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

Rijk, F.E.M. de; Veldhuisen, C.L. van; Besselink, M.G.; Hooft, J.E. van; Santvoort, H.C. van; Geenen, E.J.M. van; ... ; Dutch Pancreatitis Study Grp (2022)

Article / Letter to editor

Introduction: Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently under diagnosed 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.Methods: 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.Results: 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.Conclusion: 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.(c) 2022 The Author(s). Published by Elsevier B.V. on behalf of IAP and EPC. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

• Chronic pancreatitis
• Exocrine pancreatic insufficiency
• Expert opinion
• HaPanEU-guidelines
• Pancreatic enzyme replacement therapy

• All authors: Rijk, F.E.M. de; Veldhuisen, C.L. van; Besselink, M.G.; Hooft, J.E. van; Santvoort, H.C. van; Geenen, E.J.M. van; Hegyi, P.; Lohr, J.M.; Dominguez-Munoz, J.E.; Jonge, P.J.F. de; Bruno, M.J.; Verdonk, R.C.; Dutch Pancreatitis Study Grp
• Date: 2022-05-01
• Journal: Pancreatology
• Volume: 22
• Issue: 4
• Pages: 457 - 465
• DOI: doi:10.1016/j.pan.2022.03.013