ESPGHAN and NASPGHAN Report on the Assessment of Exocrine Pancreatic Function and Pancreatitis in Children

Taylor, Christopher J.; Chen, Kathy; Horvath, Karoly; Hughes, David; Lowe, Mark E.; Mehta, Devendra; Orabi, Abrahim I.; Screws, Jeremy; Thomson, Mike; Van Biervliet, Stephanie; Verkade, Henkjan J.; Husain, Sohail Z.; Wilschanski, Michael

doi:10.1097/mpg.0000000000000830

Cited by 59 publications

(96 citation statements)

References 105 publications

(119 reference statements)

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“…Lipase and amylase are secreted in active form, and proteases are secreted as pro‐enzymes that are converted to active forms in the proximal small bowel . Even though pancreatic enzymes are involved in the digestion of all forms of macronutrients, the major impact of EPI is on fat digestion . Azotorrhoea, excess fecal excretion of nitrogenous substances, can also occur if trypsin secretion falls below 5%–10% of normal .…”

Section: Basic Physiology Of Pancreatic Secretionmentioning

confidence: 99%

“…In infants, a delay in maturation of amylase and lipase has been noted, but this delay rarely causes symptoms . It is also noteworthy that in breast milk–fed infants, bile salt–stimulated lipase within breast milk also participates in fat digestion …”

Section: Basic Physiology Of Pancreatic Secretionmentioning

confidence: 99%

“…Diagnosing EPI in early stages is challenging, as symptoms are minimal and nonspecific. Testing includes indirect tests that estimate the consequences of EPI and direct tests that estimate pancreatic function directly . Direct tests are the gold standard but are invasive and not widely available .…”

Section: Clinical Presentation and Laboratory Investigationsmentioning

confidence: 99%

“…Also, a solid or semisolid stool is recommended for testing FE‐1. If the stool is loose, it should not be used, as the result may falsely indicate EPI because of a dilution of the enzyme concentration . A high normal value probably indicates no significant EPI, and follow‐up testing is recommended (repeat FE‐1 every year or when needed) .…”

Section: Clinical Presentation and Laboratory Investigationsmentioning

confidence: 99%

“…Exocrine pancreatic insufficiency (EPI) is defined as a decrease in the secretion of pancreatic enzymes, bicarbonate, or both, resulting in the malabsorption of nutrients . The pancreas has a large physiological reserve, and a reduction of secretion < 10% of the normal output results in the characteristic symptoms of chronic diarrhea, steatorrhea, and poor weight gain .…”

Section: Introductionmentioning

confidence: 99%

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Management of Exocrine Pancreatic Insufficiency in Children

2019

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The diagnosis of exocrine pancreatic insufficiency (EPI) can be difficult, as symptoms may be nonspecific. A delayed diagnosis of EPI can negatively impact health through poor weight gain, impaired growth, and malabsorption of nutrients. Because of active growth and development, children are more vulnerable to the consequences of untreated EPI. Pancreatic enzyme replacement therapy is the cornerstone of management and offers both symptomatic relief and improvement in clinical outcomes. Additionally, a high-energy diet with unrestricted fat and supplementation with fat-soluble vitamins is often required to optimize growth and prevent nutrition deficiencies. Cystic fibrosis (CF) is the most common condition in children that causes EPI, and improvement in nutrition management is associated with improved pulmonary function and increased survival. Currently, the management of other conditions leading to EPI in children is not well studied, and inferences from the CF literature are often necessary in caring for these patients. (Nutr Clin Pract. 2019;34(suppl 1):S27-S42)

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Section: Basic Physiology Of Pancreatic Secretionmentioning

confidence: 99%

Section: Basic Physiology Of Pancreatic Secretionmentioning

confidence: 99%

Section: Clinical Presentation and Laboratory Investigationsmentioning

confidence: 99%

Section: Clinical Presentation and Laboratory Investigationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Management of Exocrine Pancreatic Insufficiency in Children

2019

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Medical Treatment of Chronic Pancreatitis

Lowe

2018

The Pancreas

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Fat malabsorption in short bowel syndrome: A review of pathophysiology and management

Hirsch,

Wang,

Fligor

et al. 2024

Nut in Clin Prac

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Fat malabsorption is central to the pathophysiology of short bowel syndrome (SBS). It occurs in patients with insufficient intestinal surface area and/or function to maintain metabolic and growth demands. Rapid intestinal transit and impaired bile acid recycling further contribute to fat malabsorption. A significant portion of patients require parenteral nutrition (PN) for their survival but may develop sepsis and liver dysfunction as a result. Despite advancements in the treatment of SBS, fat malabsorption remains a chronic issue for this vulnerable patient population. Peer‐reviewed literature was assessed on the topic of fat malabsorption in SBS. Current management of patients with SBS involves dietary considerations, PN management, antidiarrheals, glucagon‐like peptide 2 agonists, and multidisciplinary teams. Clinical trials have focused on improving intestinal fat absorption by facilitating fat digestion with pancreatic enzymes. Targeting fat malabsorption in SBS is a potential pathway to improving lifestyle and reducing morbidity and mortality in this rare disease.

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ESPGHAN and NASPGHAN Report on the Assessment of Exocrine Pancreatic Function and Pancreatitis in Children

Cited by 59 publications

References 105 publications

Management of Exocrine Pancreatic Insufficiency in Children

Management of Exocrine Pancreatic Insufficiency in Children

Medical Treatment of Chronic Pancreatitis

Fat malabsorption in short bowel syndrome: A review of pathophysiology and management

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