Adherence to European Guidelines for Treatment and Management of Pancreatic Exocrine Insufficiency in Chronic Pancreatitis Patients

Khan, Mohsin Saeed; Rutkowski, Wiktor; Vujasinović, Miroslav; Löhr, Matthias

doi:10.3390/jcm10122737

Cited by 12 publications

(11 citation statements)

References 21 publications

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“…Another study from the US with a large cohort of CP patients and patients with pancreatic cancer emphasizes underdiagnosing PEI and undertreatment 27 . A Swedish single center study about adherence to European Guidelines for treatment and management of PEI in CP patients concludes with “there is room for further improvement” 16 . To our knowledge, this is the first multicenter study analyzing the quality of PERT in a large cohort of CP patients and exploring risk factors influencing compliance, and consequences of non‐adherence to treatment guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…24 We defined current smoking, current heavy drinking and the presence of pain as possible factors influencing PERT treatment. 16…”

Section: Definitionsmentioning

confidence: 99%

“…[12][13][14] Two studies showed moderate to low adherence to the UEG guidelines in general. 15,16 However, little is known about compliance to these guidelines concerning PERT specifically. In this study we aimed to evaluate PERT treatment in a large, Northern-European CP cohort to (1) assess the quality of adherence to treatment guidelines (2) evaluate risk-factors associated to non-adherence to treatment guidelines and (3) evaluate consequences of non-adherence to the guidelines.…”

Section: Introductionmentioning

confidence: 99%

“…This advice is based on studies measuring coefficient of fat absorption or coefficient of nitrogen absorption 12–14 . Two studies showed moderate to low adherence to the UEG guidelines in general 15,16 . However, little is known about compliance to these guidelines concerning PERT specifically.…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic enzyme treatment in chronic pancreatitis: Quality of management and adherence to guidelines–A cross‐sectional observational study

et al. 2022

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Objectives Pancreatic exocrine insufficiency (PEI) is a common complication in patients with chronic pancreatitis (CP), leading to increased morbidity and mortality if not treated adequately. Pancreatic enzyme replacement therapy|pancreas enzyme replacement therapy (PERT) is the cornerstone in treatment of patients with PEI. In the present study, we use data from the Scandinavian Baltic Pancreatic Club database to examine adherence of PERT according to United European Gastroenterology evidence‐based guidelines treatment of CP. Patients and methods Patients with definitive or probable CP according to M‐ANNHEIM diagnostic criteria were included. We collected information on exposures, exocrine function, intake of pancreatic enzymes, and markers of nutrition. Fecal elastase <200 μg/g was defined as a marker for PEI. Enzyme replacement therapy of 100,000 lipase units or more was defined as adequate treatment. Results We included 1006 patients from 8 centers in five countries. Sixty‐four percent of the patients were correctly treated. Twenty‐five per cent of PEI patients were not taking enzymes at all, and 20% of PEI patients were undertreated with insufficient PERT doses according to the guidelines. Fourteen percent of patients with sufficient pancreatic function were receiving enzymes despite normal exocrine pancreatic function. There were center differences. Current smoking was associated with lack of treatment and alcohol abuse was associated with under‐treatment. There were no associations between “no treatment” or “under‐treatment” for underweight or vitamin D deficiency. Conclusion In our CP expert centers, the adherence to guidelines for enzyme treatment is insufficient. Both patient factors and center differences have influence on treatment adherence.

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Section: Discussionmentioning

confidence: 99%

“…24 We defined current smoking, current heavy drinking and the presence of pain as possible factors influencing PERT treatment. 16…”

Section: Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pancreatic enzyme treatment in chronic pancreatitis: Quality of management and adherence to guidelines–A cross‐sectional observational study

et al. 2022

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“…( 14) A similar study was recently performed at the Karolinska University Hospital in Stockholm. (15) Both studies showed there is suboptimal compliance with these guidelines, especially for the management of EPI. These findings highlight the need for a more optimal implementation in clinical practice of the recommended standardized work-up and treatment strategy of EPI in patients with CP.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Exocrine Pancreatic Insufficiency in Chronic Pancreatitis: An International Expert Survey and Case Vignette Study

Rijk

Veldhuisen

Besselink

et al. 2022

HPB

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European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence‐based recommendations

Dominguez‐Muñoz,

Vujasinovic,

de la Iglesia

et al. 2024

UEG Journal

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Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion of nutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption and deficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high‐quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence‐Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence‐based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

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Adherence to European Guidelines for Treatment and Management of Pancreatic Exocrine Insufficiency in Chronic Pancreatitis Patients

Cited by 12 publications

References 21 publications

Pancreatic enzyme treatment in chronic pancreatitis: Quality of management and adherence to guidelines–A cross‐sectional observational study

Pancreatic enzyme treatment in chronic pancreatitis: Quality of management and adherence to guidelines–A cross‐sectional observational study

Diagnosis and Treatment of Exocrine Pancreatic Insufficiency in Chronic Pancreatitis: An International Expert Survey and Case Vignette Study

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence‐based recommendations

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