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



de Rijk, Florence EM, van Veldhuisen, Charlotte L, Besselink, Marc G ORCID: 0000-0003-2650-9350, van Hooft, Jeanin E ORCID: 0000-0002-4424-0079, van Santvoort, Hjalmar C, van Geenen, Erwin JM, Hegyi, Peter, Löhr, J-Matthias, Dominguez-Munoz, Juan E, de Jonge, Pieter Jan F
et al (show 3 more authors) (2022) Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 22 (4). pp. 457-465.

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Abstract

<h4>Introduction</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.

Item Type: Article
Uncontrolled Keywords: Dutch Pancreatitis Study Group, Pancreas, Humans, Steatorrhea, Exocrine Pancreatic Insufficiency, Pancreatitis, Chronic, Clinical Decision-Making
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 21 Apr 2022 09:54
Last Modified: 19 Mar 2023 05:07
DOI: 10.1016/j.pan.2022.03.013
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3153539