Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain.
OBJECTIVE
A previous UK study showed that 6.1% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) had evidence of severe pancreatic exocrine insufficiency (PEI), but these findings need replication. We aimed to identify the prevalence of PEI based on fecal elastase stool testing in consecutive outpatients presenting with chronic unexplained abdominal pain and/or diarrhea and/or IBS-D.


METHODS
Patients aged over 40 years presenting to hospital outpatient clinics from six sites within Australia with unexplained abdominal pain and/or diarrhea for at least 3 months and/or IBS-D were studied. Patients completed validated questionnaires and donated a stool sample in which elastase concentration was measured by ELISA. A concentration of < 100 mcg/g stool represented severe and < 200 mcg/g mild to moderate PEI. Patients whose fecal elastase was < 200 mcg/g underwent testing for pancreatic pathology with an endoscopic ultrasound or abdominal CT.


RESULTS
Two hundred eighteen patients (mean age of 60 years, 29.4% male) were studied. PEI was found in 4.6% (95% CI 2.2-8.3%) (n = 10), with five patients (2.3% (95% CI 0.8-5.3%) having severe PEI. Only male sex and heavy alcohol use were significantly associated with abnormal versus normal pancreatic functioning. Of seven patients who underwent endoscopic ultrasound or CT, two had features indicative of chronic pancreatitis.


CONCLUSIONS
One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these. This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported.
Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.|Department of Gastroenterology, John Hunter Hospital, New Lambton, New South Wales, Australia.
Nicholas J
NJ
Talley
Department of Gastroenterology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Gerald
G
Holtmann
Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Quoc Nam
QN
Nguyen
Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia.
Peter
P
Gibson
Department of Gastroenterology, Flinders Medical Centre, Bedford Park, South Australia, Australia.
Peter
P
Bampton
Teaching & Research Unit, Gosford & Wyong Hospital, Gosford, New South Wales, Australia.
Martin
M
Veysey
Mylan EPD, Macquarie, New South Wales, Australia.
James
J
Wong
Department of Gastroenterology, John Hunter Hospital, New Lambton, New South Wales, Australia.
Stephen
S
Philcox
Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.|Department of Gastroenterology, John Hunter Hospital, New Lambton, New South Wales, Australia.|Department of Gastroenterology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Natasha
N
Koloski
Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
Lisa
L
Bunby
Department of Psychology, Macquarie University, Ryde, New South Wales, Australia.
Michael
M
Jones
D015746:Abdominal Pain / Q000209:etiology*; D015415:Biomarkers / Q000032:analysis; D003967:Diarrhea / Q000209:etiology*; D019160:Endosonography; D004797:Enzyme-Linked Immunosorbent Assay; D010188:Exocrine Pancreatic Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D005243:Feces / Q000201:enzymology; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000209:etiology*; D008297:Male; D010196:Pancreatic Elastase / Q000032:analysis; D050500:Pancreatitis, Chronic / Q000150:complications / Q000000981:diagnostic imaging; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D015415:Biomarkers; D010196:Pancreatic Elastase
diarrhea and malabsorption; functional disorders; pancreatic physiology