Exocrine Pancreatic Insufficiency in Hepatic Cirrhosis: a Cross-Sectional Study
DOI:
https://doi.org/10.52787/agl.v56i1.579Keywords:
Elastase, pancreatic insufficiency, cirrhosisAbstract
Introduction. Malnutrition and sarcopenia increase morbidity and mortality in patients with liver cirrhosis. Exocrine pancreatic insufficiency may further worsen nutritional deficits.
Aim. To evaluate exocrine pancreatic function using fecal elastase in patients with liver cirrhosis due to alcohol and other causes.
Materials and methods. Cross-sectional descriptive study including patients with cirrhosis who underwent fecal elastase testing at the Hospital Clínico Universidad de Chile between February 2016 and July 2023. Demographic, clinical, nutritional, and survival variables were evaluated.
Results. Eighty-five patients were included, with a median age of 60 years. The most frequent etiologies were alcohol consumption in 40 patients (47%) and metabolic dysfunction–associated steatotic liver disease in 21 (25%). Of the 85 patients, 88% had fecal elastase >200 µg/g, 5% had values between 100–199 µg/g, and 7% had values <100 µg/g. Fecal elastase levels were significantly lower in patients with alcohol-related cirrhosis compared with those with other etiologies (p = 0.003). Among patients with alcohol-related cirrhosis, 20% had fecal elastase <200 µg/g (15% <100 µg/g). Patients consuming >20 g/day of alcohol had significantly lower fecal elastase levels (p = 0.013) than those with lower consumption.
Conclusion. In patients with alcohol-related cirrhosis, we found a 20% prevalence of reduced fecal elastase. Alcohol consumption >20 g/day was associated with lower fecal elastase levels. Considering that malnutrition and sarcopenia influence prognosis and that exocrine pancreatic insufficiency may be clinically silent, measurement of fecal elastase could be justified in patients with alcohol-related cirrhosis, particularly when nutritional deficits are present.
References
-1. Turnberg LA, Grahame G. Secretion of water and electrolytes into the duodenum in normal subjects and in patients with cirrhosis: the response to secretin and pancreozymin. Gut. 1974;15(4):273-277. doi:10.1136/gut.15.4.273.
-2. Renner IG, Rinderknecht H, Wisner JR Jr. Pancreatic secretion after secretin and cholecystokinin stimulation in chronic alcoholics with and without cirrhosis. Dig Dis Sci. 1983;28(12):1089-1093. doi:10.1007/BF01295807.
-3. Hayakawa T, Kondo T, Shibata T, Kitagawa M, Sakai Y, Sobajima H, Ishiguro H, Nakae Y, Kato K. Exocrine pancreatic function in chronic liver diseases. Am J Gastroenterol. 1991;86(2):201-204.
-4. Sakai T. Pancreatic exocrine function in patients with chronic liver disease. Kurume Med J. 1998;45(2):181-185. doi:10.2739/kurumemedj.45.181.
-5. Aoufi Rabih S, García-Agudo R, Legaz Huidobro ML, Ynfante Ferrús M, González Carro P, Pérez Roldán F, Ruiz Carrillo F, Tenías Burillo JM. Exocrine pancreatic insufficiency and chronic pancreatitis in chronic alcoholic liver disease: coincidence or shared toxicity? Pancreas. 2014;43(5):730-734. doi:10.1097/MPA.0000000000000085.
-6. Aparisi L, Sabater L, Del-Olmo J, Sastre J, Serra MA, Campello R, Bautista D, Wassel A, Rodrigo JM. Does an association exist between chronic pancreatitis and liver cirrhosis in alcoholic subjects? World J Gastroenterol. 2008;14(40):6171-6179. doi:10.3748/wjg.14.6171.
-7. Apte MV, Pirola RC, Wilson JS. Mechanisms of alcoholic pancreatitis. J Gastroenterol Hepatol. 2010;25:1816-1826. doi:10.1111/j.1440-1746.2010.06445.x.
-8. Apte MV, Pirola RC, Wilson JS. Alcohol and the pancreas. Pancreapedia: Exocrine Pancreas Knowledge Base. doi:10.3998/panc.2016.17.
-9. Zeng X, Shi ZW, Yu JJ, Wang LF, Luo YY, Jin SM, Zhang LY, Tan W, Shi PM, Yu H, Zhang CQ, Xie WF. Sarcopenia as a prognostic predictor of liver cirrhosis: a multicenter study in China. J Cachexia Sarcopenia Muscle. 2021;12:1948-1958. doi:10.1002/jcsm.12797.
