Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2017; 23(38): 6927-6930
Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.6927
Staging chronic pancreatitis with exocrine function tests: Are we better?
Cosimo Sperti, Lucia Moletta
Cosimo Sperti, Lucia Moletta, Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, 35128 Padua, Italy
Author contributions: Sperti C and Moletta L conceived the study and drafted the manuscript; both authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cosimo Sperti, Professor, Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, via giustiniani 2, 35128 Padua, Italy. csperti@libero.it
Telephone: +39-49-8218845 Fax: +39-49-8218821
Received: July 26, 2017
Peer-review started: July 27, 2017
First decision: August 30, 2017
Revised: September 7, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: October 14, 2017
Abstract

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas evolving in progressive fibrotic disruption of the gland with exocrine and endocrine pancreatic insufficiency. Although imaging features of CP are well known, their correlation with exocrine pancreatic function tests are not obvious, particularly in the early stage of the disease. There are many clinical classification of CP, all suggested for better distinguish and manage different forms based on etiological and clinical factors, and severity of the disease. Recently, a new classification of CP has been suggested: the M-ANNHEIM multiple risk factor classification that includes etiology, stage classification and degree of clinical severity. However, more accurate determination of clinical severity of CP requires a correct determination of exocrine function of the pancreas and fecal fat excretion. Recently, Kamath et al demonstrated that the evaluation of exocrine pancreatic function by acid steatocrit and fecal elastase-1 (EF-1) was helpful, but EF-1 was able to detect exocrine pancreatic insufficiency in more patients, upgrading some patients in higher stage of disease according to M-ANNHEIM classification. So, EF-1 is a more accurate test to determine exocrine pancreatic insufficiency and to stage chronic pancreatitis in the M-ANNHEIM classification. On the contrary, EF-1 determination shows low sensitivity in detecting exocrine pancreatic insufficiency in early stage of the disease.

Keywords: Chronic pancreatitis, Exocrine pancreatic insufficiency, Fecal elastase-1, Pancreatic function tests, Steathorrea

Core tip: Classification of chronic pancreatitis is useful for planning adequate diagnosis and management of the disease, particularly in the early detection and prevention of related-complications. Recognition of pancreatic exocrine insufficiency is useful for graduating severity of chronic pancreatitis in modern classification systems, and fecal elastase determination appears the better method in term of simplicity and sensitivity to stage exocrine function of the pancreas. However, sensitivity of elastase-1 is low in early stage of chronic pancreatitis, and new diagnostic tools or combination of different procedures are needed to better stage pancreatic function.