PWE-208 How common is pancreatic exocrine insufficiency in primary care? (original) (raw)
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Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines
BMJ Open Gastroenterology, 2021
IntroductionPancreatic exocrine insufficiency is a finding in many conditions, predominantly affecting those with chronic pancreatitis, pancreatic cancer and acute necrotising pancreatitis. Patients with pancreatic exocrine insufficiency can experience gastrointestinal symptoms, maldigestion, malnutrition and adverse effects on quality of life and even survival.There is a need for readily accessible, pragmatic advice for healthcare professionals on the management of pancreatic exocrine insufficiency.Methods and analysisA review of the literature was conducted by a multidisciplinary panel of experts in pancreatology, and recommendations for clinical practice were produced and the strength of the evidence graded. Consensus voting by 48 pancreatic specialists from across the UK took place at the 2019 Annual Meeting of the Pancreatic Society of Great Britain and Ireland annual scientific meeting.ResultsRecommendations for clinical practice in the diagnosis, initial management, patient e...
Practical guide to exocrine pancreatic insufficiency - Breaking the myths
BMC medicine, 2017
Exocrine pancreatic insufficiency (EPI) is characterized by a deficiency of exocrine pancreatic enzymes, resulting in malabsorption. Numerous conditions account for the etiology of EPI, with the most common being diseases of the pancreatic parenchyma including chronic pancreatitis, cystic fibrosis, and a history of extensive necrotizing acute pancreatitis. Treatment for EPI includes dietary management, lifestyle changes (i.e., decrease in alcohol consumption and smoking cessation), and pancreatic enzyme replacement therapy. Many diagnostic tests are available to diagnose EPI, however, the criteria of choice remain unclear and the causes for a false-positive test are not yet understood. Despite multiple studies on the treatment of EPI using exogenous pancreatic enzymes, there remains confusion amongst medical practitioners with regard to the best approach to diagnose EPI, as well as dosing and administration of pancreatic enzymes. Appropriate use of diagnostics and treatment approach...
Less common etiologies of exocrine pancreatic insufficiency
World Journal of Gastroenterology, 2017
Diez PM designed the "search terms" of the literature review, analyzed the data, and summarized the findings; all authors critically reviewed and revised the manuscript, and approved the final version of the article, including the authorship list.
World journal of gastroenterology : WJG, 2013
This is a medical position statement developed by the Exocrine Pancreatic Insufficiency collaborative group which is a part of the Italian Association for the Study of the Pancreas (AISP). We covered the main diseases associated with exocrine pancreatic insufficiency (EPI) which are of common interest to internists/gastroenterologists, oncologists and surgeons, fully aware that EPI may also occur together with many other diseases, but less frequently. A preliminary manuscript based on an extended literature search (Medline/PubMed, Cochrane Library and Google Scholar) of published reports was prepared, and key recommendations were proposed. The evidence was discussed at a dedicated meeting in Bologna during the National Meeting of the Association in October 2012. Each of the proposed recommendations and algorithms was discussed and an initial consensus was reached. The final draft of the manuscript was then sent to the AISP Council for approval and/or modification. All concerned part...
UPDATED APPROACH TO EXOCRINE PANCREATIC INSUFFICIENCY: 2023 GUIDELINES (Atena Editora)
UPDATED APPROACH TO EXOCRINE PANCREATIC INSUFFICIENCY: 2023 GUIDELINES (Atena Editora), 2024
Objective: To analyze the signs, diagnoses and treatments for Exocrine Pancreatic Insufficiency (EPI), according to 2023 updates, aiming to improve identification and management. Methodology: Bibliographic review structured by the PVO strategy, through the PubMed – MEDLINE database, through the search strategy: (Exocrine Pancreatic Insufficiency) AND (Management) AND ((2023) OR (Updates) OR (Guidelines), with results of 121 articles, from 2023 and 2024, and, after applying the inclusion and exclusion criteria, 16 articles remained. Review: It is noted that the symptoms of EPI are steatorrhoea/diarrhea, abdominal pain, bloating, weight loss, hypovitaminosis and, in children, developmental delay. The diagnosis is made in clinical evaluation, essential to avoid underdiagnosis, and after complementary exams: fecal elastase test, respiratory tests and pancreatic enzymes in the blood, endoscopic test, secretin-stimulated test, computed tomography, magnetic resonance imaging, endoscopic ultrasonography and Endoscopic retrograde cholangiopancreatography. Less commonly used tests are fecal fat collection and disaccharidase tests, in addition to genetic tests. Treatment must be early and consists of nutritional assessment and development of a therapeutic plan, with pancreatic enzyme replacement therapy (PERT) and lifestyle changes. PERT must be taken throughout the meal for better absorption. A new product for EPI is Encala (Envara Health), which does not depend on enzymes and offers good results. Restricted fat diets are a concern for compromising the absorption of vitamins and reducing the effectiveness of PERT. Final considerations: Exocrine pancreatic insufficiency (EPI) is characterized by poor digestion and absorption of nutrients, with symptoms such as steatorrhea and abdominal pain. Early diagnosis is crucial, especially in patients at high risk due to conditions such as chronic pancreatitis. Diagnostic methods include laboratory and imaging tests, and treatment focuses on enzyme replacement and lifestyle adjustments. There is a continued need for research to optimize the diagnosis and treatment of EPI.
