Published online Oct 25, 2018. doi: 10.4292/wjgpt.v9.i5.39
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: 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.