Prevalence and risk factors of exocrine pancreatic insufficiency in patients with chronic pancreatitis: A systematic review and meta-analysis

Background: Chronic pancreatitis (CP) is a progressive disorder causing irreversible pancreatic damage and exocrine pancreatic insufficiency (EPI), which affects CP patients’ absorption, nutrition, and quality of life. However, its global prevalence and risk factors are inconsistently reported. This review aimed to determine EPI prevalence in CP patients and influencing factors. Methods: This systematic review and meta-analysis (PROSPERO: CRD42024618687; PRISMA-compliant) synthesized 14 studies (7663 patients, 2004–2024) to determine pooled prevalence and influencing factors of EPI. Statistical analyses were performed using STATA 18.0, including random-effects meta-analysis, subgroup analyses (geography, diagnostic method, and study design), sensitivity analysis, and publication bias assessment. Results: The pooled EPI prevalence in CP patients was 40.0% (95% confidence interval [CI]: 33.5%–46.7%). Diagnostic methods significantly affected estimates: the fecal elastase-1 test yielded the highest rate (52.1%, 95% CI: 44.2%–59.9%), far exceeding the steatorrhea/fecal fat test (21.1%) and 13 C-mixed triglyceride breath test (31.6%). Geographic variability was observed (Asia: 31.3%, Europe: 44.5%, and North America: 39.8%) but lacked statistical significance. Smoking emerged as a key risk factor (odds ratio=1.51, 95% CI: 1.25–1.76). Painless CP patients showed a slightly higher EPI prevalence (~47%). Conclusions: The prevalence rate of EPI in CP patients is globally high. The risk factors include smoking. Diagnostic variability necessitates standardized screening and research into its underlying mechanisms.