Raffaele Pezzilli1, Gabriele Capurso2, Massimo Falconi3, Luca Frulloni4, Giampiero Macarri5, Guido Costamagna6, Alfredo Di Leo7, Paola Salacone8, Antonio Carroccio9, Alessandro Zerbi10. 1. From the Department of Gastroenterology, Polyclinic of Sant'Orsola, Bologna. 2. Department of Gastroenterology, S. Andrea Hospital, Rome. 3. Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan. 4. Department of Gastroenterology, Borgoroma Hospital, Verona. 5. Department of Gastroenterology, A. Murri Hospital, Fermo. 6. Department of Surgical Digestive Endoscopy, Gemelli Hospital, Rome. 7. Department of Gastroenterology, University Hospital, Bari. 8. Department of Gastroenterology, Mauriziano Hospital, Turin. 9. Department of Internal Medicine Giovanni Paolo II Hospital, Sciacca. 10. Pancreatic Surgery, Humanitas Hospital, Milan, Italy.
Abstract
OBJECTIVE: To evaluate a rapid checklist capable of identifying exocrine pancreatic insufficiency in outpatients. METHODS: Prospective observational study of a multicenter cohort. RESULTS: One hundred and two patients were enrolled; 61.8% of the patients had medically-treated benign or malignant pancreatic disease, and 38.2% had a pancreatic resection. Visual examination of the feces was evaluated in 84 patients and it was related to steatorrhea in 51 patients (50.0%). Receiver operating characteristic curves were evaluated for each symptom or clinical sign and four of them (ie, increase in daily bowel movements, number of bowel movements, fatty stools, >10% weight loss) had a satisfactory area under the curve. At multivariate analysis, fatty stools and >10% weight loss entered into this analysis having an area under the curve of 0.916 (95% confidence interval, 0.851-0.981). At 1 month and at one year of follow-up, the pancreatic enzyme replacement therapy administered showed that pancreatic extracts were able to significantly improve the increase in daily bowel movements, the number of bowel movements, fatty and bulky stools and >10% weight loss. CONCLUSION: Both fatty stools and >10% weight loss were able to clinically evaluate steatorrhea, and their improvement was sufficient to evaluate substitution therapy.
OBJECTIVE: To evaluate a rapid checklist capable of identifying exocrine pancreatic insufficiency in outpatients. METHODS: Prospective observational study of a multicenter cohort. RESULTS: One hundred and two patients were enrolled; 61.8% of the patients had medically-treated benign or malignant pancreatic disease, and 38.2% had a pancreatic resection. Visual examination of the feces was evaluated in 84 patients and it was related to steatorrhea in 51 patients (50.0%). Receiver operating characteristic curves were evaluated for each symptom or clinical sign and four of them (ie, increase in daily bowel movements, number of bowel movements, fatty stools, >10% weight loss) had a satisfactory area under the curve. At multivariate analysis, fatty stools and >10% weight loss entered into this analysis having an area under the curve of 0.916 (95% confidence interval, 0.851-0.981). At 1 month and at one year of follow-up, the pancreatic enzyme replacement therapy administered showed that pancreatic extracts were able to significantly improve the increase in daily bowel movements, the number of bowel movements, fatty and bulky stools and >10% weight loss. CONCLUSION: Both fatty stools and >10% weight loss were able to clinically evaluate steatorrhea, and their improvement was sufficient to evaluate substitution therapy.