title: Relationship between the exocrine and endocrine pancreas after acute pancreatitis.
abstract: OBJECTIVE
  To determine the prevalence and time course of pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis.
  
  
  METHODS
  Relevant literature cited in three major biomedical journal databases (EMBASE, MEDLINE, and Scopus) was reviewed independently by two authors. There were no language constraints but the search was limited to human studies. Studies included were cohort studies of adult patients who were discharged after an attack of acute pancreatitis. Patients were excluded if they were under 18 years of age or had a previous diagnosis of prediabetes or diabetes mellitus, pancreatic exocrine insufficiency, or chronic pancreatitis. The main outcome measure was the prevalence of concomitant pancreatic exocrine insufficiency in patients who were diagnosed with prediabetes and diabetes mellitus after an attack of acute pancreatitis. Subgroup analysis was conducted for patients who were diagnosed with prediabetes only and those who were diagnosed with diabetes mellitus only. Subgroup analysis looking at the time course of concomitant pancreatic exocrine and endocrine insufficiency was also conducted. Pooled prevalence and corresponding 95% confidence intervals were calculated for all outcome measures and P-values < 0.05 were deemed statistically significant.
  
  
  RESULTS
  Eight clinical studies comprising of 234 patients met all eligibility criteria. The pooled prevalence of newly diagnosed prediabetes or diabetes in individuals after acute pancreatitis was 43% (95%CI: 30%-56%). The pooled prevalence of pancreatic exocrine insufficiency in individuals after acute pancreatitis was 29% (95%CI: 19%-39%). The prevalence of concomitant pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes was 40% (95%CI: 25%-55%). The prevalence of concomitant pancreatic exocrine insufficiency among individuals with prediabetes alone and diabetes mellitus alone was 41% (95%CI: 12%-75%) and 39% (95%CI: 28%-51%), respectively. Further analysis showed that the prevalence of concomitant pancreatic exocrine insufficiency in individuals with prediabetes or diabetes decreases over time after an attack of acute pancreatitis.
  
  
  CONCLUSIONS
  Pancreatic exocrine insufficiency occurs in 40% of individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis. Further studies are needed to investigate the pathogenesis of diabetes in this setting.
authors.affiliation: Stephanie L M Das, James I C Kennedy, Anthony R J Phillips, John A Windsor, Maxim S Petrov, Department of Surgery, University of Auckland, Auckland 1142, New Zealand.
authors.forename: Stephanie L M
authors.initials: SL
authors.lastname: Das
authors.affiliation: Stephanie L M Das, James I C Kennedy, Anthony R J Phillips, John A Windsor, Maxim S Petrov, Department of Surgery, University of Auckland, Auckland 1142, New Zealand.
authors.forename: James I C
authors.initials: JI
authors.lastname: Kennedy
authors.affiliation: Stephanie L M Das, James I C Kennedy, Anthony R J Phillips, John A Windsor, Maxim S Petrov, Department of Surgery, University of Auckland, Auckland 1142, New Zealand.
authors.forename: Rinki
authors.initials: R
authors.lastname: Murphy
authors.affiliation: Stephanie L M Das, James I C Kennedy, Anthony R J Phillips, John A Windsor, Maxim S Petrov, Department of Surgery, University of Auckland, Auckland 1142, New Zealand.
authors.forename: Anthony R J
authors.initials: AR
authors.lastname: Phillips
authors.affiliation: Stephanie L M Das, James I C Kennedy, Anthony R J Phillips, John A Windsor, Maxim S Petrov, Department of Surgery, University of Auckland, Auckland 1142, New Zealand.
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
authors.affiliation: Stephanie L M Das, James I C Kennedy, Anthony R J Phillips, John A Windsor, Maxim S Petrov, Department of Surgery, University of Auckland, Auckland 1142, New Zealand.
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
mesh_terms: D000208:Acute Disease; D000818:Animals; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007515:Islets of Langerhans / Q000503:physiopathology*; D046790:Pancreas, Exocrine / Q000503:physiopathology*; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011236:Prediabetic State / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D013997:Time Factors
keywords: Acute pancreatitis; Endocrine insufficiency; Pancreatic exocrine insufficiency; Pancreatogenic diabetes