Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study

Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists reg...

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Published in:	Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 22; no. 4; pp. 457 - 465
Main Authors:	van Veldhuisen, Charlotte L., Besselink, Marc G., van Santvoort, Hjalmar C., Löhr, J-Matthias, Dominguez-Munoz, Juan E., Bruno, Marco J., Verdonk, Robert C., Falconi, Massimo, Engjom, Trond, Ooi, Chee Y., Frulloni, Luca, Neoptolemos, John, Wilcox, Charles, Liao, Zhuan, Mössner, Joachim, Cui, Yunfeng, de Madaria, Enrique, Distler, Marius, Aghdassi, Ali, Beyer, Georg, Kwanten, Wilhelmus, Conlon, Kevin, Paiella, Salvatore, Alconchel, Felipe, Marino, Marco Vito, de Meijer, Vincent E., Domingo, Carlos, Kleeff, Jorg, Lie Chu, Michael Jen, Bouwense, Stefan, Nashidengo, Pueya Rashid, Konstantinos, Perivoliotis, Lopez-Lopez, Victor, Ignatavicius, Povilas, Wicherts, Dennis, Serrablo, Alejandro, Jie Chu, Michael Jen, Ptasnuka, Margarita, Petrulionis, Marius, Noel, Colin Byron, Castro, Ernest, Recordare, Alfonso, Stättner, Stefan, Ausania, Fabio, Egorov, Viacheslav, Ebrahim, Mohamed, Adams, David, Oracz, Grzegorz, Masamune, Atsushi, Amodio, Antonio, Srivastava, Anshu, Beilman, Gregory J., Berger, Zoltan, Lindkvist, Bjorn, Czakó, Laszlo, Lakhtakia, Sundeep, Duggan, Sinaed N., Kwon, Chang-Il, Phillips, Anna Evans, Gleeson, Ferga C., Lehman, Glen A., Greenhalf, William, Halloran, Christopher M., Ikeura, Tsukasa, Haldorsen, Ingfrid S., Itoi, Takao, Windsor, John, Poulsen, Jakob Lykke, Frokjaer, Jens Brondum, Larino-Noia, Jose, Wang, Dan, Garcia, Julio Iglesias, Larusch, Jessica, Arvanitakis, Marianna, Buchler, Markus W., Levy, Marlon F., Nojgaard, Camilla, Khashab, Mouen A., Delhaye, Myriam, Okazaki, Kazuichi, Ghaneh, Paula, Banks, Peter A., Gupta, Pankaj, Michl, Patrick, Levy, Philippe, Amann, Stephen T., Schwarzenberg, Sarah Jane, Isaji, Shuiji, Olesen, Soren Schou, Novovic, Srdan, Werlin, Steven L., Topazian, Mark D., Weiss, Frank Ulrich, Akshintala, Venakata S., Morinville, Veronique D., Vincze, Aron, Singh, Vikesh K., Cui, Naiqiang, Zhang, Hong, Li, Zhao-shen
Format:	Journal Article
Language:	English
Published:	Switzerland Elsevier B.V 01-05-2022 Elsevier Limited
Subjects:	Asymptomatic Chronic pancreatitis Clinical Decision-Making Decision making Enzymes Exocrine pancreatic insufficiency Exocrine Pancreatic Insufficiency - diagnosis Exocrine Pancreatic Insufficiency - etiology Exocrine Pancreatic Insufficiency - therapy Expert opinion Gastroenterology HaPanEU-guidelines Hospitals Humans Laboratories Malnutrition Medical diagnosis Medicin och hälsovetenskap Pancreas Pancreatic enzyme replacement therapy Pancreatitis Pancreatitis, Chronic - complications Pancreatitis, Chronic - diagnosis Pancreatitis, Chronic - therapy Patients Steatorrhea Steatorrhea - diagnosis Steatorrhea - etiology Steatorrhea - therapy Vitamin D HaPanEU-guidelines Expert opinion Exocrine pancreatic insufficiency Chronic pancreatitis Pancreatic enzyme replacement therapy
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Summary:	Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists regarding the management of exocrine pancreatic insufficiency. An online survey and case vignette study was sent to experts in chronic pancreatitis and members of various pancreatic associations: EPC, E-AHPBA and DPSG. Experts were selected based on publication record from the past 5 years. Overall, 252 pancreatologists participated of whom 44% had ≥ 15 years of experience and 35% treated ≥ 50 patients with chronic pancreatitis per year. Screening for exocrine pancreatic insufficiency as part of the diagnostic work-up for chronic pancreatitis is performed by 69% and repeated annually by 21%. About 74% considers nutritional assessment to be part of the standard work-up. Patients are most frequently screened for deficiencies of calcium (47%), iron (42%), vitamin D (61%) and albumin (59%). In case of clinically steatorrhea, 71% prescribes enzyme supplementation. Of all pancreatologists, 40% refers more than half of their patients to a dietician. Despite existing guidelines, 97% supports the need for more specific and tailored instructions regarding the management of exocrine pancreatic insufficiency. This survey identified a lack of consensus and substantial practice variation among international pancreatologists regarding guidelines pertaining the management of exocrine pancreatic insufficiency. These results highlight the need for further adaptation of these guidelines according to current expert opinion and the level of available scientific evidence.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1424-3903 1424-3911 1424-3911
DOI:	10.1016/j.pan.2022.03.013