Gastroenterology Review
eISSN: 1897-4317
ISSN: 1895-5770
Gastroenterology Review/Przegląd Gastroenterologiczny
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Original paper

The prevalence of exocrine pancreatic insufficiency in diabetes mellitus – a multicentre study

Roland Kadaj-Lipka
1
,
Marta Wynimko
2
,
Karolina Borowska
2
,
Edward Franek
2, 3
,
Agnieszka Mądro
4
,
Barbara Skrzydło‑Radomańska
4
,
Halina Cichoż­‑Lach
4
,
Barbara Włodarczyk
5
,
Ewa Małecka-Wojciesko
5
,
Elżbieta Czkwianianc
6
,
Krystian Adrych
7
,
Stanisław Głuszek
8, 9, 10
,
Dorota Kozieł
11
,
Grażyna Rydzewska
1, 11

  1. Department of Gastroenterology and Internal Medicine, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
  2. Clinical Department of Internal Medicine, Endocrinology and Diabetology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
  3. Mossakowski Institute of Clinical Research, Polish Academy of Science, Warsaw, Poland
  4. Department of Gastroenterology and Hepatology with Endoscopy Unit, Medical University of Lublin, Poland
  5. Department of Digestive Tract Diseases, Medical University of Lodz, Poland.
  6. Department of Gastroenterology, Allergology and Pediatrics ICZMP of the Polish Maternal Memorial Hospital Research Institute, Lodz, Poland
  7. Department of Gastroenterology and Hepatology, Medical University of Gdansk, Poland
  8. Department of Surgical Oncology, Holy Cross Cancer Centre, Kielce, Poland
  9. Department of Surgery, Hospital of the Ministry of Interior and Administration, Kielce, Poland
  10. Institute of Genetics and Animal Biotechnology, Polish Academy of Sciences, Magdalenka, Poland
  11. Collegium Medicum, Jan Kochanowski University, Kielce, Poland
Gastroenterology Rev
Online publish date: 2026/05/14
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1. Singh VK, Haupt ME, Geller DE, et al. Less common etiologies of exocrine pancreatic insufficiency. World J Gastroenterol 2017; 23: 7059-76.
2. Zsóri G, Illés D, Terzin V, et al. Exocrine pancreatic insufficiency in type 1 and type 2 diabetes mellitus: do we need to treat it? A systematic review. Pancreatology 2018; 18: 559-65.
3. Struyvenberg MR, Martin CR, Freedman SD. Practical guide to exocrine pancreatic insufficiency – breaking the myths. BMC Med 2017; 15: 29.
4. Dominguez-Muñoz JE, Vujasinovic M, de la Iglesia D, et al.; European PEI Multidisciplinary Group. European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations. United European Gastroenterol J 2025; 13: 125-72.
5. Hardt PD, Ewald N. Exocrine pancreatic insufficiency in diabetes mellitus: a complication of diabetic neuropathy or a different type of diabetes? Exp Diabetes Res 2011; 2011: 761950.
6. Leeds JS, Oppong K, Sanders DS. The role of fecal elastase-1 in detecting exocrine pancreatic disease. Nat Rev Gastroenterol Hepatol 2011; 8: 405-15.
7. Piciucchi M, Capurso G, Archibugi L, et al. Exocrine pancreatic insufficiency in diabetic patients: prevalence, mechanisms, and treatment. Int J Endocrinol 2015; 2015: 595649.
8. Radlinger B, Ramoser G, Kaser S. Exocrine pancreatic insufficiency in type 1 and type 2 diabetes. Curr Diab Rep 2020; 20: 18.
9. Parihar V, Ballester R, Ridgway PF, et al. Screening for undiagnosed pancreatic exocrine insufficiency (PEI) in a cohort of diabetic patients using faecal elastase testing and PEI scoring system. Acta Diabetol 2024; 61: 1301-7.
10. Mohapatra S, Majumder S, Smyrk TC, et al. Diabetes mellitus is associated with an exocrine pancreatopathy: conclusions from a review of literature. Pancreas 2016; 45: 1104-10.
11. Lindkvist B, Nilsson C, Kvarnström M, Oscarsson J. Importance of pancreatic exocrine dysfunction in patients with type 2 diabetes: a randomized crossover study. Pancreatology 2018; 18: 550-8.
12. Forsmark CE. Diagnosis and management of exocrine pancreatic insufficiency. Curr Treat Options Gastroenterol 2018; 16: 306-15.
13. Hardt PD, Hauenschild A, Nalop J, et al. High prevalence of exocrine pancreatic insufficiency in diabetes mellitus: a multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. Pancreatology 2003; 3: 395-402.
