Diagnosis and Management of Exocrine Pancreatic Insufficiency

Current Treatment Options in Gastroenterology
Chris E Forsmark

Abstract

Recent studies have documented that many patients with pancreatic exocrine insufficiency (EPI) are not identified and are not treated with appropriate dosages of pancreatic enzyme replacement therapy. This review will summarize the approach to diagnosis, treatment, and monitoring for treatment effect and complications in patients with exocrine insufficiency. While chronic pancreatitis is the most commonly identified cause of EPI, pancreatic cancer and pancreatic surgery are increasingly important. The diagnosis of EPI remains challenging, but fecal elastase is the most clinically useful test. Treatment requires an understanding of the appropriate dosage and timing of enzyme replacement, but recent studies show that clinicians often do not have this understanding. Monitoring and prevention of complications of EPI is increasingly important, particularly osteopenia and osteoporosis. In those that fail to respond, coexistent small intestinal bacterial overgrowth should be considered. Many clinicians do not consider EPI in the differential diagnosis, and patients with EPI are routinely undertreated in the USA. Appropriate identification of those at risk and use of appropriate enzyme therapy, along with monitoring for metabolic compl...Continue Reading

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Citations

Jul 28, 2020·Cancers·Caspar FranckMarino Venerito
Jun 6, 2020·Current Gastroenterology Reports·Lawrence R Schiller
Mar 7, 2019·The Korean Journal of Internal Medicine·Chang-Il KwonGlen A Lehman
Dec 12, 2019·F1000Research·Yaseen Perbtani, Chris E Forsmark
Oct 11, 2020·Medicina·Carmelo Diéguez-CastilloOctavio Caba
Feb 3, 2021·The Journal of Clinical Investigation·Rodger A Liddle
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Jul 21, 2020·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Maria RinzivilloFrancesco Panzuto

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