Abstract
We thank Dr. Sharma and colleagues for their sound comments on our article regarding pancreatic tuberculosis. 1 Indeed, due to the methodology of a systematic review, we had to exclude many fine original investigations, including some from the authors’ group in Chandigarh, India. Because of previous disappointing experience in another study where we tried to solicit detailed patient information from published studies from the authors, we resisted this time-consuming effort this time. Furthermore, we concur that many studies were from the pre-endosonography (EUS) area with 28% of the patients receiving EUS in this systematic review. As immanent with a systematic review, we had to restrict the analysis to those studies giving detailed information on individual patients. Still, a total of 116 studies had to be analysed in depth with a total of 166 patients with complete information. Beside the information that could be gathered from any of the previous original studies in pancreatic tuberculosis, we specifically asked whether there were signs of inflammatory activity in the pancreatic gland, pancreatitis, namely, elevated amylase or lipase levels in serum (which was not the case), or signs of endocrine or exocrine pancreatic insufficiency. As it turned out, this question could not be answered by the available published data. Although there is a clear indication of an increased risk of diabetes mellitus in pancreatic tuberculosis patients, no such data exist for the exocrine function or insufficiency. However, as discussed in our article, there must be a small but significant number of patients with this complication if one could deduct this from the frequency of chronic pancreatitis (6.6%) and diarrhea (3.1%). Of note, the first-ever patient with pancreatic exocrine insufficiency treated successfully with meshed-up fresh veal pancreas had pancreatic tuberculosis. 2 If indeed Sharma and colleagues do have data on diabetes mellitus and pancreatic exocrine insufficiency, it would be important to learn about their results.
The pre-press publication of our article online stirred up surprising activity on social media. Together with the sound comment from Sharma and colleagues, this is indicative that the topic, 138 years after the discovery by Robert Koch, 3 is as important as ever and will hopefully stimulate further studies.
