Diagnosis and management of pancreatic exocrine insufficiency (PEI) in primary care: consensus guidance of a Canadian expert panel

References

• Dominguez-Munoz JE. Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency: when is it indicated, what is the goal and how to do it? Adv Med Sci 2011;56:1–5
   PubMed Web of Science ®Google Scholar
• Gaskin KJ, Durie PR, Lee L, Hill R, Forstner GG. Colipase and lipase secretion in childhood-onset pancreatic insufficiency. Delineation of patients with steatorrhea secondary to relative colipase deficiency. Gastroenterology 1984;86:1–7
   PubMed Web of Science ®Google Scholar
• Lankisch PG, Lembcke B, Wemken G, Creutzfeldt W. Functional reserve capacity of the exocrine pancreas. Digestion 1986;35:175–181
   PubMed Web of Science ®Google Scholar
• Muniraj T, Aslanian HR, Farrell J, Jamidar PA. Chronic pancreatitis, a comprehensive review and update. Part I: epidemiology, etiology, risk factors, genetics, pathophysiology, and clinical features. Dis Mon 2014;60:530–550
   PubMed Web of Science ®Google Scholar
• Toouli J, Biankin AV, Oliver MR, Pearce CB, Wilson JS, Wray NH. Management of pancreatic exocrine insufficiency: Australasian Pancreatic Club recommendations. Med J Aust 2010;193:461–467
   PubMed Web of Science ®Google Scholar
• Duggan S. A Practical Guide to the Nutritional Management of Chronic Pancreatitis. Pract Gastroenterol 2013;118:24–32
   Google Scholar
• Haaber AB, Rosenfalck AM, Hansen B, Hilsted J, Larsen S. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int J Pancreatol 2000;27:21–27
   PubMedGoogle Scholar
• Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut 2005;54Suppl 6:vi1–28
   PubMed Web of Science ®Google Scholar
• D'Haese JG, Ceyhan GO, Demir IE, Layer P, Uhl W, Lohr M, et al. Pancreatic enzyme replacement therapy in patients with exocrine pancreatic insufficiency due to chronic pancreatitis: a 1-year disease management study on symptom control and quality of life. Pancreas 2014;43:834–841
   PubMed Web of Science ®Google Scholar
• Trang T, Chan J, Graham DY. Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency in the 21(st) century. World J Gastroenterol 2014;20:11467-11485.
   PubMed Web of Science ®Google Scholar
• Sugumar A, Pearson, R.K. Pancreatic Exocrine Insufficiency: The Primary Care Perspective. http://www.medscape.org/viewarticle/724507. Accessed May 2017. Medscape; 2010.
   Google Scholar
• Pongprasobchai S. Maldigestion from pancreatic exocrine insufficiency. Journal of gastroenterology and hepatology 2013;28Suppl4:99–102
   Web of Science ®Google Scholar
• DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 1973;288:813–815
   PubMed Web of Science ®Google Scholar
• Andersen DK. Mechanisms and emerging treatments of the metabolic complications of chronic pancreatitis. Pancreas 2007;35:1–15
   PubMed Web of Science ®Google Scholar
• Haas S, Krins S, Knauerhase A, Lohr M. Altered bone metabolism and bone density in patients with chronic pancreatitis and pancreatic exocrine insufficiency. JOP 2015;16:58–62
   PubMed Web of Science ®Google Scholar
• Ammann RW, Raimondi S, Maisonneuve P, Mullhaupt B. Is obesity an additional risk factor for alcoholic chronic pancreatitis? Pancreatology 2010;10:47–53
   PubMed Web of Science ®Google Scholar
• Lowenfels AB, Maisonneuve P, Sullivan T. The changing character of acute pancreatitis: epidemiology, etiology, and prognosis. Curr Gastroenterol Rep 2009;11:97–103
   PubMedGoogle Scholar
• Teichmann J, Riemann JF, Lange U. Prevalence of exocrine pancreatic insufficiency in women with obesity syndrome: assessment by pancreatic fecal elastase 1. ISRN Gastroenterol 2011; 2011:951686.
