Pancreas is a doubled-entity organ, with both an exocrine and an endocrine component, reciprocally interacting in a composed system whose function is relevant for digestion, absorption, and homeostasis of nutrients. Thus, it is not surprising that disorders of the exocrine pancreas also affect the endocrine system and vice versa. It is well-known that patients with chronic pancreatitis develop a peculiar form of diabetes (type III), caused by destruction and fibrotic injury of islet cells. However, less is known on the influence of diabetes on pancreatic exocrine function. Pancreatic exocrine insufficiency (PEI) has been reported to be common in diabetics, with a prevalence widely ranging, in different studies, in both type I (25–74%) and type II (28–54%) diabetes. A long disease duration, high insulin requirement, and poor glycemic control seem to be risk factors for PEI occurrence. The impact of pancreatic exocrine replacement therapy on glycemic, insulin, and incretins profiles has not been fully elucidated. The present paper is aimed at reviewing published studies investigating the prevalence of PEI in diabetic patients and factors associated with its occurrence.

Background: Scoring systems for severe acute pancreatitis (SAP) prediction should be used in conjunction with pre‐test probability to establish post‐test probability of SAP, but data of this kind are lacking.Objective: To investigate the predictive value of commonly employed scoring systems and their usefulness in modifying the pre‐test probability of SAP.Methods: Following PRISMA statement and MOOSE checklists after PROSPERO registration, PubMed was searched from inception until September 2022. Retrospective, prospective, cross‐sectional studies or clinical trials on patients with acute pancreatitis defined as Revised Atlanta Criteria, reporting rate of SAP and using at least one score among Bedside Index for Severity in Acute Pancreatitis (BISAP), Acute Physiology and Chronic Health Examination (APACHE)‐II, RANSON, and Systemic Inflammatory Response Syndrome (SIRS) with their sensitivity and specificity were included. Random effects model meta‐analyses were performed. Pre‐test probability and likelihood ratio (LR) were combined to estimate post‐test probability on Fagan nomograms. Pooled severity rate was used as pre‐test probability of SAP and pooled sensitivity and specificity to calculate LR and generate post‐test probability. A priori hypotheses for heterogeneity were developed and sensitivity analyses planned.Results: 43 studies yielding 14,116 acute pancreatitis patients were included: 42 with BISAP, 30 with APACHE‐II, 27 with Ranson, 8 with SIRS. Pooled pre‐test probability of SAP ranged 16.6%–25.3%. The post‐test probability of SAP with positive/negative score was 47%/6% for BISAP, 43%/5% for APACHE‐II, 48%/5% for Ranson, 40%/12% for SIRS. In 18 studies comparing BISAP, APACHE‐II, and Ranson in 6740 patients with pooled pre‐test probability of SAP of 18.7%, post‐test probability when scores were positive was 48% for BISAP, 46% for APACHE‐II, 50% for Ranson. When scores were negative, post‐test probability dropped to 7% for BISAP, 6% for Ranson, 5% for APACHE‐II. Quality, design, and country of origin of the studies did not explain the observed high heterogeneity.Conclusions: The most commonly used scoring systems to predict SAP perform poorly and do not aid in decision‐making.

Different inflammation-based scores such as the neutrophil/lymphocyte ratio (NLR), the Odonera Prognostic Nutritional Index (PNI), the Glasgow Prognostic Score, the platelet/lymphocyte ratio, and the C-reactive protein/albumin ratio have been found to be significantly associated with pancreatic cancer (PDAC) prognosis. However, most studies have investigated patients undergoing surgery, and few of them have compared these scores. We aimed at evaluating the association between inflammatory-based scores and PDAC prognosis. In a single center cohort study, inflammatory-based scores were assessed at diagnosis and their prognostic relevance as well as that of clinic-pathological variables were evaluated through multiple logistic regression and survival probability analysis. In 206 patients, age, male sex, tumor size, presence of distant metastasis, access to chemotherapy, and an NLR > 5 but not other scores were associated with overall survival (OS) at multivariate analysis. Patients with an NLR < 5 had a median survival of 12 months compared to 4 months in those with an NLR > 5. In the 81 patients with distant metastasis at diagnosis, an NLR > 5 resulted in the only variable significantly associated with survival. Among patients with metastatic disease who received chemotherapy, the median survival was 3 months in patients with an NLR > 5 and 7 months in those with an NLR < 5. The NLR might drive therapeutic options in PDAC patients, especially in the setting of metastatic disease.