Faecal elastase-1 is an independent predictor of survival in advanced pancreatic cancer

Pancreatic exocrine insufficiency in pancreatic cancer: A review of the literature

“…Also, Traverso et al reported no dyspepsia in 7 out of 8 patients following PPPD (1 duodenal cancer, 1 pancreatic cancer, 8 chronic pancreatitis) despite the presence of severe PEI based on a 72-h faecal fat assay (mean 44 g/24 h) [46]. Altogether, these results demonstrate a lack of correlation between dyspepsia and PEI both in non-surgical patients with pancreatic cancer and patients following pancreatic surgery [23,24,45,46].…”

“…Generally, a high prevalence of PEI in patients with unresectable pancreatic cancer was demonstrated in several studies. Perez et al detected PEI in 75% of cases utilizing a 72-h faecal fat test, and Partelli et al demonstrated extreme PEI (FE1 ≤20 g/g) in 25%, severe PEI (FE1 20-100 g/g) in 14%, and moderate PEI (FE1 100-200 g/g) in 11% [23,24]. Lower FE1 level was more frequently diagnosed in patients with pancreatic head cancer, jaundice, and clinical steatorrhea [23,24].…”

“…This is based on early studies of DiMagno et al demonstrating that mild PEI with subtle changes on pancreatic function tests resulted in no significant clinical symptoms, whereas severe PEI, with loss of 90% of pancreatic exocrine function in chronic pancreatitis, caused maldigestion of fat and protein leading to dyspepsia and steatorrhea [44]. However, more recent studies of unresectable pancreatic cancer, including two trials with 12 and 194 patients, respectively, found no statistically significant correlation between subjective steatorrhea and the presence of fat malabsorption verified by stool testing [23,24]. In fact, only 16.7% of patients with very severe PEI had clinically evident steatorrhea in one trial.…”

“…Perez et al detected PEI in 75% of cases utilizing a 72-h faecal fat test, and Partelli et al demonstrated extreme PEI (FE1 ≤20 g/g) in 25%, severe PEI (FE1 20-100 g/g) in 14%, and moderate PEI (FE1 100-200 g/g) in 11% [23,24]. Lower FE1 level was more frequently diagnosed in patients with pancreatic head cancer, jaundice, and clinical steatorrhea [23,24]. Acknowledging a high prevalence of PEI in this patient cohort, Sikkens et al prospectively assessed the incidence of PEI in 32 patients with unresectable cancer of the pancreatic head [25].…”

“…In fact, only 16.7% of patients with very severe PEI had clinically evident steatorrhea in one trial. Whereas 5.2% of patients had subjective steatorrhea without objective PEI [24].…”