Fat malabsorption screening in chronic pancreatitis

OBJECTIVES: As the major metabolic complications of chronic pancreatitis are exocrine and endocrine dysfunction, leading to malabsorption and diabetes, the aims of this study were to screen patients with chronic pancreatitis for exocrine dysfunction, to correlate the prevalence of such dysfunction with the etiology and severity of pancreatitis, and to evaluate the effect of dysfunction on weight loss. METHODS: Sixty patients were studied. In 44 patients, pancreatitis was alcoholic, and in 16, idiopathic. Patients' age, sex, alcohol consumption and smoking habits, duration of the disease, body mass index, and the presence of steatorrhea were recorded. The severity of pancreatitis was assessed by imaging procedures, including secretin-enhanced magnetic resonance cholangiopancreatography, and patients were classified according to the Cambridge system. Exocrine function was evaluated by the triolein breath test and acid steatocrit. RESULTS: A significant positive correlation was found between breath test and steatocrit values. As a screening test for exocrine pancreatic dysfunction, the sensitivity of clinical steatorrhea was insufficient (38%). Of the 60 patients, 38 (63%) developed exocrine dysfunction within 5 yr of the onset of the pancreatitis and 56 (94%) after 10 yr. Moreover, undetected or untreated malabsorption had a harmful effect on weight, even in the absence of overt clinical steatorrhea. CONCLUSIONS: To avoid nutritional deterioration, early screening for fat malabsorption should be recommended in chronic pancreatitis, whatever its etiology, using the acid steatocrit, a reliable, easy, and inexpensive test.