Evaluation and management of exocrine pancreatic insufficiency: pearls and pitfalls.
Journal
Current opinion in gastroenterology
ISSN: 1531-7056
Titre abrégé: Curr Opin Gastroenterol
Pays: United States
ID NLM: 8506887
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
pmc-release:
01
09
2024
medline:
3
8
2023
pubmed:
2
8
2023
entrez:
2
8
2023
Statut:
ppublish
Résumé
The diagnosis and management of exocrine pancreatic dysfunction (EPD) can be challenging. EPD classically results from conditions that cause loss of pancreatic acinar cell function and decreased digestive enzyme production. However, several conditions may contribute to signs or symptoms of EPD with otherwise normal pancreatic exocrine function. A thoughtful approach to considering these conditions, along with their specific therapies, can guide a tailored management approach. An EPD severity classification schema has been proposed, which emphasizes a shift towards a more restrictive prescription of pancreas enzyme replacement therapy (PERT) for patients with milder EPD. In contrast, PERT use has been associated with a measurable survival benefit among individuals with EPD and pancreatic cancer, so the prescription of PERT may be more liberal in this population. Recent publications in the cystic fibrosis population offer pearls guiding the titration and optimization of PERT. Among individuals with severe EPD, PERT is an effective therapy. Among individuals with milder EPD, although PERT is effective, there may be opportunities to provide additional and potentially more effective therapies.
Identifiants
pubmed: 37530731
doi: 10.1097/MOG.0000000000000951
pii: 00001574-202309000-00015
pmc: PMC10403264
mid: NIHMS1897954
doi:
Substances chimiques
Gastrointestinal Agents
0
Types de publication
Review
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
428-435Subventions
Organisme : NIDDK NIH HHS
ID : U01 DK108320
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK108327
Pays : United States
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Clin Gastroenterol Hepatol. 2012 Oct;10(10):1088-95
pubmed: 22642958
J Endourol. 2021 Nov;35(11):1693-1700
pubmed: 33906435
Pancreatology. 2016 Nov - Dec;16(6):988-994
pubmed: 27681502
Pancreas. 2016 Sep;45(8):1104-10
pubmed: 26918874
Am J Gastroenterol. 2019 Jul;114(7):1163-1171
pubmed: 31008737
Curr Treat Options Gastroenterol. 2015 Sep;13(3):347-53
pubmed: 26077487
J Cyst Fibros. 2020 Jan;19(1):16-25
pubmed: 31175004
Dig Dis Sci. 2023 May;68(5):1754-1761
pubmed: 36370243
Pancreatology. 2018 Apr;18(3):253-262
pubmed: 29482892
Yale J Biol Med. 1996 Jul-Aug;69(4):317-21
pubmed: 9273985
Clin Transl Gastroenterol. 2019 Sep;10(9):e00072
pubmed: 31517648
J Clin Pharmacol. 2015 Aug;55(8):854-65
pubmed: 25689042
Iran J Pediatr. 2011 Mar;21(1):65-71
pubmed: 23056766
United European Gastroenterol J. 2022 Oct;10(8):844-853
pubmed: 35981311
Pancreatology. 2023 Mar;23(2):151-157
pubmed: 36610873
J Pediatr Gastroenterol Nutr. 2018 Oct;67(4):527-532
pubmed: 30074573
J Gastroenterol. 2019 Mar;54(3):261-270
pubmed: 30232597
Int J Clin Pharmacol Ther. 2013 Apr;51(4):263-73
pubmed: 23357842
Pancreas. 2018 Apr;47(4):e15-e16
pubmed: 29521945
J Pediatr. 1995 Nov;127(5):681-4
pubmed: 7472816
Pancreas. 2022 Apr 1;51(4):310-318
pubmed: 35695742
Aliment Pharmacol Ther. 2020 May;51(10):958-967
pubmed: 32249970
United European Gastroenterol J. 2020 Nov;8(9):1115-1125
pubmed: 32631175
Surg Pathol Clin. 2016 Dec;9(4):705-715
pubmed: 27926368
Clin Kidney J. 2021 Aug 12;15(2):194-204
pubmed: 35145635
Sci Rep. 2022 Feb 4;12(1):1949
pubmed: 35121775
J Clin Med. 2021 Dec 10;10(24):
pubmed: 34945075
BMJ Open. 2021 May 13;11(5):e042067
pubmed: 33986039
J Pediatr. 2004 Sep;145(3):322-6
pubmed: 15343184
J Cyst Fibros. 2021 Sep;20(5):e33-e39
pubmed: 33279468
Front Pediatr. 2022 Jul 22;10:909925
pubmed: 35935370
Pancreas. 2020 Jul;49(6):793-798
pubmed: 32541636
Pancreas. 2016 Feb;45(2):241-7
pubmed: 26390420
Best Pract Res Clin Gastroenterol. 2022 Feb-Mar;56-57:101785
pubmed: 35331397
Gastroenterology. 2023 May;164(6):e1-e2
pubmed: 36270335
Clin J Am Soc Nephrol. 2021 Mar 8;16(3):487-495
pubmed: 32900691
Curr Med Res Opin. 2018 Jan;34(1):25-33
pubmed: 28985688
Front Oncol. 2021 Feb 25;11:627612
pubmed: 33732647
J Dig Dis. 2022 May;23(5-6):331-340
pubmed: 35703114
Pancreatology. 2022 Jan;22(1):168-172
pubmed: 34916141
F1000Res. 2019 Nov 26;8:
pubmed: 31824646
J Cyst Fibros. 2017 Nov;16 Suppl 2:S70-S78
pubmed: 28986019
Gastroenterol Clin North Am. 2020 Sep;49(3):571-587
pubmed: 32718571
Am J Gastroenterol. 2020 Mar;115(3):322-339
pubmed: 32022720
Am Fam Physician. 2011 Nov 1;84(9):1042-8
pubmed: 22046946
J Pediatr Gastroenterol Nutr. 2022 Nov 1;75(5):e94-e97
pubmed: 36070542
N Engl J Med. 1973 Apr 19;288(16):813-5
pubmed: 4693931
Dig Dis Sci. 2022 Dec;67(12):5666-5675
pubmed: 35704255
Cancer Immunol Res. 2018 Dec;6(12):1453-1458
pubmed: 30275274
Medicine (Baltimore). 2017 May;96(19):e6758
pubmed: 28489752
Pancreatology. 2021 Aug;21(5):1009-1010
pubmed: 34006458
Curr Opin Gastroenterol. 2020 Sep;36(5):421-427
pubmed: 32740002
Mayo Clin Proc. 1979 Mar;54(3):157-62
pubmed: 431121
Pancreas. 2017 Nov/Dec;46(10):1251-1258
pubmed: 29040194
Clin Nutr. 2016 Jun;35(3):557-77
pubmed: 27068495
Pancreatology. 2020 Oct;20(7):1368-1378
pubmed: 32967795
Gastroenterology. 2020 Oct;159(4):1526-1532
pubmed: 32679220
Clin Gastroenterol Hepatol. 2018 Aug;16(8):1220-1228.e4
pubmed: 29374614