14. Vujasinovic M, Zaletel J, Tepes B, et al. Low prevalence of exocrine pancreatic insufficiency in patients with diabetes mellitus. Pancreatology 2013; 13: 343-6.
15. Kumar P, Gowdappa B, Hosmani T, Urs T. Exocrine dysfunction correlates with endocrinal impairment of pancreas in type 2 diabetes mellitus. Indian J Endocrinol Metab 2017; 22: 121-5.
16. Kadaj-Lipka R, Rydzewska G. Exocrine pancreatic insufficiency and causes of abdominal symptoms in diabetes patients. Gastroenterology Rev 2020; 15: 289-93.
17. Larger E, Philippe MF, Barbot-Trystram L, et al. Complications pancreatic exocrine function in patients with diabetes. Diabet Med 2012; 29: 1047-54.
18. Jalal M, Leeds JS, Ching HL, et al. Are we missing pancreatic exocrine insufficiency in ‘at-risk’ groups? Prospective assessment of the current practice and yield of faecal elastase testing in patients with diabetes mellitus, HIV and/or high alcohol intake. Clin Med (Lond) 2023; 23: 588-93.
19. Foster TP, Bruggeman B, Campbell-Thompson M, et al. Exocrine pancreas dysfunction in type 1 diabetes. Endocr Pract 2020; 26: 1505-13.
20. Vanga RR, Tansel A, Sidiq S, et al. Diagnostic performance of measurement of fecal elastase-1 in detection of exocrine pancreatic insufficiency: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018; 16: 1220-8.
21. Levy P, Dominguez-Munoz E, Imrie C, et al. Epidemiology of chronic pancreatitis: burden of the disease and consequences. Review. United Eur Gastroenterol J 2014; 2: 345-54.
22. Price DA, Schmid ML, Ong EL, et al. Pancreatic exocrine insufficiency in HIV-positive patients. HIV Med 2005; 6: 33-6.
23. Maconi G, Dominici R, Molteni M, et al. Prevalence of pancreatic insufficiency in inflammatory bowel diseases. Assessment by fecal elastase-1. Dig Dis Sci 2008; 53: 262-70.
24. Loser C, Mollgaard A, Folsch UR. Faecal elastase 1: a novel, highly sensitive, and specific tubeless pancreatic function test. Gut 1996; 39: 580-6.
25. Lew D, Afghani E, Pandol S. Chronic pancreatitis: current status and challenges for prevention and treatment. Dig Dis Sci 2017; 62: 1702-12.
26. Dominguez-Munoz JE, Hardt PD, Lerch MM, Lohr MJ. Potential for screening for pancreatic exocrine insufficiency using the fecal elastase-1 test. Dig Dis Sci 2017; 62: 1119-30.
27. Siegmund E, Löhr JM, Schuff-Werner P. The diagnostic validity of non-invasive pancreatic function tests – a meta-analysis. Z Gastroenterol 2004; 42: 1117-28.
28. Rathmann W, Haastert B, Icks A, et al. Low faecal elastase 1 concentrations in type 2 diabetes mellitus. Scand J Gastroenterol 2001; 36: 1056-61.
29. Yilmaztepe A, Ulukaya E, Ersoy C, et al. Investigation of fecal pancreatic elastase-1 levels in type 2 diabetic patients. Turk J Gastroenterol 2005; 16: 75-80.
30. Nunes ACR, Pontes JM, Rosa A, et al. Screening for pancreatic exocrine insufficiency in patients with diabetes mellitus. Am J Gastroenterol 2003; 98: 2672-5.
31. Kadaj-Lipka R, Lipiński M, Adrych K, et al. Diagnostic and therapeutic recommendations for chronic pancreatitis. Recommendations of the Working Group of the Polish Society of Gastroenterology and the Polish Pancreas Club. Gastroenterology Rev 2018; 13: 167-81.
32. Alexandre-Heymann L, Lemoine AY, Nakib S, et al. Nutritional markers in patients with diabetes and pancreatic exocrine failure. Acta Diabetol 2019; 56: 651-8.
33. Smith RC, Smith SF, Wilson J, et al. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology 2016; 16: 164-80.
34. Alexandre-Heymann L, Lemoine AY, Nakib S, et al. Nutritional markers in patients with diabetes and pancreatic exocrine failure. Acta Diabetol 2019; 56: 651-8.
35. Kobayashi T, Nakanishi K, Kajio H, et al. Pancreatic cytokeratin: an antigen of pancreatic exocrine cell autoantibodies in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1990; 33: 363-70.
36. Koziel D, Suliga E, Grabowska U, Gluszek S. Morphological and functional consequences and quality of life following severe acute pancreatitis. Ann Ital Chir 2017; 6: 403-11.
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