-10. Dumont C, Wuestenberghs F, Lanthier N, Piessevaux H, Dahlqvist G. Malnutrition is highly prevalent in hospitalized cirrhotic patients and associates with a poor outcome. Acta Gastroenterol Belg. 2022;85:311-319. doi:10.51821/85.2.9016.
-11. Fozouni L, Mohamad Y, Lebsack A, Freise C, Stock P, Lai JC. Frailty is associated with increased rates of acute cellular rejection within 3 months after liver transplantation. Liver Transpl. 2020;26:390-396. doi:10.1002/lt.25669.
-12. Löser C, Möllgaard A, Fölsch UR. Faecal elastase 1: a novel, highly sensitive, and specific tubeless pancreatic function test. Gut. 1996;39:580-586. doi:10.1136/gut.39.4.580.
-13. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, Romero D, Abdelmalek MF, Anstee QM, Arab JP, Arrese M, Bataller R, Beuers U, Boursier J, Bugianesi E, Byrne CD, Castro Narro GE, Chowdhury A, Cortez-Pinto H, Cryer DR, Cusi K, El-Kassas M, Klein S, Eskridge W, Fan J, Gawrieh S, Guy CD, Harrison SA, Kim SU, Koot BG, Korenjak M, Kowdley KV, Lacaille F, Loomba R, Mitchell-Thain R, Morgan TR, Powell EE, Roden M, Romero-Gómez M, Silva M, Singh SP, Sookoian SC, Spearman CW, Tiniakos D, Valenti L, Vos MB, Wong VW, Xanthakos S, Yilmaz Y, Younossi Z, Hobbs A, Villota-Rivas M, Newsome PN. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78:1966-1986. doi:10.1097/HEP.0000000000000520.
-14. Romiti A, Merli M, Martorano M, Parrilli G, Martino F, Riggio O, Truscelli A, Capocaccia L, Budillon G. Malabsorption and nutritional abnormalities in patients with liver cirrhosis. Ital J Gastroenterol. 1990;22:118-123.
-15. Pace A, de Weerth A, Berna M, Hillbricht K, Tsokos M, Bläker M, Pueschel K, Lohse AW. Pancreas and liver injury are associated in individuals with increased alcohol consumption. Clin Gastroenterol Hepatol. 2009;7:1241-1246. doi:10.1016/j.cgh.2009.06.010.
-16. Singhvi A, Abromitis R, Althouse AD, Bataller R, Arteel GE, Yadav D. Coexistence of alcohol-related pancreatitis and alcohol-related liver disease: a systematic review and meta-analysis. Pancreatology. 2020;20:1069-1077. doi:10.1016/j.pan.2020.07.412.
-17. Llibre-Nieto G, Lira A, Vergara M, Casas M, Solé C, Ferrusquía-Acosta J, Puig-Diví V, Grau-López L, Barradas JM, Solà M, Miquel M, Sánchez-Delgado J. Prevalence of radiological chronic pancreatitis and exocrine pancreatic insufficiency in patients with decompensated liver disease: is fecal elastase useful in this setting? Nutrients. 2023;15(2):375. doi:10.3390/nu15020375.
-18. Vege SS, Chari ST. Chronic pancreatitis. N Engl J Med. 2022;386:869-878. doi:10.1056/NEJMcp1809396.
-19. de la Iglesia D, Agudo-Castillo B, Galego-Fernández M, Rama-Fernández A, Domínguez-Muñoz E. Diagnostic accuracy of fecal elastase-1 test for pancreatic exocrine insufficiency: a systematic review and meta-analysis. UEG J. 2025;13:1571-1582. doi:10.1002/ueg2.70061.
-20. DiMagno EP, Go VLW, Summerskill WHJ. Relations between pancreatic enzyme output and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973;288:813-815.
-21. Domínguez-Muñoz JE, Vujasinovic M, de la Iglesia D, Cahen D, Capurso G, Gubergrits N, Hegyi P, Hungin P, Ockenga J, Paiella S, Perkhofer L, Rebours V, Rosendahl J, Salvia R, Scheers I, Szentesi A, Bonovas S, Piovani D, Löhr JM. European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: evidence-based recommendations. United European Gastroenterol J. 2025;13(1):125-172.
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Víctor Henríquez Auba, Carmen Hurtado, Carla Mancilla Asencio, Pauline Herman, Alexandra Neman, Zoltán Berger
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
