Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: Prevalence and diagnostic use

Lindkvist, Björn; Phillips, Mary; Domínguez‐Muñoz, J. Enrique

doi:10.1016/j.pan.2015.07.001

Cited by 111 publications

(94 citation statements)

References 93 publications

(144 reference statements)

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“…This creates a conundrum when patients are given pancreatic enzyme supplementation to combat PEI. Supplementation can improve steatorrhea as a symptom, but does not necessarily indicate the proper absorption of nutrients, or ultimately improve the nutritional status of patients [31,65]. …”

Section: Discussionmentioning

confidence: 99%

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

et al. 2017

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Pancreatic cancer is an aggressive malignancy with a poor prognosis. The disease and its treatment can cause significant nutritional impairments that often adversely impact patient quality of life (QOL). The pancreas has both exocrine and endocrine functions and, in the setting of cancer, both systems may be affected. Pancreatic exocrine insufficiency (PEI) manifests as weight loss and steatorrhea, while endocrine insufficiency may result in diabetes mellitus. Surgical resection, a central component of pancreatic cancer treatment, may induce or exacerbate these dysfunctions. Nutritional and metabolic dysfunctions in patients with pancreatic cancer lack characterization, and few guidelines exist for nutritional support in patients after surgical resection. We reviewed publications from the past two decades (1995–2016) addressing the nutritional and metabolic status of patients with pancreatic cancer, grouping them into status at the time of diagnosis, status at the time of resection, and status of nutritional support throughout the diagnosis and treatment of pancreatic cancer. Here, we summarize the results of these investigations and evaluate the effectiveness of various types of nutritional support in patients after pancreatectomy for pancreatic adenocarcinoma (PDAC). We outline the following conservative perioperative strategies to optimize patient outcomes and guide the care of these patients: (1) patients with albumin < 2.5 mg/dL or weight loss > 10% should postpone surgery and begin aggressive nutrition supplementation; (2) patients with albumin < 3 mg/dL or weight loss between 5% and 10% should have nutrition supplementation prior to surgery; (3) enteral nutrition (EN) should be preferred as a nutritional intervention over total parenteral nutrition (TPN) postoperatively; and, (4) a multidisciplinary approach should be used to allow for early detection of symptoms of endocrine and exocrine pancreatic insufficiency alongside implementation of appropriate treatment to improve the patient’s quality of life.

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Section: Discussionmentioning

confidence: 99%

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

et al. 2017

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“…Physicians should be aware that an exact cut-off of FE-1 levels for PEI in different clinical scenarios cannot be established, and that FE-1 levels should be considered together with an appropriate evaluation of symptoms, signs, and nutritional status [74]. For example, in patients with chronic diarrhea, low FE-1 results support the need to investigate whether this symptom is caused by pancreatic disease and PEI.…”

Section: Fe-1 Cut-off Limitsmentioning

confidence: 99%

Potential for Screening for Pancreatic Exocrine Insufficiency Using the Fecal Elastase-1 Test

et al. 2017

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The early diagnosis of pancreatic exocrine insufficiency (PEI) is hindered because many of the functional diagnostic techniques used are expensive and require specialized facilities, which prevent their widespread availability. We have reviewed current evidence in order to compare the utility of these functional diagnostic techniques with the fecal elastase-1 (FE-1) test in the following three scenarios: screening for PEI in patients presenting with symptoms suggestive of pancreatic disease, such as abdominal pain or diarrhea; determining the presence of PEI in patients with an established diagnosis of pancreatic disease, such as chronic pancreatitis or cystic fibrosis; determining exocrine status in disorders not commonly tested for PEI, but which have a known association with this disorder. Evidence suggests the FE-1 test is reliable for the evaluation of pancreatic function in many pancreatic and non-pancreatic disorders. It is non-invasive, is less time-consuming, and is unaffected by pancreatic enzyme replacement therapy. Although it cannot be considered the gold-standard method for the functional diagnosis of PEI, the advantages of the FE-1 test make it a very appropriate test for screening patients who may be at risk of this disorder.

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“…Up to 63% of patients with CP have fat-soluble vitamin deficiencies 35 36. Vitamin D deficiency exists in many patients with CP (and the general population) and although its presence is not diagnostic, deficiencies should be corrected 37. Several serum markers have been associated with the development of PEI including magnesium, haemoglobin, albumin, prealbumin and retinol binding protein 38.…”

Section: Diagnosis Of Cpmentioning

confidence: 99%

Practical guide to the management of chronic pancreatitis

Jalal

Campbell

Hopper

2018

Frontline Gastroenterol

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Chronic pancreatitis (CP) is an irreversible fibroinflammatory disorder of the pancreas. It presents with relapsing, remitting upper abdominal pain accompanied by features of malabsorption due to pancreatic exocrine insufficiency and endocrine deficiency with the development of diabetes mellitus. The associated increased hospitalisation and high economic burden are related to CP often presenting at advanced stage with irreversible consequences. Diagnosing CP at an early stage is still challenging and therefore CP is believed to be under-reported. Our understanding of this disease has evolved over the last few years with attempts to redesign the definition of CP. Better recognition of the risk factors and conditions associated with CP can lead to an earlier diagnosis and coupled with a multidisciplinary approach to treatment, ultimately reduce complications. This article reviews the epidemiology, risk factors, diagnosis and management of CP.

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Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: Prevalence and diagnostic use

Cited by 111 publications

References 93 publications

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

Potential for Screening for Pancreatic Exocrine Insufficiency Using the Fecal Elastase-1 Test

Practical guide to the management of chronic pancreatitis

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