ArticleUnited European gastroenterology journal2013
Synopsis of recent guidelines on pancreatic exocrine insufficiency.
Article in United European gastroenterology journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
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Who cites it
29 citing papers in PubMed, 3 syntheses or guidelines pooled it, 79 citations in OpenAlex.
- Factors That Affect Prevalence of Small Intestinal Bacterial Overgrowth in Chronic Pancreatitis: A Systematic Review, Meta-Analysis, and Meta-Regression.Clinical and translational gastroenterology · 2019Pooled it
- Contribution of pancreatic enzyme replacement therapy to survival and quality of life in patients with pancreatic exocrine insufficiency.World journal of gastroenterology · 2019Pooled it
- Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas.World journal of gastroenterology · 2013Guideline
- Utility of Fecal Elastase-1 in Estimating Exocrine Pancreatic Function in Cystic Fibrosis: A Scoping Review.Pediatric pulmonology · 2026Article
- Association of sarcopenia and pancreatic exocrine insufficiency in older adults type 2 diabetes mellitus patients.Aging clinical and experimental research · 2025Article
- In-Vitro Comparison of Physical Characteristics, Enzyme Content, and Release Kinetics of Pancreatic Enzyme Preparations Available in Europe and Canada.Drugs in R&D · 2025Article
- Modulating the Gut-Muscle Axis: Increasing SCFA-Producing Gut Microbiota Commensals and Decreasing Endotoxin Production to Mitigate Cancer Cachexia.Microorganisms · 2025Review
- Turkish Society of Gastroenterology: Pancreas Working Group, Acute Pancreatitis Committee Consensus Report.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2024Review
- Validity and Diagnostic Ability of Pancreatic Exocrine Insufficiency Questionnaire in Turkish Patients.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2024Article
- Impacts of pancreatic exocrine insufficiency on gut microbiota.Journal of Zhejiang University. Science. B · 2024Article
- Utilising Pancreatic Exocrine Insufficiency in the Detection of Resectable Pancreatic Ductal Adenocarcinoma.Cancers · 2023Article
- Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma.World journal of gastrointestinal surgery · 2021Review
- Russian Consensus on Exo- and Endocrine Pancreatic Insufficiency After Surgical Treatment.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2021Article
- In vitro Comparison of Pancreatic Enzyme Preparations Available in the Indian Market.Drug design, development and therapy · 2021Article
- Exocrine Pancreas Dysfunction in Type 1 Diabetes.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2020Review
- Review
- Pancreatic Exocrine Insufficiency as a Complication of Gastrointestinal Surgery and the Impact of Pancreatic Enzyme Replacement Therapy.Digestive diseases (Basel, Switzerland) · 2020Review
- Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines.Nature reviews. Gastroenterology & hepatology · 2019Review
- Practical guide to the management of chronic pancreatitis.Frontline gastroenterology · 2019Review
- Structure and function of the exocrine pancreas in patients with type 1 diabetes.Reviews in endocrine & metabolic disorders · 2019Review
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn recent years, three national gastroenterology societies established guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency (PEI). In addition, the Cochrane Collaboration issued a review.
objectiveThe purpose of this paper is to present an overview of the recommendations and concordance between the four recent published guidelines and stimulate further discussion.
methodsA review of the Australian, German and Italian guidelines and the Cochrane review was conducted, and a synthesis was made of common statements.
resultsThere is a high degree of agreement on almost all items within these guidelines, both in the diagnosis of PEI and in terms of therapy and approach to management of PEI. In addition, novel emerging developments are highlighted, such as the fecal elastase-1 test, which is widely used but is not suitable for measuring mild-to-moderate PEI despite its ability to positively establish the diagnosis of severe PEI. One of the few novel tests proving to be useful is the (13)C mixed-chain triglycerides (MCT) breath test. This test, albeit an excellent quantitative test, is not widely used and is rarely available. The use of this test is making it apparent that there is a difference between treating the symptoms of PEI and treating malnutrition, the broader underlying defect. This may have direct consequences for the dosing of pancreatic enzymes (pancreatin), in that the consensus starting dose of all guidelines may be too low for some patients. Although chronic pancreatitis in adults and cystic fibrosis in children account for the main evidence base used for PEI, other indications are also discussed.
conclusionsThere is good concordance between recommendations provided by international groups. More prospective studies are required in many areas, including the use of pancreatic enzymes in other gastrointestinal disorders, such as celiac disease and irritable bowel syndrome (IBS). We also need to assess the feasibility of the (13)C MCT breath test. At the same time, it needs to be confirmed that higher doses of pancreatic enzymes are really necessary to not only relieve the symptoms of PEI but also treat malnutrition appropriately.
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