Diagnosis of Exocrine Pancreatic Insufficiency

被引:36
作者
Phil A. Hart
Darwin L. Conwell
机构
[1] The Ohio State University Wexner Medical Center,Section of Pancreatic Disorders, Division of Gastroenterology, Hepatology, & Nutrition
关键词
Exocrine insufficiency; Steatorrhea; Chronic pancreatitis; Pancreatic enzymes; Lipase;
D O I
10.1007/s11938-015-0057-8
中图分类号
学科分类号
摘要
The accurate diagnosis of exocrine pancreatic insufficiency (EPI) helps identify those in need of pancreatic enzyme replacement therapy. Conversely, ruling out EPI identifies those in which additional evaluation should be pursued to explain their symptoms. There are many available tests that can be used to diagnose EPI; however, the tests must be tailored to each clinical scenario. Tests that are convenient but less accurate (e.g., fecal elastase-1, qualitative fecal fat determination) are best suited for patients with a high pretest probability of EPI. In contrast, tests that are highly accurate but more cumbersome (e.g., endoscopic pancreatic function testing, 72-h fecal fat collection) are favored in patients suspected to have mild EPI or an early stage of chronic pancreatitis. Additional research is needed to identify a more convenient means of accurately diagnosing at all stages of EPI.
引用
收藏
页码:347 / 353
页数:6
相关论文
共 104 条
[1]  
Durno C(2002)Genotype and phenotype correlations in patients with cystic fibrosis and pancreatitis Gastroenterology 123 1857-64
[2]  
Corey M(1994)The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis Gastroenterology 107 1481-7
[3]  
Zielenski J(2010)High prevalence of low-trauma fracture in chronic pancreatitis Am J Gastroenterol 105 2680-6
[4]  
Layer P(2014)High prevalence of osteoporosis in patients with chronic pancreatitis: a systematic review and meta-analysis Clin Gastroenterol Hepatol 12 219-28
[5]  
Yamamoto H(2003)Quality of life assessment after pancreatic enzyme replacement therapy in chronic pancreatitis Can J Gastroenterol 17 597-603
[6]  
Kalthoff L(2012)Chronic pancreatitis: making the diagnosis Clin Gastroenterol Hepatol 10 1088-95
[7]  
Tignor AS(2011)Pancreatic exocrine insufficiency: diagnosis and treatment J Gastroenterol Hepatol 26 12-6
[8]  
Wu BU(2014)American pancreatic association practice guidelines in chronic pancreatitis: evidence-based report on diagnostic guidelines Pancreas 43 1143-62
[9]  
Whitlock TL(2002)Cholecystokinin-stimulated peak lipase concentration in duodenal drainage fluid: a new pancreatic function test Am J Gastroenterol 97 1392-7
[10]  
Duggan SN(2012)Endoscopic pancreatic function test using combined secretin and cholecystokinin stimulation for the evaluation of chronic pancreatitis Gastrointest Endosc 75 764-8