Biomaterial Database

Diagnosis and management of pancreatic exocrine insufficiency. 2017

Mehrdad Nikfarjam, and Jeremy S Wilson, and Ross C Smith, and

Austin Health, Melbourne, VIC mehrdad.nikfarjam@gmail.com.

In 2015, the Australasian Pancreatic Club (APC) published the Australasian guidelines for the management of pancreatic exocrine insufficiency (http://pancreas.org.au/2016/01/pancreatic-exocrine-insufficiency-guidelines). Pancreatic exocrine insufficiency (PEI) occurs when normal digestion cannot be sustained due to insufficient pancreatic digestive enzyme activity. This may be related to a breakdown, at any point, in the pancreatic digestive chain: pancreatic stimulation; synthesis, release or transportation of pancreatic enzymes; or synchronisation of secretions to mix with ingested food. Main recommendations: The guidelines provide advice on diagnosis and management of PEI, noting the following: A high prevalence of PEI is seen in certain diseases and conditions, such as cystic fibrosis, acute and chronic pancreatitis, pancreatic cancer and pancreatic surgery. The main symptoms of PEI are steatorrhoea or diarrhoea, abdominal pain, bloating and weight loss. These symptoms are non-specific and often go undetected and untreated. PEI diagnosis is predominantly based on clinical findings and the presence of underlying disease. The likelihood of PEI in suspected patients has been categorised into three groups: definite, possible and unlikely. If left untreated, PEI may lead to complications related to fat malabsorption and malnutrition, and have an impact on quality of life. Pancreatic enzyme replacement therapy (PERT) remains the mainstay of PEI treatment with the recommended adult initial enzyme dose being 25 000-40 000 units of lipase per meal, titrating up to a maximum of 75 000-80 000 units of lipase per meal. Adjunct acid-suppressing therapy may be useful when patients still experience symptoms of PEI on high dose PERT. Nutritional management by an experienced dietitian is essential. Changes in management as a result of these guidelines: These are the first guidelines to classify PEI as being definite, possible or unlikely, and provide a diagnostic algorithm to facilitate the early diagnosis of PEI and appropriate use of PERT.

UI	MeSH Term	Description	Entries
D010188	Exocrine Pancreatic Insufficiency	A malabsorption condition resulting from greater than 10% reduction in the secretion of pancreatic digestive enzymes (LIPASE; PROTEASES; and AMYLASE) by the EXOCRINE PANCREAS into the DUODENUM. This condition is often associated with CYSTIC FIBROSIS and with chronic PANCREATITIS.	Pancreatic Insufficiency,Exocrine Pancreatic Insufficiencies,Insufficiencies, Exocrine Pancreatic,Insufficiencies, Pancreatic,Insufficiency, Exocrine Pancreatic,Insufficiency, Pancreatic,Pancreatic Insufficiencies,Pancreatic Insufficiencies, Exocrine,Pancreatic Insufficiency, Exocrine
D011788	Quality of Life	A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral, social environment as well as health and disease.	HRQOL,Health-Related Quality Of Life,Life Quality,Health Related Quality Of Life
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001315	Australia	The smallest continent and an independent country, comprising six states and two territories. Its capital is Canberra.	Canton and Enderbury Islands,Christmas Island,Christmas Island (Australia)
D012955	Societies, Medical	Societies whose membership is limited to physicians.	Medical Societies,Medical Society,Society, Medical
D017410	Practice Guidelines as Topic	Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.	Clinical Guidelines as Topic,Best Practices,Best Practice
D056947	Enzyme Replacement Therapy	Therapeutic replacement or supplementation of defective or missing enzymes to alleviate the effects of enzyme deficiency (e.g., GLUCOSYLCERAMIDASE replacement for GAUCHER DISEASE).	Enzyme Replacement Therapies,Replacement Therapies, Enzyme,Replacement Therapy, Enzyme,Therapies, Enzyme Replacement,Therapy, Enzyme Replacement
D018529	Nutritional Support	The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include FLUID THERAPY which normalizes body fluids to restore WATER-ELECTROLYTE BALANCE.	Artificial Feeding,Feeding, Artificial,Support, Nutritional
D019468	Disease Management	A broad approach to appropriate coordination of the entire disease treatment process that often involves shifting away from more expensive inpatient and acute care to areas such as preventive medicine, patient counseling and education, and outpatient care. This concept includes implications of appropriate versus inappropriate therapy on the overall cost and clinical outcome of a particular disease. (From Hosp Pharm 1995 Jul;30(7):596)	Disease Managements,Management, Disease,Managements, Disease