Pancreas, 2020
Objectives: Pancreatic exocrine insufficiency (PEI) is a common complication of chronic pancreatitis. However, little is known about the natural course of PEI and the effect of pancreatic enzyme replacement therapy on symptoms. The aim of this study was to evaluate the natural course and treatment of PEI in a nationwide cohort of patients with chronic pancreatitis. Methods: Patients with chronic pancreatitis were selected from the multicenter Dutch Chronic Pancreatitis Registry. Patients were classified in 3 groups: definite PEI, potential PEI, and no PEI. Definite PEI and no PEI were compared regarding the course of disease, symptoms, treatment, and quality of life. Results: Nine hundred eighty-seven patients were included from 29 centers, of which 304 patients (31%) had definite PEI; 451 (46%), potentially PEI; and 232 (24%), no PEI. Patients with definite PEI had significantly more malabsorption symptoms, a lower body mass index, and aberrant defecation. Lowered quality of life was not independently associated with PEI. Of the PEI patients using pancreatic enzyme replacement therapy, 47% still reported steatorrhea. Conclusions: Pancreatic exocrine insufficiency is associated with malabsorption symptoms and a lower body mass index. Some form of pancreatic enzyme replacement therapy is reasonably effective in alleviating malabsorption symptoms, but improvement of treatment is needed.
Management of pancreatic exocrine insufficiency: Australasian Pancreatic Club recommendations
The Medical journal of Australia, 2010
Pancreatic exocrine insufficiency (PEI) occurs when the amounts of enzymes secreted into the duodenum in response to a meal are insufficient to maintain normal digestive processes. The main clinical consequence of PEI is fat maldigestion and malabsorption, resulting in steatorrhoea. Pancreatic exocrine function is commonly assessed by conducting a 3-day faecal fat test and by measuring levels of faecal elastase-1 and serum trypsinogen. Pancreatic enzyme replacement therapy is the mainstay of treatment for PEI. In adults, the initial recommended dose of pancreatic enzymes is 25,000 units of lipase per meal, titrating up to a maximum of 80,000 units of lipase per meal. In infants and children, the initial recommended dose of pancreatic enzymes is 500 units of lipase per gram of dietary fat; the maximum daily dose should not exceed 10,000 units of lipase per kilogram of bodyweight. Oral pancreatic enzymes should be taken with meals to ensure adequate mixing with the chyme. Adjunct ther...
Pancreatic exocrine insufficiency: Diagnosis and treatment
Journal of Gastroenterology and Hepatology, 2011
Pancreatic insufficiency is a major consequence of pancreatic diseases leading to a loss of pancreatic parenchyma, obstruction of the main pancreatic duct, decreased pancreatic stimulation, or acid-mediated inactivation of pancreatic enzymes. In addition, gastrointestinal and pancreatic surgical resections are frequent causes. Clinical manifestations include abdominal cramps, steatorrhea and malnutrition. Malnutrition, the main contributing factor of weight loss, has been related to a high morbidity and mortality secondary to an increased risk of malnutrition-related complications and cardiovascular events. Assessments of exocrine pancreatic function, such as fecal fat quantification and 13 Ctriglyceride breath test, are the method of choice for diagnosis. In clinical practice, highrisk patient populations include those with severe necrotizing pancreatitis, gastrointestinal and pancreatic surgery, cancer of pancreas head, and those with pancreatic calcifications. Apart from relief of maldigestion-related symptoms, the main goal of pancreatic enzyme substitution therapy is to ensure a normal nutritional status. Therapy of pancreatic insufficiency is based on the oral administration of exogenous pancreatic enzymes. Restriction of fat intake, though traditionally important in conventional treatment, should be reconsidered. Enzyme substitution therapy should ideally mimic the physiological pattern of pancreatic exocrine secretion, and pancreatic enzymes in the form of enteric-coated minimicrospheres are considered as the most elaborated commercially available enzyme preparations. In general, pancreatic exocrine insufficiency in patients after surgery may be managed similarly to patients with chronic pancreatitis. This review focuses on current perspectives in diagnosis and treatment of pancreatic exocrine insufficiency and practical suggestions on its clinical management.