Non-alcoholic fatty pancreas disease and pancreatic exocrine insufficiency: pilot study and systematic review

Hartwig Maetzel, Wiktor Rutkowski, Nikola Panic, Amir Mari, Aleksandra Hedström, Paula Kulinski, Per Stål, Sven Petersson, Torkel B. Brismar, J. Matthias Löhr, Miroslav Vujasinovic

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The prevalence of non-alcoholic fatty pancreas disease (NAFPD) is estimated as 2–46% among patients without known pancreatic diseases. An association between NAFPD and non-alcoholic fatty liver disease (NAFLD) has been proposed, as well as an association between NAFPD and pancreatic exocrine insufficiency (PEI). Patients and methods: Patients with histologically confirmed NAFLD were included in the study. The control group consisted of individuals included in a surveillance screening program. Magnetic resonance imaging (MRI) of the pancreas was performed in all patients and fat measurement was made using 2-point Dixon imaging. Fecal elastase-1 (FE-1) was performed to evaluate pancreatic exocrine function. Additionally, a 13C-mixed triglyceride breath test (13 C-MTG-BT) was performed in patients with FE-1 < 200 μg/g. Results: Imaging signs of NAFPD were present in 17 (71%) patients; 11 (85%) from the NAFLD group and 6 (55%) from the control group. FE-1 < 200 μg/g was found in six (25%) patients (four in the NAFLD group and two in the control group); however, none of them had clinical symptoms of PEI. Therefore, in five out of six patients with low FE-1, a 13C-MTG-BT was performed, showing normal results (>20.9%) in all tested patients. Furthermore, the serum nutritional panel was normal in all patients with low FE-1. A systematic review identified five studies relevant to the topic. Conclusion: NAFPD was found in 85% of patients with NAFLD and in 55% of control patients. We did not diagnose PEI in either group. A literature review showed PEI in 9–56% of patients with NAFPD.

Original languageEnglish
Pages (from-to)1030-1037
Number of pages8
JournalScandinavian Journal of Gastroenterology
Volume58
Issue number9
DOIs
StatePublished - 2023

Bibliographical note

Publisher Copyright:
© 2023 Informa UK Limited, trading as Taylor & Francis Group.

Funding

Study (MV) is supported by the Swedish Magtarmfondens stipendium for research and Ruth and Richard Julin Foundation for research. PS was supported by Stockholm County Council K2017-4579 and ALF RS2020-0731 (not related to this study). The authors thank the Swedish Society for Development of Pancreatology (SveSuP) for continuing support, promotion, and creating awareness of pancreas diseases in Swedish society. We also thank our research nurses Maura Krook and Parnia Najjar for their research support.

FundersFunder number
Swedish Magtarmfondens stipendium for research and Ruth and Richard Julin Foundation
Swedish Society for Development of Pancreatology
Stockholms Läns LandstingK2017-4579, ALF RS2020-0731

    Keywords

    • Metabolic syndrome
    • fatty pancreas
    • non-alcoholic fatty liver disease
    • non-alcoholic fatty pancreas disease
    • pancreatic exocrine insufficiency

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