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Diagnosis and Management of Exocrine Pancreatic Insufficiency

  • Pancreas (V Chandrasekhara, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

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.

Recent findings

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.

Summary

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 complications of EPI, are essential to provide effective care for these patients.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Box 100214, 1329 SW 16th St, Suite 5251, Gainesville, FL, 32610-0214, USA

    Chris E. Forsmark MD

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Correspondence to Chris E. Forsmark MD.

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Chris E Forsmark declares that he has no conflict of interest.

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This article is part of the Topical Collection on Pancreas

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Forsmark, C.E. Diagnosis and Management of Exocrine Pancreatic Insufficiency. Curr Treat Options Gastro 16, 306–315 (2018). https://doi.org/10.1007/s11938-018-0186-y

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  • DOI: https://doi.org/10.1007/s11938-018-0186-y

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