1. Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study
- Author
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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, Peter Hegyi, J-Matthias Löhr, Juan E. Dominguez-Munoz, 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 Neoptolemos, Charles Wilcox, Vujasinovic Miroslav, Guru Trikudanathan, Zhuan Liao, Truls Hauge, Joachim Mössner, Chantal Hoge, Paul Fockens, Sven Mieog, Gabriele Capurso, Yunfeng Cui, Enrique de Madaria, Marius Distler, Ali Aghdassi, David C. Whitcomb, Kylie Russell, Georg Beyer, Lumír Kunovsky, Wilhelmus Kwanten, Andrea Kazemi Nava, Kevin Conlon, A.K. Siriwardena, Salvatore Paiella, Felipe Alconchel, Marco Vito Marino, Vincent E. de Meijer, Carlos Domingo, Jorg Kleeff, Aarti Lakshmanan, Michael Jen Lie Chu, Stefan Bouwense, Pueya Rashid Nashidengo, Perivoliotis Konstantinos, Edoardo Maria Muttillo, Garzali Ibrahim Umar, Maria Jesus Castro Santiago, Victor Lopez-Lopez, Francesco Torri, Moritz Schmelzle, Povilas Ignatavicius, Dennis Wicherts, Antonio Gomes, Nikolaos A. Machairas, Panagiotis I. Dorovinis, Alejandro Serrablo, Kjetil Soreide, Mohammad Rahbari, Michael Jen Jie Chu, Margarita Ptasnuka, Marius Petrulionis, Colin Byron Noel, Ernest 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, Asbjorn Mohr Drewes, Antonio Amodio, Temel Tirkes, Anshu Srivastava, Gregory J. Beilman, Zoltan Berger, Bjorn Lindkvist, Giulia Martina Cavestro, Cheryl Gariepy, Laszlo Czakó, Milena Di Leo, Vishal Sharma, Sundeep Lakhtakia, Surinder Singh Rana, Sinaed N. Duggan, Chang-Il Kwon, Anna Evans Phillips, Christopher E. Forsmark, Ferga C. Gleeson, Glen A. Lehman, William Greenhalf, Guido Costamagna, Christopher M. Halloran, Helmut Friess, Henrik Hojgaard Rasmussen, Tsukasa Ikeura, Ingfrid S. Haldorsen, Takao Itoi, Jacob R. Izbicki, John Windsor, Jakob Lykke Poulsen, Jens Brondum Frokjaer, Jose Larino-Noia, Dan Wang, Julio Iglesias Garcia, Evangelos Kalaitzakis, Kararzyna Wertheim-Tysarowska, Kensuke Kubota, Jessica Larusch, Markus M. Lerch, Liang-Hao Hu, Mert Erkan, Jorg D. Machicado, Marianna Arvanitakis, Markus W. Buchler, Marlon F. Levy, Melvin B. Heyman, Camilla Nojgaard, Mouen A. Khashab, Myriam Delhaye, Takeshi Ogura, Kazuichi Okazaki, Paula Ghaneh, Peter A. Banks, Pankaj Gupta, Georgios I. Papachristou, Patrick Michl, Philippe Levy, Aldis Pukitis, Raffaele Pezzilli, Ryan D. Baron, Stephen T. Amann, Sarah Jane Schwarzenberg, Shuiji Isaji, Soren Schou Olesen, Srdan Novovic, Steven J. Hughes, Steven L. Werlin, Tanja Gonska, Timothy B. Gardner, Mark D. Topazian, Frank Ulrich Weiss, Venakata S. Akshintala, Veronique D. Morinville, Vinciane Rebours, Aron Vincze, Vikesh K. Singh, Naiqiang Cui, Hong Zhang, Zhao-shen Li, Integrated Research on Energy, Environment & Socie, Molecular Active Systems, Gastroenterology and hepatology, Gastroenterology & Hepatology, Graduate School, Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and Gastroenterology and Hepatology
- Subjects
Pancreatic enzyme replacement therapy ,Hepatology ,Endocrinology, Diabetes and Metabolism ,Clinical Decision-Making ,Exocrine pancreatic insufficiency ,Gastroenterology ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,Steatorrhea ,SDG 3 - Good Health and Well-being ,Expert opinion ,Pancreatitis, Chronic ,Humans ,HaPanEU-guidelines ,Pancreas ,Chronic pancreatitis - Abstract
IntroductionDespite 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.MethodsAn 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.ResultsOverall, 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.ConclusionThis 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. 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.
- Published
- 2022