Exocrine Pancreatic Insufficiency Following Acute Pancreatitis: Systematic Review and Meta-Analysis

Wei Huang, Daniel de la Iglesia-García, Iria Baston-Rey, Cristina Calviño-Suarez, Jose Lariño-Noia, Julio Iglesias-Garcia, Na Shi, Xiaoying Zhang, Wenhao Cai, Lihui Deng, Danielle Moore, Vikesh K. Singh, Qing Xia, John A. Windsor, J. Enrique Domínguez-Muñoz, Robert Sutton

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background/Objectives: The epidemiology of exocrine pancreatic insufficiency (EPI) after acute pancreatitis (AP) is uncertain. We sought to determine the prevalence, progression, etiology and pancreatic enzyme replacement therapy (PERT) requirements for EPI during follow-up of AP by systematic review and meta-analysis. Methods: Scopus, Medline and Embase were searched for prospective observational studies or randomized clinical trials (RCTs) of PERT reporting EPI during the first admission (between the start of oral refeeding and before discharge) or follow-up (≥ 1 month of discharge) for AP in adults. EPI was diagnosed by direct and/or indirect laboratory exocrine pancreatic function tests. Results: Quantitative data were analyzed from 370 patients studied during admission (10 studies) and 1795 patients during follow-up (39 studies). The pooled prevalence of EPI during admission was 62% (95% confidence interval: 39–82%), decreasing significantly during follow-up to 35% (27–43%; risk difference: − 0.34, − 0.53 to − 0.14). There was a two-fold increase in the prevalence of EPI with severe compared with mild AP, and it was higher in patients with pancreatic necrosis and those with an alcohol etiology. The prevalence decreased during recovery, but persisted in a third of patients. There was no statistically significant difference between EPI and new-onset pre-diabetes/diabetes (risk difference: 0.8, 0.7–1.1, P = 0.33) in studies reporting both. Sensitivity analysis showed fecal elastase-1 assay detected significantly fewer patients with EPI than other tests. Conclusions: The prevalence of EPI during admission and follow-up is substantial in patients with a first attack of AP. Unanswered questions remain about the way this is managed, and further RCTs are indicated.

Original languageEnglish (US)
Pages (from-to)1985-2005
Number of pages21
JournalDigestive diseases and sciences
Issue number7
StatePublished - Jul 15 2019


  • Acute pancreatitis
  • Exocrine pancreatic insufficiency
  • Necrotizing pancreatitis
  • Pancreatic enzyme replacement therapy
  • Severe pancreatitis

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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