To study the prevelance of vitamin d deficency in chronic pancreatitis and it’s correlation with severity of the disease

Background: Chronic pancreatitis (CP) is a result of progressive and irreversible damage of the pancreas. This process leads to progressive loss of pancreatic exocrine and endocrine function. Pancreatic exocrine insufficiency following chronic pancreatitis can cause or worsen an existing vitamin D deficiency.
Objective: In this study, we aim to determine the prevalence of vitamin D deficiency among chronic pancreatitis patients. We also intend to determine the correlation of vitamin D deficiency with the severity of disease as classified by modified Cambridge classification.
Methods: The study was conducted in patients admitted in Medical Gastroenterology department, Madras Medical College, RGGGH from January 2018 to December 2018. Newly diagnosed chronic pancreatitis were included in the study. Clinical history and baseline evaluation (biochemical and imaging) was done for all the patients. Severity was assessed by modified Cambridge scoring system. Determination of 25-hydroxyvitamin D (25 OH D, the amount of 25OHD3 and 25OHD2) is committed by certified ID-LC-MS method (Liquid chromatography-tandem mass spectrometry) with accuracy and precision within 7.5% and linearity range 3.0-300.0nmol/L. Levels of 25OHD below 25nmol/L were defined as deficiency, 25-50nmol/L- as severe insufficiency, 50-75 nmol/L - mild insufficiency and above 75 nmol/L - as normal, or without insufficiency.
Results: Study encompassed 140 patients in two subgroups: 108 patients with proven CP (52% males; group mean-aged 52.7 years) and 38 matched control subjects (43% males, mean-aged 54.2 yrs) who consented to participate. Vitamin D (25OHD) levels in CP patients were found lower than in the control subjects(p 0.036). Absolute 25OHD deficiency (values under 25nmol/L) was observed in 37.5% (41) of patients with CP, while the absence of deficiency (25OHD >75 nmol/L) was found only in 8.3% (8) patients. The mean 25OHD levels were found lower in patients who were associated with diabetes. We found a difference between 25OHD mean values for subgroups 1- 4 by CT/MRCP (p<0.001). Patients with less severe CP assessed by means of CT/MRCP had lowest incidence of vitamin D deficiency. Also, no deficiency was only found in 4 patients Cambridge 1 and 2 patients Cambridge 2 (5.6% and 2.8% respectively). Between the subgroups of mild (Cambridge 1 and 2) and severe structural changes (Cambridge 3 and 4) there was also a statistically significant difference, p <0.0001.
Conclusion: Most of our CP patients were with vitamin D deficiency and insufficiency and there was a strong relationship between 25OHD levels and severity of morphological imaging data with increased risk for 25OHD deficiency. Therefore, vitamin D assessment should be done in all cases of pancreatitis and should be supplemented accordingly.