Ross C Smith1, Sarah F Smith2, Jeremy Wilson3, Callum Pearce4, Nick Wray5, Ruth Vo3, John Chen6, Chee Y Ooi7, Mark Oliver8, Tamarah Katz9, Richard Turner10, Mehrdad Nikfarjam11, Christopher Rayner12, Michael Horowitz13, Gerald Holtmann14, Nick Talley15, John Windsor16, Ron Pirola17, Rachel Neale18. 1. Department of Surgery, University of Sydney, NSW, Australia; Australasian Pancreatic Club, Australia. Electronic address: Ross.smith@sydney.edu.au. 2. Australasian Pancreatic Club, Australia. 3. Liverpool Hospital, University of NSW, Australia. 4. Institute for Immunology and Infectious Diseases, Murdoch University, WA, Australia; Fremantle Hospital, WA, Australia. 5. Nutrition & Dietetics, School of Health Sciences, Flinders University, Adelaide, SA, Australia. 6. South Australian Liver Transplant & HPB Unit, RAH & Flinders Medical Centre, SA, Australia. 7. School of Women's and Children's Health, Dept. of Medicine, University of NSW, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia. 8. Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia. 9. Sydney Children's Hospital, Randwick, NSW, Australia. 10. Hobart Clinical School and Dept. Surgery, University of Tasmania, Australia. 11. Dept. Surgery, University of Melbourne, VIC, Australia; Australasian Pancreatic Club, Australia. 12. School of Medicine, University of Adelaide, SA, Australia; Centre for Digestive Diseases, Royal Adelaide Hospital, SA, Australia. 13. Endocrine and Metabolic Unit, University of Adelaide and Royal Adelaide Hospital, SA, Australia. 14. Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia; Translational Research Institute, Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Qld, Australia. 15. Faculty of Health and Medicine, University of Newcastle, NSW, Australia; Royal Australasian College of Physicians, Australia. 16. Dept. of Surgery, University of Auckland, New Zealand. 17. Faculty of Medicine, SW Sydney Clinical School, University of NSW, Australia. 18. Cancer Control Laboratory, Queensland Institute of Medical Research, Qld, Australia.
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.
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.
Authors: Nicholas Zdenkowski; George Radvan; Leanna Pugliese; Julie Charlton; Christopher Oldmeadow; Allison Fraser; Antonino Bonaventura Journal: Support Care Cancer Date: 2017-02-04 Impact factor: 3.603
Authors: Igor E Khatkov; Igor V Maev; Sayyar R Abdulkhalov; Sergey A Alekseenko; Ruslan B Allikhanov; Igor G Bakulin; Natalia V Bakulina; Andrey U Baranovskiy; Ekaterina V Beloborodova; Elena A Belousova; Sergey E Voskanyan; Lyudmila V Vinokurova; Vladimir B Grinevich; Vladimir V Darvin; Elena A Dubtsova; Tatiana G Dyuzheva; Vyacheslav I Egorov; Mikhail G Efanov; Roman E Izrailov; Vyacheslav L Korobka; Bogdan N Kotiv; Nikolay Yu Kokhanenko; Yury A Kucheryavy; Maria A Livzan; Vladimir K Lyadov; Karine A Nikolskaya; Marina F Osipenko; Victor D Pasechnikov; Ekaterina Yu Plotnikova; Oleg A Sablin; Vladimir I Simanenkov; Victor V Tsvirkun; Vladislav V Tsukanov; Alexey V Shabunin; Dmitry S Bordin; Professional Medical Society Pancreatic Club Russia Journal: Turk J Gastroenterol Date: 2021-03 Impact factor: 1.852
Authors: Timothy P Foster; Brittany Bruggeman; Martha Campbell-Thompson; Mark A Atkinson; Michael J Haller; Desmond A Schatz Journal: Endocr Pract Date: 2020-12 Impact factor: 3.443