INS and Peptic ulcer: The main arguments contra TP were the following metabolic consequences: (1) endocrine insufficiency with a complete insulin deficiency and the necessity of insulin therapy [24], (2) exocrine insufficiency with steatorrhea and the need of durable pancreatic enzyme replacement, (3) the development of steatohepatis with progressive liver failure [25], and (4) the lack of bicarbonate secretion with an increased risk for the development of marginal and peptic ulcers resulting in continuous application of proton pump inhibitors [24].