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

Citation

Smith, RC and Smith, SF and Wilson, J and Pearce, C and Wray, N and Vo, R and Chen, J and Ooi, CY and Oliver, M and Katz, T and Turner, R and Nikfarjam, M and Rayner, CK and Horowitz, M and Holtmann, G and Talley, N and Windsor, J and Pirola, R and Neale, R, Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency, Pancreatology, 16, (2) pp. 164-180. ISSN 1424-3903 (2016) [Refereed Article]

Copyright Statement

2016, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd.

DOI: doi:10.1016/j.pan.2015.12.006

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. Copyright (C) 2016, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.

Item Details

Item Type:Refereed Article
Keywords:exocrine pancreatic insufficiency, pancreatic exocrine replacement therapy, pancreatic diseases, pancreatic function tests, pancreatic neoplasms, pancreatitis
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Venereology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Turner, R (Professor Richard Turner)
ID Code:152724
Year Published:2016
Web of Science® Times Cited:42
Deposited By:Medicine
Deposited On:2022-08-23
Last Modified:2022-09-21
Downloads:0

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