Pancreatic calcifications: no indicator of severe exocrine pancreatic insufficiency

Pancreatic calcifications are believed to occur only in advanced stages of exocrine pancreatic insufficiency. This belief has been reevaluated by correlating the results of the secretin-pancreozymin test, fecal fat analysis, and the presence of pancreatic calcifications on plain abdominal x-rays in 79 patients with chronic pancreatitis. Exocrine pancreatic insufficiency was classified as slight, moderate, or severe according to the results of the function tests, and pancreatic calcifications were assessed semi-quantitatively (grades 1-3) by an independent examiner. The results showed that severe exocrine pancreatic insufficiency did occur even in the absence of calcifications. Calcifications were more frequently detected with increasing severity of exocrine pancreatic insufficiency. The qualitative demonstration of pancreatic calcification was, however, not an indicator of severe, decompensated exocrine pancreatic insufficiency (50% false-positive results). It is concluded that pancreatic calcification is not necessarily an indicator of severe exocrine pancreatic insufficiency, and vice versa. Comparison between the results of tests for endocrine pancreatic function and plain abdominal x-ray showed such similarity that it can also be concluded that pancreatic calcifications are no indication of abnormal endocrine function, and vice versa.