Romanian guidelines on the diagnosis and treatment of exocrine pancreatic insufficiency.

Cristian Gheorghe, Andrada Seicean, Adrian Saftoiu, Marcel Tantau, Eugen Dumitru, Mariana Jinga, Lucian Negreanu, Bogdan Mateescu, Liana Gheorghe, Mihai Ciocirlan, Cristina Cijevschi, Gabriel Constantinescu, Simona Dima, Mircea Diculescu

Journal: Journal of gastrointestinal and liver diseases : JGLD 2016;24(1):117-23

PMID: 25822444

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Abstract

In assessing exocrine pancreatic insufficiency (EPI), its diverse etiologies and the heterogeneous population affected should be considered. Diagnosing this condition remains a challenge in clinical practice especially for mild-to-moderate EPI, with the support of the time-consuming breath test or the coefficient of fat absorption. The fecal elastase-1 test, less precise for the diagnosis, cannot be useful for assessing treatment efficacy. Pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment, whereby enteric-coated mini-microspheres are taken with every meal, in progressive doses based on an individual's weight and clinical symptoms. The main indication for PERT is chronic pancreatitis, in patients who have clinically relevant steatorrhea, abnormal pancreatic function test or abnormal function tests associated with symptoms of malabsorption such as weight loss or meteorism. While enzyme replacement therapy is not recommended in the initial stages of acute pancreatitis, pancreatic exocrine function should be monitored for at least 6-18 months. In the case of unresectable pancreatic cancer, replacement enzyme therapy helps to maintain weight and improve overall quality of life. It is also indicated in patients with celiac disease, who have chronic diarrhea (in spite of gluten-free diet), and in patients with cystic fibrosis with proven EPI.

Address: Carol Davila University of Medicine and Pharmacy;Fundeni Clinical Institute, Bucharest, Romania.; Iuliu Hatieganu University of Medicine and Pharmacy;Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. [email protected].; Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark; University of Medicine; Research Center of Gastroenterology and Hepatology, Craiova, Romania.; Iuliu Hatieganu University of Medicine and Pharmacy;Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.; Faculty of Medicine, Ovidius University, Constanta, Romania.; Carol Davila University of Medicine and Pharmacy; Medicine and Gastroenterology Clinic, Carol Davila Central University Emergency Military Hospital, Bucharest, Romania.; Carol Davila University of Medicine and Pharmacy; Emergency University Hospital, Bucharest, Romania.; Carol Davila University of Medicine and Pharmacy; Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.; Carol Davila University of Medicine and Pharmacy; Fundeni Clinical Institute, Bucharest, Romania.; Grigore T. Popa University of Medicine and Pharmacy; Institute of Gastroenterology and Hepatology, Iasi, Romania.; Carol Davila University of Medicine and Pharmacy; Gastroenterology Department, Floreasca Hospital, Bucharest, Romania.; Fundeni Clinical Institute, Bucharest, Romania.

DOI: 10.15403/jgld.2014.1121.app

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https://doi.org/10.15403/jgld.2014.1121.app

MeSH Terms: Enzyme Replacement Therapy, Exocrine Pancreatic Insufficiency, Humans, Pancreatic Function Tests, Predictive Value of Tests, Romania, Time Factors, Treatment Outcome