Journal article
Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency
Pancreatology, Vol.16(2), pp.164-180
2016
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.
Details
- Title
- Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency
- Authors/Creators
- R.C. Smith (Author/Creator) - The University of SydneyS.F. Smith (Author/Creator) - Australasian Pancreatic Club, AustraliaJ. Wilson (Author/Creator) - Liverpool HospitalC. Pearce (Author/Creator) - Fremantle HospitalN. Wray (Author/Creator) - Flinders UniversityR. Vo (Author/Creator) - Liverpool HospitalJ. Chen (Author/Creator) - Flinders Medical CentreC.Y. Ooi (Author/Creator) - Sydney Children's HospitalM. Oliver (Author/Creator) - Royal Children's HospitalT. Katz (Author/Creator) - Sydney Children's HospitalR. Turner (Author/Creator) - University of TasmaniaM. Nikfarjam (Author/Creator) - The University of MelbourneC. Rayner (Author/Creator) - Royal Adelaide HospitalM. Horowitz (Author/Creator) - Royal Adelaide HospitalG. Holtmann (Author/Creator) - The University of QueenslandN. Talley (Author/Creator) - University of Newcastle AustraliaJ. Windsor (Author/Creator) - University of AucklandR. Pirola (Author/Creator) - UNSW SydneyR. Neale (Author/Creator) - QIMR Berghofer Medical Research Institute
- Publication Details
- Pancreatology, Vol.16(2), pp.164-180
- Publisher
- Elsevier B.V.
- Identifiers
- 991005540185307891
- Copyright
- © 2015 Elsevier B.V.
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.151 Pancreas & Gall Bladder Disorders
- 1.151.676 Pancreatitis
- Web Of Science research areas
- Gastroenterology & Hepatology
- ESI research areas
- Clinical Medicine