Assessment of Exocrine Pancreatic Insufficiency in Type 2 Diabetic Mellitus Patients Presenting with Dyspepsia: A Cross-sectional Observational Study

Background: Diabetes mellitus (DM) virtually affects the gastrointestinal (GI) tract in protean ways, including but not limited to small intestinal bacterial overgrowth, GI reflux disease, gastroparesis, neuropathy, pancreatopathy, and non-alcoholic fatty liver disease. The primary aim of the present study was to assess exocrine pancreatic insufficiency (EPI) in dyspeptic type 2 diabetes mellitus (T2DM) patients. Objectives: The secondary objectives were to assess the correlation between the severity of EPI and the severity of dyspepsia and to evaluate the correlation between glycaemic control and the extent of EPI. Methods: T2DM patients presenting with dyspepsia to the General Medicine and Gastroenterology Department of AIIMS Rishikesh, India, were screened for the inclusion and exclusion criteria, and the enrolled participants were subjected to glycated hemoglobin (HbA1c), the Short Form Leeds Dyspepsia Questionnaire, and pancreatic faecal elastase (PFE) by enzyme-linked immunosorbent assay. Results: In 41 subjects, 36.6% (15) had EPI. Among the participants, 22.0% and 14.6% had mild-to-moderate and severe EPI, respectively. There was a significant correlation between glycaemic control (HbA1c%) and faecal elastase concentration (r=-0.51, P<0.001). No statistically significant correlation was found between the severity of dyspepsia (SF-LDQ) and pancreatic fecal elastase (µg; r=-0.01, P=0.957). Conclusion: Overall, a large number of T2DM patients with dyspepsia had EPI, and a significant correlation was observed between glycaemic control and EPI. Further studies are needed to determine if pancreatic enzyme supplementation can alleviate dyspeptic symptoms.