   PubMedGoogle Scholar
• Whitcomb DC. Genetic risk factors for pancreatic disorders. Gastroenterology 2013;144:1292–1302
   PubMed Web of Science ®Google Scholar
• Zator Z, Whitcomb DC. Insights into the genetic risk factors for the development of pancreatic disease. Therap Adv Gastroenterol 2017;10:323–336
   PubMed Web of Science ®Google Scholar
• Tolstrup JS, Kristiansen L, Becker U, Gronbaek M. Smoking and risk of acute and chronic pancreatitis among women and men: a population-based cohort study. Arch Intern Med 2009;169:603–609
   PubMedGoogle Scholar
• Yadav D, Hawes RH, Brand RE, Anderson MA, Money ME, Banks PA, et al. Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis. Arch Intern Med 2009;169:1035–1045
   PubMedGoogle Scholar
• Yadav D, Whitcomb DC. The role of alcohol and smoking in pancreatitis. Nat Rev Gastroenterol Hepatol 2010;7:131–145
   PubMed Web of Science ®Google Scholar
• Law R, Parsi M, Lopez R, Zuccaro G, Stevens T. Cigarette smoking is independently associated with chronic pancreatitis. Pancreatology 2010;10:54–59
   PubMed Web of Science ®Google Scholar
• Maisonneuve P, Frulloni L, Mullhaupt B, Faitini K, Cavallini G, Lowenfels AB, et al. Impact of smoking on patients with idiopathic chronic pancreatitis. Pancreas 2006;33:163–168
   PubMed Web of Science ®Google Scholar
• Talamini G, Bassi C, Falconi M, Sartori N, Vaona B, Bovo P, et al. Smoking cessation at the clinical onset of chronic pancreatitis and risk of pancreatic calcifications. Pancreas 2007;35:320–326
   PubMed Web of Science ®Google Scholar
• Rebours V, Vullierme MP, Hentic O, Maire F, Hammel P, Ruszniewski P, et al. Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship. Pancreas 2012;41:1219–1224
   PubMed Web of Science ®Google Scholar
• Lindkvist B, Appelros S, Manjer J, Berglund G, Borgstrom A. A prospective cohort study of smoking in acute pancreatitis. Pancreatology 2008;8:63–70
   PubMed Web of Science ®Google Scholar
• Lindkvist B, Dominguez-Munoz JE, Luaces-Regueira M, Castineiras-Alvarino M, Nieto-Garcia L, Iglesias-Garcia J. Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreatology 2012;12:305–310
   PubMed Web of Science ®Google Scholar
• Ramsey ML, Conwell DL, Hart PA. Complications of Chronic Pancreatitis. Dig Dis Sci. 2017;62:1745-1750. doi: 10.1007/s10620-017-4518-x. Epub 2017 Mar 9
   PubMed Web of Science ®Google Scholar
• Beharry S, Ellis L, Corey M, Marcon M, Durie P. How useful is fecal pancreatic elastase 1 as a marker of exocrine pancreatic disease? J Pediatr 2002;141:84–90
   PubMed Web of Science ®Google Scholar
• Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol 2013;19:7258–7266
   PubMed Web of Science ®Google Scholar
• Pezzilli R, Morselli-Labate AM, Palladoro F, Campana D, Piscitelli L, Tomassetti P, et al. The ELISA fecal elastase-1 polyclonal assay reacts with different antigens than those of the monoclonal assay. Pancreas 2005;31:200–201
   PubMed Web of Science ®Google Scholar
• Schneider A, Funk B, Caspary W, Stein J. Monoclonal versus polyclonal ELISA for assessment of fecal elastase concentration: pitfalls of a new assay. Clin Chem 2005;51:1052–1054
   PubMed Web of Science ®Google Scholar
• Schibli S, Corey M, Gaskin KJ, Ellis L, Durie PR. Towards the ideal quantitative pancreatic function test: analysis of test variables that influence validity. Clin Gastroenterol Hepatol 2006;4:90–97
   PubMed Web of Science ®Google Scholar
• Seiler CM, Izbicki J, Varga-Szabo L, Czako L, Fiok J, Sperti C, et al. Randomised clinical trial: a 1-week, double-blind, placebo-controlled study of pancreatin 25 000 Ph. Eur. minimicrospheres (Creon 25000 MMS) for pancreatic exocrine insufficiency after pancreatic surgery, with a 1-year open-label extension. Aliment Pharmacol Ther 2013;37:691–702
   PubMed Web of Science ®Google Scholar
• Viokace Product Monograph. Aptalis Pharma Canada Inc, Mont-Saint-Hilaire, QC. Date of revision: June 22, 2015.
