Gastrointestinal Symptom Burden After Total Pancreatectomy With Islet Autotransplantation: A Prospective...

Total pancreatectomy with islet autotransplantation (TPIAT) is performed for the most disabling cases of recurrent acute pancreatitis and chronic pancreatitis. Post-TPIAT, patients often report gastrointestinal (GI) symptoms suggestive of dysmotility and small intestinal bacterial overgrowth. The goal of this study was to characterize patient-reported outcomes related to GI health and quality of life (QoL) after TPIAT.

Patients aged 18 years or older who underwent TPIAT at the University of Minnesota since July 2006 were eligible for enrollment. In addition to providing demographic information, participants completed the following questionnaires electronically: National Institutes of Health (NIH) Patient-Reported Outcomes Measurement System GI Symptom Scale, RAND 36-Item Short Form Survey, and the NIH Health-Related Quality of Life 14 Survey.

Study surveys were completed by 27% (82/300) of patients contacted, at a median of 8 years after surgery. Participants reported significantly more severe belly pain ( t -score 57.9, 95% CI: 55.1-60.7), gas/bloating (57.7, 56.1-59.2), nausea/vomiting (56.8, 54.6-59.0), and diarrhea (53.6, 51.5-55.8) compared with the general population. A previous diagnosis of small intestinal bacterial overgrowth (SIBO) was associated with more severe belly pain (coefficient 8.54, 95% CI: 2.58-14.50, P =0.006), gas/bloating (5.65, 2.66-8.64, P <0.001), and nausea/vomiting (4.85, 0.34-9.34, P =0.035). More severe nausea/vomiting and diarrhea were negatively associated with several QoL measures.

Post-TPIAT, patients experience severe belly pain, gas/bloating, nausea/vomiting, and diarrhea at higher rates compared with the general population. Patients who report a diagnosis of SIBO were more likely to have these symptoms, with the exception of diarrhea. Nausea/vomiting and diarrhea appear to have the largest impact on QoL measures.