Staging chronic pancreatitis with exocrine function tests: Are we better?

Table 1 Advantages and pitfalls of function tests for pancreatic exocrine insufficiency

Test	Advantages	Pitfalls
Aspiration of pancreatic contents (during secretin-cholecystokinin/cerulein administration)	High sensitivity	Invasive; only available in specialized centers
CFA	Gold standard; useful in monitoring PERT	Need of a strict diet; unpleasant and long stool collection; no simultaneous PERT
FE-1	Easy test; widely available; no need to stop PERT	Low sensitivity in mild PEI; not clear cut-off
Acid steatocrit	Good correlation with CFA	Lack of standardization; Influenced by dietary fat intake
13C-mixed Triglyceride Breath Test	Good sensitivity in detecting mild to moderate PEI; useful in monitoring PERT	Only available in specialized center; false positive results in non pancreatic fat malabsorpion

CFA: Coefficient off at absorption; PERT: Pancreatic enzyme supplementation therapy; FE-1: Fecal elastase-1; PEI: Pancreatic exocrine insufficiency.