CHRONIC CALCIFIC PANCREATITIS OF THE TROPICS (CCPT) - SPECTRUM AND CORRELATES OF EXOCRINE AND ENDOCRINE PANCREATIC DYSFUNCTION

The exocrine and endocrine pathophysiology of chronic calcific pancrea titis of the tropics (CCPT) remains elusive. The objective of this stu dy was to evaluate the spectrum and correlates of the exocrine and end ocrine pancreatic dysfunction in CCPT. Thirty-seven consecutive patien ts with a clinico-radiological diagnosis of CCPT were stratified into three subgroups: CCPT-normal glucose tolerance (NGT), CCPT-abnormal gl ucose tolerance (IGT) and CCPT-diabetes mellitus (DM), Ten ketosis res istant young diabetic (KRDY) patients, 10 classical insulin dependent diabetes mellitus (IDDM) patients and 18 healthy matched controls were included for comparison. Fecal chymotrypsin (FCT) levels and blood C- peptide levels (basal and post i.v. glucagon stimulation) were estimat ed for assessing the exocrine and endocrine pancreatic functions, resp ectively. Sonography was performed to evaluate the pancreatic size and ductal diameter. Pancreatic exocrine-endocrine correlation was examin ed by studying the C-peptide/fecal chymotrypsin ratio (CP/FCT) (CP/FCT of normal controls = 1). Mean FCT levels in all 3 subgroups of CCPT ( NGT: 3.4 mu g; IGT: 0.82 mu/g; DM: 2.4 mu/g) were very low (87-96% red uction in exocrine pancreatic dysfunction; mean FCT in healthy control s was 22.8 mu/g) (P < 0.0001). In contrast, KRDY and IDDM patients dis played 50-54% reduction in pancreatic acinar function (P < 0.001). Bas al and stimulated C-peptide levels progressively fell in the 3 CCPT su bsets (NGT: 0.23 and 0.46 > IGT: 0.14 and 0.29 > DM 0.10 and 0.14) (P < 0.01). CCPT patients exhibited pancreatic atrophy and ductal dilatat ion (> 3 mm). There was a progressive exocrine and endocrine dysfuncti on in the CCPT patients with appearance of glucose tolerance abnormali ties-greater magnitude of acinar cell damage in CCPT-DM/CCPT-IGT patie nts. Exocrine pancreatic dysfunction is disproportionately severe in C CPT patients (CP/FCT: 2.3-13.3), while KRDY and IDDM patients display dominant endocrine damage (CP/FCT: 0.3-0.7).