Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Review

Volume 9, Number 6, December 2016, pages 87-91

Non-Alcoholic Fatty Pancreatic Disease: A Review of Literature

**Table 1.** Common Nomenclature for Pancreatic Steatosis as Described by Smits and van Geenen [11]
Nomenclature	Definition
Pancreatic lipomatosis	General terms that can be used for all forms of pancreatic fat accumulation
Pancreatic steatosis
Fatty pancreas
Lipomatous pseudohypertrophy	An extreme variant of pancreatic fat accumulation when pancreas is enlarged (uniformly or focally), the exocrine system is replaced by fat, and when no association can be found with obesity.
Fatty replacement	Damage of pancreatic acinar cells leading to their death which then results in their replacement in the pancreas by adipocytes (usually irreversible).
Fatty infiltration	Pancreatic infiltration of adipocytes caused by obesity (possibly reversed by weight reduction and appropriate medications).
Non-alcoholic fatty pancreas disease	Pancreatic fat accumulation in association with obesity and metabolic syndrome.
Non-alcoholic fatty steatopancreatitis	Pancreatitis owing to pancreatic fat accumulation.

Table 1. Common Nomenclature for Pancreatic Steatosis as Described by Smits and van Geenen [11]

Nomenclature

Definition

Pancreatic lipomatosis

General terms that can be used for all forms of pancreatic fat accumulation

Pancreatic steatosis

Fatty pancreas

Lipomatous pseudohypertrophy

An extreme variant of pancreatic fat accumulation when pancreas is enlarged (uniformly or focally), the exocrine system is replaced by fat, and when no association can be found with obesity.

Fatty replacement

Damage of pancreatic acinar cells leading to their death which then results in their replacement in the pancreas by adipocytes (usually irreversible).

Fatty infiltration

Pancreatic infiltration of adipocytes caused by obesity (possibly reversed by weight reduction and appropriate medications).

Non-alcoholic fatty pancreas disease

Pancreatic fat accumulation in association with obesity and metabolic syndrome.

Non-alcoholic fatty steatopancreatitis

Pancreatitis owing to pancreatic fat accumulation.

**Table 2.** Etiology of Pancreatic Steatosis [11, 18-29]
Increasing age
Obesity
Diabetes mellitus
Alcohol use in excess of 14 g/week
Hemochromatosis
Viral infections: hepatitis B, reovirus, human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS)
Malnutrition states: kwashiorkor
Medication: gemcitabine, rosiglitazone
Congenital syndromes: cystic fibrosis, Shwachman-Diamond syndrome, Johanson-Blizzard syndrome, heterozygous carboxyl-ester-lipase mutations

Table 2. Etiology of Pancreatic Steatosis [11, 18-29]

Increasing age

Obesity

Diabetes mellitus

Alcohol use in excess of 14 g/week

Hemochromatosis

Viral infections: hepatitis B, reovirus, human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS)

Malnutrition states: kwashiorkor

Medication: gemcitabine, rosiglitazone

Congenital syndromes: cystic fibrosis, Shwachman-Diamond syndrome, Johanson-Blizzard syndrome, heterozygous carboxyl-ester-lipase mutations

**Table 3.** Imaging Modalities for Diagnosis of Pancreatic Steatosis [11, 28-31]
Imaging modality	Advantage	Disadvantage
Ultrasonography (USG)	Widely available	Pancreas may not be visible in obese patients. Pancreatic fibrosis also appears hyperechogenic similar to fat deposition. Pancreas echogenicity has been traditionally compared with liver echogenicity. Liver is metabolically very active and its echogenicity exhibits high variance.
Endoscopic ultrasound (EUS)	The close proximity of the ultrasound probe to the pancreas results in superior spatial resolution compared with CT and MRI.	Invasive procedure. Requires sedation. Carries risk of complications.
Computed tomography (CT)	Easily available. Can be performed without intravenous contrast for diagnosis of pancreatic steatosis.	No cut-off points for pancreatic steatosis on CT have been defined. Exposure to radiation. Mild degree of focal fatty replacement of pancreas cannot be diagnosed with CT alone.
Magnetic resonance imaging (MRI)	Quantify pancreatic fat content with high accuracy.	Lack of research. The detection limit for pancreatic steatosis is unknown.

Table 3. Imaging Modalities for Diagnosis of Pancreatic Steatosis [11, 28-31]

Imaging modality

Advantage

Disadvantage

Ultrasonography (USG)

Widely available

Pancreas may not be visible in obese patients.
Pancreatic fibrosis also appears hyperechogenic similar to fat deposition.
Pancreas echogenicity has been traditionally compared with liver echogenicity. Liver is metabolically very active and its echogenicity exhibits high variance.

Endoscopic ultrasound (EUS)

The close proximity of the ultrasound probe to the pancreas results in superior spatial resolution compared with CT and MRI.

Invasive procedure.
Requires sedation.
Carries risk of complications.

Computed tomography (CT)

Easily available.
Can be performed without intravenous contrast for diagnosis of pancreatic steatosis.

No cut-off points for pancreatic steatosis on CT have been defined.
Exposure to radiation.
Mild degree of focal fatty replacement of pancreas cannot be diagnosed with CT alone.

Magnetic resonance imaging (MRI)

Quantify pancreatic fat content with high accuracy.

Lack of research. The detection limit for pancreatic steatosis is unknown.