Background Chronic pancreatitis (CP) can lead to pancreatic exocrine insufficiency (PEI), causing protein malabsorption and altered amino acid levels. Our aim is to investigate amino acid levels in patients with CP and to assess the associations with exocrine insufficiency, pancreatic elastography, and the severity of CP. Methods Twenty-five patients with CP were prospectively enrolled in this study. A control group included 28 age- and gender-matched subjects without pancreatic disease. Amino acids were quantified using the Biocrates MxP Quant 500 kit. Differences in amino acid levels were calculated using the non-parametric Wilcoxon test. Pancreatic stiffness was evaluated by EUS-elastography, PEI was assessed using fecal elastase-1 levels. The severity of CP was determined using the M-ANNHEIM classification. Results The ratio of nonessential amino acids to essential amino acids, glutamic acid and aspartic acid levels were significantly increased in the CP group, whereas tryptophan levels were significantly decreased in CP. A positive correlation between proteinogenic amino acids and the severity of pancreatitis was found. Proline levels showed a strong correlation with the CP severity index (r = 0.63), a significant correlation with elastase-1 values (r = −0.48, p = 0.02), and a moderate correlation with pancreatic stiffness (r = 0.47, p = 0.09). Conclusion Patients with CP have altered amino acid blood levels, an increased ratio of nonessential to essential amino acids. The severity of CP was found to increase the levels of nonessential amino acids, with proline showing the strongest associations with severity, elastase-1 levels, and pancreatic stiffness.
Malvik et al. (Tue,) studied this question.