   Google Scholar
• Yaghoobi M, McNabb-Baltar J, Bijarchi R, Cotton PB. Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials. Canadian journal of gastroenterology & hepatology 2016; 2016:8541839.
   PubMed Web of Science ®Google Scholar
• Muniraj T, Aslanian HR, Farrell J, Jamidar PA. Chronic pancreatitis, a comprehensive review and update. Part II: Diagnosis, complications, and management. Dis Mon 2015;61:5–37
   PubMed Web of Science ®Google Scholar
• Borowitz DS, Grand RJ, Durie PR. Use of pancreatic enzyme supplements for patients with cystic fibrosis in the context of fibrosing colonopathy. Consensus Committee. J Pediatr 1995;127:681–684
   Google Scholar
• Cotazym Product Monograph. Merck Canada Inc, Kirkland, QC. Date of revision: February 13, 2015.
   Google Scholar
• Creon Product Monograph. BGP Pharma ULC, St-Laurent, QC. Date of revision: October 15, 2015.
   Google Scholar
• Pancrease Product Monograph. Janssen Inc, Toronto, ON. Date of revision: January 31, 2014.
   Google Scholar
• FitzSimmons SC, Burkhart GA, Borowitz D, Grand RJ, Hammerstrom T, Durie PR, et al. High-dose pancreatic-enzyme supplements and fibrosing colonopathy in children with cystic fibrosis. N Engl J Med 1997;336:1283–1289
   PubMed Web of Science ®Google Scholar
• de la Iglesia-Garcia D, Huang W, Szatmary P, Baston-Rey I, Gonzalez-Lopez J, Prada-Ramallal G, et al. Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis. Gut. 2017;66:1354-1355. doi: 10.1136/gutjnl-2016-312529. Epub 2016 Dec 9
   PubMed Web of Science ®Google Scholar
• Trapnell BC, Strausbaugh SD, Woo MS, Tong SY, Silber SA, Mulberg AE, et al. Efficacy and safety of PANCREAZE(R) for treatment of exocrine pancreatic insufficiency due to cystic fibrosis. J Cyst Fibros 2011;10:350–356
   PubMed Web of Science ®Google Scholar
• Goldberg DM. Proteases in the evaluation of pancreatic function and pancreatic disease. Clinica chimica acta; international journal of clinical chemistry 2000;291:201–221
   PubMed Web of Science ®Google Scholar
• Dominguez-Munoz JE, Iglesias-Garcia J, Iglesias-Rey M, Vilarino-Insua M. Optimising the therapy of exocrine pancreatic insufficiency by the association of a proton pump inhibitor to enteric coated pancreatic extracts. Gut 2006;55:1056–1057
   PubMed Web of Science ®Google Scholar
• Pezzilli R, Andriulli A, Bassi C, Balzano G, Cantore M, Delle Fave G, et al. Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas. World J Gastroenterol 2013;19:7930–7946
   PubMed Web of Science ®Google Scholar
• Nordback I, Pelli H, Lappalainen-Lehto R, Jarvinen S, Raty S, Sand J. The recurrence of acute alcohol-associated pancreatitis can be reduced: a randomized controlled trial. Gastroenterology 2009;136:848–855
   PubMed Web of Science ®Google Scholar
• Teshima CW, Bridges RJ, Fedorak RN. Canadian Digestive Health Foundation Public Impact Series 5: Pancreatitis in Canada. Incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol 2012;26:544–545
   PubMed Web of Science ®Google Scholar
• Ahmed Ali U, Issa Y, Hagenaars JC, Bakker OJ, van Goor H, Nieuwenhuijs VB, et al. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis. Clin Gastroenterol Hepatol 2016;14:738–746
   PubMed Web of Science ®Google Scholar
• Cavestro GM, Leandro G, Di Leo M, Zuppardo RA, Morrow OB, Notaristefano C, et al. A single-centre prospective, cohort study of the natural history of acute pancreatitis. Dig Liver Dis 2015;47:205–210
   PubMedGoogle Scholar
• Cystic Fibrosis Canada. The Canadian Cystic Fibrosis Registry: 2014 Annual Report. https://cysticfibrosis.uberflip.com/i/705240-cystic-fibrosis-canada-registry/0. Accessed May 2017.; 2016.
