From Inflammation to Dysfunction: The Impact of a First Acute Pancreatitis Episode on Pancreatic Function

Background/Objectives: The complexity of acute pancreatitis (AP) extends beyond its immediate complications. This study aimed to evaluate both exocrine and endocrine pancreatic dysfunctions following a first episode of AP, assessed at diagnosis and during a 6-month follow-up period. Methods: A prospective analysis was conducted on patients with a first episode of AP. Pancreatic endocrine function was evaluated using fasting glucose and glycated hemoglobin (HbA1c) levels, while pancreatic exocrine function was assessed through fecal elastase-1 (FE-1) testing and the novel Pancreatic Exocrine Insufficiency Questionnaire (PEI-Q). Results: Altogether, data from 112 time-point observations were analyzed with respect to endocrine and exocrine insufficiency after a first episode of AP, with 60 patients enrolled at baseline, 33 (55%) completing the first follow-up, and 19 (31.67%) completing the second follow-up. Based on PEI-Q scores, 75% of patients showed pancreatic exocrine insufficiency (PEI) at baseline. This rate decreased significantly to 33.3% at 2 months, with a further slight decline to 26.3% at 6 months. In contrast, FE-1 testing identified PEI in only 23% of patients at baseline, with a similar progressive improvement in time. Regarding the endocrine function, hyperglycemia was noted at baseline (mean serum glucose 120.75 ± 49.89 mg/dL), with a decreasing trend and normalization observed at follow-up. Conclusions: The pancreas has a remarkable recovery potential, with both exocrine and endocrine dysfunctions seen during the hospitalization for AP being transient. However, follow-up after AP is essential, as pancreatic insufficiency can significantly impact patients' quality of life.