Recommendations from the European guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency
Miroslav Vujasinović, Daniel de la Iglesia, J. Enrique Domínguez‐Muñoz, Matthias Löhr, Hana Algül, Livia Archibugi, Marianna Arvanitakis, Sorin Barbu, Georg Beyer, Mihailo Bezmarevic, Frank Bodewes, Marja A. Boermeester, Stefanos Bonovas, Dmitry Bordin, Marco Bruno, Djuna Cahen, Gabriele Capurso, Güralp Ceyhan, Laszlo Czako, Ferdinando D'Amico, Enrique De Madaria, Julian De Martino, Pierre H. Deprez, Christos Dervenis, Petr Dité, Asbjørn Drewes, Sinead N. Duggan, Deniz Duman, Trond Engjom, Nils Ewald, Ovidiu Fabian, Pierluigi Fracasso, Helmut Friess, Jens Brøndum Frøkjær, Luca Frulloni, Sebastien Gaujoux, Cristian Gheorghe, Sophie Gohy, Natalya Gubergrits, Philip Hardt, Truls Hauge, Peter Hegyi, Andrew Hopper, Pali Hungin, Julio Iglesias-Garcia, Jutta Keller, Mariia Kiriukova, Jörg Kleeff, Alexander Kleger, Andrea Laghi, José Larino-Noia, Johanna Laukkarinen, John Leeds, Björn Lindkvist, Etna Masip, Giovanni Marchegiani, Amir Mari, Emma Martinez-Moneo, Julia Mayerle, Anders Molven, Johann Ockenga, Alexey Okhlobystin, Salvatore Paiella, Nikola Panic, Andrea Parniczky, Lukas Perkhofer, Raffaele Pezzilli, Mary Phillips, Daniele Piovani, Goran Poropat, Jelena Rakic Matic, Vinciane Rebours, Keith Roberts, Stuart Robinson, Jonas Rosendahl, Roberto Salvia, Vasile Sandru, Alain Sauvanet, Isabelle Scheers, Alexander Schneider, Oleg Shvets, Serena Stigliano, Davor Stimac, Oliver Strobel, Andrea Szentesi, Hester Timmerhuis, Mihaela Udrescu, Szilard Vancsa, Vicki Veness, Michael Wilschanski, Heiko Witt
Abstract
BACKGROUND: Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below a level that allows normal digestion of nutrients. Pancreatic disease and pancreatic surgery are the main causes of PEI, but other conditions can affect the digestive function of the pancreas. METHODS: In collaboration with European Digestive Surgery (EDS), European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), European Society for Clinical Nutrition and Metabolism (ESPEN), European Society of Digestive Oncology (ESDO), and European Society of Primary Care Gastroenterology (ESPCG) the working group developed European guidelines for the diagnosis and therapy of PEI. United European Gastroenterology (UEG) provided both endorsement and financial support for the development of the guidelines. RESULTS: Recommendations covered topics related to the clinical management of PEI: concept, pathogenesis, clinical relevance, general diagnostic approach, general therapeutic approach, PEI secondary to chronic pancreatitis, PEI after acute pancreatitis, PEI associated with pancreatic cancer, PEI secondary to cystic fibrosis, PEI after pancreatic surgery, PEI after esophageal, gastric, and bariatric surgery, PEI in patients with type 1 and type 2 diabetes, and PEI in other conditions. CONCLUSIONS: The European guidelines for the diagnosis and therapy of PEI provide evidence-based recommendations concerning key aspects of the etiology, diagnosis, therapy, and follow-up, based on current available evidence. These recommendations should serve as a reference standard for existing management of PEI and as a guide for future clinical research. This article summarizes the recommendations and statements.