   Google Scholar
• Ahmed N, Corey M, Forstner G, Zielenski J, Tsui LC, Ellis L, et al. Molecular consequences of cystic fibrosis transmembrane regulator (CFTR) gene mutations in the exocrine pancreas. Gut 2003;52:1159–1164
   PubMed Web of Science ®Google Scholar
• Canadian Diabetes Association. An Economic Tsunami: The Cost of Diabetes in Canada. https://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/economic-tsunami-cost-of-diabetes-in-canada-english.pdf. Accessed May 2017.; 2009.
   Google Scholar
• Hardt PD, Ewald N. Exocrine pancreatic insufficiency in diabetes mellitus: a complication of diabetic neuropathy or a different type of diabetes? Exp Diabetes Res 2011;2011:761950.
   PubMedGoogle Scholar
• Cui Y, Andersen DK. Pancreatogenic diabetes: special considerations for management. Pancreatology 2011;11:279–294
   PubMed Web of Science ®Google Scholar
• Makuc J. Management of pancreatogenic diabetes: challenges and solutions. Diabetes Metab Syndr Obes 2016;9:311–315
   PubMed Web of Science ®Google Scholar
• Malka D, Hammel P, Sauvanet A, Rufat P, O'Toole D, Bardet P, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology 2000;119:1324–1332
   PubMed Web of Science ®Google Scholar
• Pan J, Xin L, Wang D, Liao Z, Lin JH, Li BR, et al. Risk Factors for Diabetes Mellitus in Chronic Pancreatitis: A Cohort of 2011 Patients. Medicine (Baltimore) 2016;95:e3251
   PubMed Web of Science ®Google Scholar
• Wang W, Guo Y, Liao Z, Zou DW, Jin ZD, Zou DJ, et al. Occurrence of and risk factors for diabetes mellitus in Chinese patients with chronic pancreatitis. Pancreas 2011;40:206–212
   PubMed Web of Science ®Google Scholar
• Lanng S, Hansen A, Thorsteinsson B, Nerup J, Koch C. Glucose tolerance in patients with cystic fibrosis: five year prospective study. Bmj 1995;311:655–659
   PubMed Web of Science ®Google Scholar
• Canadian Cancer Society. Canadian Cancer Statistics. Special Topic: Predictions of the Future Burden of Cancer in Canada. http://www.cancer.ca/∼/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2015-EN.pdf. Accessed May 2017. 2015.
   Google Scholar
• Bartel MJ, Asbun H, Stauffer J, Raimondo M. Pancreatic exocrine insufficiency in pancreatic cancer: A review of the literature. Dig Liver Dis 2015;47:1013–1020
   PubMedGoogle Scholar
• Freelove R, Walling AD. Pancreatic cancer: diagnosis and management. Am Fam Physician 2006;73:485–492
   PubMed Web of Science ®Google Scholar
• Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance Report to December 31, 2013. http://www.phac-aspc.gc.ca/aids-sida/publication/survreport/2013/dec/assets/pdf/hiv-aids-surveillence-eng.pdf. Accessed May 2017.; 2014.
