Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency

Smith, Ross C., Smith, Sarah F., Wilson, Jeremy, Pearce, Callum, Wray, Nick, Vo, Ruth, Chen, John, Ooi, Chee Y., Oliver, Mark, Katz, Tamarah, Turner, Richard, Nikfarjam, Mehrdad, Rayner, Christopher, Horowitz, Michael, Holtmann, Gerald, Talley, Nick, Windsor, John, Pirola, Ron and Neale, Rachel (2015) Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology, 16 2: 164-180. doi:10.1016/j.pan.2015.12.006

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Author Smith, Ross C.
Smith, Sarah F.
Wilson, Jeremy
Pearce, Callum
Wray, Nick
Vo, Ruth
Chen, John
Ooi, Chee Y.
Oliver, Mark
Katz, Tamarah
Turner, Richard
Nikfarjam, Mehrdad
Rayner, Christopher
Horowitz, Michael
Holtmann, Gerald
Talley, Nick
Windsor, John
Pirola, Ron
Neale, Rachel
Title Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency
Journal name Pancreatology   Check publisher's open access policy
ISSN 1424-3911
1424-3903
Publication date 2015-01-01
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.pan.2015.12.006
Open Access Status Not yet assessed
Volume 16
Issue 2
Start page 164
End page 180
Total pages 17
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Language eng
Subject 2712 Endocrinology, Diabetes and Metabolism
2721 Hepatology
1310 Endocrinology
Abstract Aim Because of increasing awareness of variations in the use of pancreatic exocrine replacement therapy, the Australasian Pancreatic Club decided it was timely to re-review the literature and create new Australasian guidelines for the management of pancreatic exocrine insufficiency (PEI). Methods A working party of expert clinicians was convened and initially determined that by dividing the types of presentation into three categories for the likelihood of PEI (definite, possible and unlikely) they were able to consider the difficulties of diagnosing PEI and relate these to the value of treatment for each diagnostic category. Results and conclusions Recent studies confirm that patients with chronic pancreatitis receive similar benefit from pancreatic exocrine replacement therapy (PERT) to that established in children with cystic fibrosis. Severe acute pancreatitis is frequently followed by PEI and PERT should be considered for these patients because of their nutritional requirements. Evidence is also becoming stronger for the benefits of PERT in patients with unresectable pancreatic cancer. However there is as yet no clear guide to help identify those patients in the 'unlikely' PEI group who would benefit from PERT. For example, patients with coeliac disease, diabetes mellitus, irritable bowel syndrome and weight loss in the elderly may occasionally be given a trial of PERT, but determining its effectiveness will be difficult. The starting dose of PERT should be from 25,000-40,000 IU lipase taken with food. This may need to be titrated up and there may be a need for proton pump inhibitors in some patients to improve efficacy.
Formatted abstract
Aim: Because of increasing awareness of variations in the use of pancreatic exocrine replacement therapy, the Australasian Pancreatic Club decided it was timely to re-review the literature and create new Australasian guidelines for the management of pancreatic exocrine insufficiency (PEI).

Methods: A working party of expert clinicians was convened and initially determined that by dividing the types of presentation into three categories for the likelihood of PEI (definite, possible and unlikely) they were able to consider the difficulties of diagnosing PEI and relate these to the value of treatment for each diagnostic category.

Results and conclusions: Recent studies confirm that patients with chronic pancreatitis receive similar benefit from pancreatic exocrine replacement therapy (PERT) to that established in children with cystic fibrosis. Severe acute pancreatitis is frequently followed by PEI and PERT should be considered for these patients because of their nutritional requirements. Evidence is also becoming stronger for the benefits of PERT in patients with unresectable pancreatic cancer. However there is as yet no clear guide to help identify those patients in the ‘unlikely’ PEI group who would benefit from PERT. For example, patients with coeliac disease, diabetes mellitus, irritable bowel syndrome and weight loss in the elderly may occasionally be given a trial of PERT, but determining its effectiveness will be difficult. The starting dose of PERT should be from 25,000–40,000 IU lipase taken with food. This may need to be titrated up and there may be a need for proton pump inhibitors in some patients to improve efficacy.
Keyword Exocrine pancreatic insufficiency
Pancreatic exocrine replacement therapy
Pancreatic diseases
Pancreatic function tests
Pancreatic neoplasms
Pancreatitis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Medicine
Official 2016 Collection
 
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Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
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