (37) | 18 (51) | NR |
| Pezzilli et al. | 75 (75) | 0 (0) | 5 (7) | FE-1 < 200 µg/gg | Index admission: 9 (12) | 0 (0) | NR | NR | NR | NR |
| Gupta et al. | 30 (30) | 0 (0) | 25 (83) | FFE > 7 g/d; urinary d-xylose excretion < 20% | 12 (40) | 4 (13) | 12 (40) | 12 (40) | 13 (43) | NR |
| Uomo et al. | 65 (40) | 2 (5) | 19 (48) | Serum pancreoauryl test < 4.5 µg/ml; FE-1 < 200 µg/g | 9 (23) | 0 (0) | 0 (0) | 6 (16) | 2 (5) | NR |
| Andersson et al. | 40 (40) | 1 (2.5) | 4 (10) | FE-1 < 200 µg/g | 1 (3) | 3 (8) | NR | 22 (55) | NR | SF-36 |
| Xu et al. | 65 (65) | 0 (0) | 5 (8) | FE-1 < 200 µg/gg | 38 (59) | 33 (51) | NR | NR | 20 (31) | NR |
| Garip et al. | 109 (109) | 13 (12) | 5 (5) | FE-1 < 200 µg/gg | 15 (14) | NR | NR | 33 (30) | NR | NR |
| Kahl et al. | 56 (56) | NR | NR | FE-1 < 200 µg/g | Index admission: 20 (36) | 26 (46)f | NR | NR | NR | FACT-Pa |
| Vujasinovic et al. | 100 (100) | NR | NR | FE-1 < 200 µg/gg with measuring serum iron, magnesium, folic acid and vitamins A, D, E and B12 | 21 (21) | NR | 25 (25) | 14 (14) | NR | NR |
| Winter Gasparoto et al. | 16 (16) | 0 (0) | 5 (31) | FFE with positive Sudan stain | 1 (6) | 1 (6) | NR | 12 (75) | 2 (13) | SF-36 |
| Chandrasekaran et al. | 35 (35) | 0 (0) | 21 (60) | FFE > 7 g/d | 14 (40) | 21 (60) | 3 (8.6) | 17 (48.6) | NR | NR |
| Ermolov et al. | 210 (80) | NR | 136 (65)e | FE-1 < 200 µg/gg | 28 (35) | NR | 58 (28) | 62 (30) | 12 (15) | GIQLI |
| Nikkola et al. | 77 (45) | 5 (7)e | 0 (0) | FE-1 < 200 µg/g | 11 (24) | NR | 27 (35)e | 20 (26)e | 9 (12)e | NR |
| Koziel et al. | 150 (150) | 17 (11) | 18 (12) | FE-1 < 200 µg/gg | 21 (14) | NR | 44 (29) | 18 (14) | 58 (39) | SF-36 |
| Tu et al. | 113 (113) | 0 (0) | 73 (65) | FE-1 < 200 µg/gg | 40 (35) | NR | NR | 67 (59) | NR | NR |
| van Brunschot et al. | 98 (83) | 18 (18) | 98 (100) | FE-1 < 200 µg/gg | 41 (49) | 29 (35) | NR | 19 (23) | NR | NR |
EPI exocrine pancreatic insufficiency, DM diabetic mellitus, RAP recurrent acute pancreatitis, NR not reported, NBT-PABA N-benzoyl-l-tyrosyl-P-aminobenzoic acid, SCT secretin-cerulein (or pancreozymin) test, FFE fecal fat excretion, FE-1 fecal elastase-1, AACT amino acid consumption test, PERT pancreatic enzyme replacement therapy, GIQLI Gastrointestinal Quality of Life Index, FACIT Functional Assessment of Chronic Illness Therapy, SF-36 Short Form 36 Health Survey Questionnaire, FACT Functional Assessment of Cancer Therapy
aIncluded necrosectomy, drainage and local lavage procedures
bData refer to follow-up studies if not otherwise stated and with maximal numbers of EPI during observational period
cBicarbonate < 70 mEq/l, lipase < 97 kUI/h, chymotrypsin > 11 kUI/h
dLundh test meal amylase < 11,000 U/h, lipase < 110,000 U/h and trypsin < 7000 U/h
eData are derived from original enrolled patients rather than actual analyzed patients
fContained all the patients in the PERT arm in a randomized controlled trial comparing placebo versus PERT
gThese studies defined severity of EPI with FE-1 levels: 100–200 µg/g mild to moderate and < 100 µg/g severe