   Google Scholar
• Martin TC, Scourfield A, Rockwood N, Martin NK, Patel N, Nelson M, et al. Pancreatic insufficiency in patients with HIV infection: role of didanosine questioned. HIV Med 2013;14:161–166
   PubMed Web of Science ®Google Scholar
• Tamburrino D, Partelli S, Crippa S, Manzoni A, Maurizi A, Falconi M. Selection criteria in resectable pancreatic cancer: a biological and morphological approach. World J Gastroenterol 2014;20:11210–11215
   PubMed Web of Science ®Google Scholar
• Azhari H, Rahhal R, Uc A. Is Total Pancreatectomy with Islet Autotransplantation A Reasonable Choice for Pediatric Pancreatitis? JOP 2015;16:335–341
   PubMed Web of Science ®Google Scholar
• Kesseli SJ, Smith KA, Gardner TB. Total pancreatectomy with islet autologous transplantation: the cure for chronic pancreatitis? Clinical and translational gastroenterology 2015;6:e73.
   PubMed Web of Science ®Google Scholar
• Leffler DA, Dennis M, Hyett B, Kelly E, Schuppan D, Kelly CP. Etiologies and predictors of diagnosis in nonresponsive celiac disease. Clin Gastroenterol Hepatol 2007;5:445–450
   PubMed Web of Science ®Google Scholar
• O'Mahony S, Howdle PD, Losowsky MS. Review article: management of patients with non-responsive coeliac disease. Aliment Pharmacol Ther 1996;10:671–680
   PubMed Web of Science ®Google Scholar
• Pulido O, Zarkadas M, Dubois S, Macisaac K, Cantin I, La Vieille S, et al. Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease. Can J Gastroenterol 2013;27:449–453
   PubMed Web of Science ®Google Scholar
• Vujasinovic M, Tepes B, Volfand J, Rudolf S. Exocrine pancreatic insufficiency, MRI of the pancreas and serum nutritional markers in patients with coeliac disease. Postgraduate medical journal 2015;91:497–500
   PubMed Web of Science ®Google Scholar
• Leeds JS, Hopper AD, Hurlstone DP, Edwards SJ, McAlindon ME, Lobo AJ, et al. Is exocrine pancreatic insufficiency in adult coeliac disease a cause of persisting symptoms? Aliment Pharmacol Ther 2007;25:265–271
   PubMed Web of Science ®Google Scholar
• ARUP Laboratories. Vitamin A (Retinol), Serum or Plasma. http://ltd.aruplab.com/Tests/Pub/0080525. Accessed May 2017.
   Google Scholar
• Ansstas G, N. Gopalswamy, et al. Vitamin A Deficiency. http://emedicine.medscape.com/article/126004-overview. Accessed May 2017. Medscape; 2016.
   Google Scholar
• Janz T, Pearson C. Health at a Glance: Vitamin D blood levels of Canadians. http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11727-eng.htm. Accessed May 2017. Statistics Canada; 2015.
   Google Scholar
• Tangpricha V, Khazai NB. Vitamin D Deficiency and Related Disorders Workup. http://emedicine.medscape.com/article/128762-workup. Accessed May 2017. Medscape; 2016.
   Google Scholar
• Charbek E. Vitamin E: Reference Range. http://emedicine.medscape.com/article/2088716-overview. Accessed May 2017. Medscape; 2014.
   Google Scholar
• Statistics Canada. Vitamin B12 status of Canadians, 2009 to 2011. http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11731-eng.htm#n1, accessed May 2017.
   Google Scholar
• Chawla J. Nutritional Neuropathy Clinical Presentation. http://emedicine.medscape.com/article/1171558-clinical, accessed May 2017. 2015.
   Google Scholar
• Glasbrenner B, Malfertheiner P, Buchler M, Kuhn K, Ditschuneit H. Vitamin B12 and folic acid deficiency in chronic pancreatitis: a relevant disorder? Klinische Wochenschrift 1991;69:168–172
   PubMedGoogle Scholar
• Kraemer CM. Vitamin K: Reference Range. http://emedicine.medscape.com/article/2088738-overview#a1. Accessed May 2017. Medscape; 2015.
   Google Scholar