Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Oct 25, 2018; 9(5): 39-46
Published online Oct 25, 2018. doi: 10.4292/wjgpt.v9.i5.39
Challenges in the management of pancreatic exocrine insufficiency
Benjamin Myles Shandro, Rani Nagarajah, Andrew Poullis
Benjamin Myles Shandro, Rani Nagarajah, Andrew Poullis, Department of Gastroenterology, St George’s University Hospitals NHS Foundation Trust, Tooting, London SW17 0QT, United Kingdom
Author contributions: Shandro BM, Nagarajah R and Poullis A conceived the editorial; Shandro BM and Nagarajah R drafted the manuscript; Shandro BM and Poullis A revised the manuscript; and all authors approved the final version of the article.
Conflict-of-interest statement: The author declares no conflicts of interest regarding this paper.
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: Benjamin Myles Shandro, MBBS, MRCP, Doctor, Specialist registrar, Department of gastroenterology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London SW17 0QT, United Kingdom. bshandro@nhs.net
Telephone: +07-88-1368767
Received: July 10, 2018
Peer-review started: July 10, 2018
First decision: August 2, 2018
Revised: August 6, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: October 25, 2018
Core Tip

Core tip: Pancreatic exocrine insufficiency (PEI) is common, and the prevalence is likely to increase in line with global trends in associated conditions (notably increasing age and diabetes mellitus). The classical symptom of steatorrhoea is a late presentation of PEI. The diagnosis should be considered far earlier, based on risk factors and clinical history. A current, pragmatic approach to diagnosis combines clinical history, assessment of nutritional status and measurement of faecal elastase-1. Treatment with pancreatic enzyme replacement therapy (PERT) is safe and effective. PERT must be adequately dosed, monitored, and optimized to ensure its benefits are realized.