What is the natural history and progression of exocrine pancreatic insufficiency (EPI), and what is its association with cardiovascular events?

Updated: Aug 12, 2021
  • Author: Samer Al-Kaade, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The natural history and progression of EPI depend on the underlying etiology. For example, patients with autoimmune pancreatitis or cystic fibrosis may progress to almost complete insufficiency, whereas those with alcohol-induced EPI may recover from or at least halt the progression of pancreatic insufficiency if they abstain from alcohol. Even with complete loss of exocrine function, however, protease and lipase supplements are effective in restoring normal digestion of dietary nutrients.

A prospective, longitudinal cohort study by de la Iglesia et al indicated that in patients with chronic pancreatitis, EPI is an independent risk factor for cardiovascular events, with the incidence rate ratio for such events in patients with EPI compared with those without being 3.67. In addition, the odds ratio for cardiovascular events in individuals with a combination of EPI and diabetes mellitus was higher than for EPI patients without diabetes. [27]


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