title: Pancreatic exocrine insufficiency, diabetes mellitus and serum nutritional markers after acute pancreatitis.
abstract: OBJECTIVE
  To investigate impairment and clinical significance of exocrine and endocrine pancreatic function in patients after acute pancreatitis (AP).
  
  
  METHODS
  Patients with AP were invited to participate in the study. Severity of AP was determined by the Atlanta classification and definitions revised in 2012. Pancreatic exocrine insufficiency (PEI) was diagnosed by the concentration of fecal elastase-1. An additional work-up, including laboratory testing of serum nutritional markers for determination of malnutrition, was offered to all patients with low levels of fecal elastase-1 FE. Hemoglobin A1c or oral glucose tolerance tests were also performed in patients without prior diabetes mellitus, and type 3c diabetes mellitus (T3cDM) was diagnosed according to American Diabetes Association criteria.
  
  
  RESULTS
  One hundred patients were included in the study: 75% (75/100) of patients had one attack of AP and 25% (25/100) had two or more attacks. The most common etiology was alcohol. Mild, moderately severe and severe AP were present in 67, 15 and 18% of patients, respectively. The mean time from attack of AP to inclusion in the study was 2.7 years. PEI was diagnosed in 21% (21/100) of patients and T3cDM in 14% (14/100) of patients. In all patients with PEI, at least one serologic nutritional marker was below the lower limit of normal. T3cDM was more frequently present in patients with severe AP (P = 0.031), but was also present in some patients with mild and moderately severe AP. PEI was present in all degrees of severity of AP. There were no statistically significantly differences according to gender, etiology and number of AP attacks.
  
  
  CONCLUSIONS
  As exocrine and endocrine pancreatic insufficiency can develop after AP, routine follow-up of patients is necessary, for which serum nutritional panel measurements can be useful.
authors.affiliation: Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Vujasinovic
authors.affiliation: Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia.
authors.forename: Bojan
authors.initials: B
authors.lastname: Tepes
authors.affiliation: Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia.
authors.forename: Jana
authors.initials: J
authors.lastname: Makuc
authors.affiliation: Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia.
authors.forename: Sasa
authors.initials: S
authors.lastname: Rudolf
authors.affiliation: Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia.
authors.forename: Jelka
authors.initials: J
authors.lastname: Zaletel
authors.affiliation: Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia.
authors.forename: Tjasa
authors.initials: T
authors.lastname: Vidmar
authors.affiliation: Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia.
authors.forename: Maja
authors.initials: M
authors.lastname: Seruga
authors.affiliation: Miroslav Vujasinovic, Jana Makuc, Tjasa Vidmar, Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec 2380, Slovenia.
authors.forename: Bostjan
authors.initials: B
authors.lastname: Birsa
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D010188:Exocrine Pancreatic Insufficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010195:Pancreatitis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Acute pancreatitis; Diabetes mellitus; Pancreatic exocrine insufficiency; Serum nutritional markers