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. 2022 Jun 28;11(13):3724.
doi: 10.3390/jcm11133724.

Exocrine and Endocrine Insufficiency in Autoimmune Pancreatitis: A Matter of Treatment or Time?

Sara Nikolic  1   2 , Patrick Maisonneuve  3 , Ingrid Dahlman  1 , J-Matthias Löhr  4   5 , Miroslav Vujasinovic  1   4
Affiliations

Exocrine and Endocrine Insufficiency in Autoimmune Pancreatitis: A Matter of Treatment or Time?

Sara Nikolic et al. J Clin Med. .

Abstract

Background: Autoimmune pancreatitis (AIP) is a specific form of chronic pancreatitis with a high relapse rate after treatment. AIP patients are burdened with an increased risk of long-term sequelae such as exocrine and endocrine insufficiency. Our objective was to investigate if pharmacological treatment affects both endocrine and exocrine pancreatic function in patients with AIP.

Methods: We included 59 patients with definite AIP in the final analysis. Screening for diabetes mellitus (DM) and pancreatic exocrine insufficiency (PEI) was performed at the time of AIP diagnosis and during follow-up.

Results: There were 40 (67.8%) males and 19 (32.2%) females; median age at diagnosis was 65 years. Median follow-up after the diagnosis of AIP was 62 months. PEI prevalence at diagnosis was 72.7% and was 63.5% at follow-up. The cumulative incidence of DM was 17.9%, with a prevalence of DM at diagnosis of 32.8%. No strong association was found between pharmacological treatment and occurrence of PEI and DM. Univariate analysis identified potential risk factors for PEI (other organ involvement and biliary stenting) and for DM (overweight, blue-collar profession, smoking, weight loss or obstructive jaundice as presenting symptoms, imaging showing diffuse pancreatic enlargement, smoking). In a multivariate analysis, only obstructive jaundice was identified as a risk factor for DM both at diagnosis and during follow-up.

Conclusions: Our results suggest that the prevalence of endocrine and exocrine insufficiency in AIP is high at diagnosis with an additional risk of PEI and DM during follow-up despite pharmacological treatment.

Keywords: autoimmune pancreatitis; diabetes mellitus; pancreatic exocrine insufficiency; treatment.

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Conflict of interest statement

M.V.: Abbott (lecture fee), Mylan (lecture fee); S.N.: Ferring (lecture fee), Mylan (lecture fee), Krka (lecture fee); P.M.: none; I.D.: Novonordisk (lecture fee); J.-M.L: Abbott (lecture fee), Mylan (lecture fee).

Figures

Figure 1
Figure 1
Flow chart of patients. AIP = autoimmune pancreatitis; ICDC = International Consensus Diagnostic Criteria; N = number of patients.
Figure 2
Figure 2
Prevalence of DM at diagnosis of AIP and cumulative incidence during the follow-up (stratified by obstructive jaundice, profession, and smoking status). Smoking status missing for 5 patients, profession for 11 patients; Analysis is restricted to 58 patients with available information about DM at diagnosis.
See this image and copyright information in PMC

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