Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study
Florence E.M. de Rijk, Charlotte L. van Veldhuisen, Marc G. Besselink, Jeanin E. van Hooft, Hjalmar C. van Santvoort, Erwin J. M. van Geenen, Péter Hegyi, Matthias Löhr, J. Enrique Domínguez‐Muñoz, Pieter Jan F. de Jonge, Marco J. Bruno, Robert C. Verdonk, Massimo Falconi, Wen‐Bin Zou, Trond Engjom, Chee Y. Ooi, Robert Sutton, Luca Frulloni, John P. Neoptolemos, C. Mel Wilcox, Vujasinovic Miroslav, Guru Trikudanathan, Zhuan Liao, Truls Hauge, Joachim Mössner, Chantal Hoge, Paul Fockens, J. Sven D. Mieog, Gabriele Capurso, Yunfeng Cui, Enrique de‐Madaria, Marius Distler, Ali A. Aghdassi, David C. Whitcomb, Kylie Russell, Georg Beyer, Lumír Kunovsky, Wilhelmus J. Kwanten, Andrea Nava, Kevin C. Conlon, Ajith K. Siriwardena, Salvatore Paiella, Felipe Alconchel, Marco V. Marino, Vincent E. de Meijer, Carlos Domingo, Jörg Kleeff, Aarti Lakshmanan, Michael Jen Lie Chu, Stefan A.W. Bouwense, Pueya Rashid Nashidengo, Perivoliotis Konstantinos, Edoardo Maria Muttillo, Garzali Ibrahim Umar, Maria Jesús Castro Santiago, Víctor López‐López, Francesco Torri, Moritz Schmelzle, Povilas Ignatavičius, Dennis A. Wicherts, António Gomes, Nikolaos Machairas, Panagiotis Dorovinis, Alejandro Serrablo, Kjetil Søreide, Mohammad Rahbari, Michael Jen Jie Chu, Margarita Ptašņuka, Marius Petrulionis, Colin Noel, Ernesto Castro, Marcello Di Martino, Alfonso Recordare, Stefan Stättner, Fabio Ausania, Vera Hartman, Geert Roeyen, Viacheslav Egorov, Tomas Vanagas, Mohamed Ebrahim, Elena Arabadzhieva, Giuseppe Malleo, Liang Li, David Adams, Grzegorz Oracz, Reddy D. Nageshwar, Alexander Waldthaler, Atsushi Masamune, Asbjørn Mohr Drewes, Antonio Amodio, Temel Tirkes, Anshu Srivastava, Gregory J. Beilman, Zoltán Berger, Björn Lindkvist, Giulia Martina Cavestro, Cheryl E. Gariepy, László Czakó, Milena Di Leo, Vishal Sharma
Abstract
INTRODUCTION: Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed 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.