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Review
. 2013 Nov 28;19(44):7930-46.
doi: 10.3748/wjg.v19.i44.7930.

Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas

Raffaele Pezzilli  1 , Angelo Andriulli, Claudio Bassi, Gianpaolo Balzano, Maurizio Cantore, Gianfranco Delle Fave, Massimo Falconi; Exocrine Pancreatic Insufficiency collaborative (EPIc) Group
Affiliations
Review

Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas

Raffaele Pezzilli et al. World J Gastroenterol. .

Abstract

This is a medical position statement developed by the Exocrine Pancreatic Insufficiency collaborative group which is a part of the Italian Association for the Study of the Pancreas (AISP). We covered the main diseases associated with exocrine pancreatic insufficiency (EPI) which are of common interest to internists/gastroenterologists, oncologists and surgeons, fully aware that EPI may also occur together with many other diseases, but less frequently. A preliminary manuscript based on an extended literature search (Medline/PubMed, Cochrane Library and Google Scholar) of published reports was prepared, and key recommendations were proposed. The evidence was discussed at a dedicated meeting in Bologna during the National Meeting of the Association in October 2012. Each of the proposed recommendations and algorithms was discussed and an initial consensus was reached. The final draft of the manuscript was then sent to the AISP Council for approval and/or modification. All concerned parties approved the final version of the manuscript in June 2013.

Keywords: Chronic pancreatitis; Clinical studies; Exocrine pancreatic insufficiency; Gastric surgery; Pancreatic neoplasms; Pancreatic surgery; Risk factors.

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Figures

Figure 1
Figure 1
Algorithm for monitoring and treating exocrine pancreatic insufficiency in patients hospitalized for acute pancreatitis. PERT: Pancreatic enzyme replacement therapy.
Figure 2
Figure 2
Algorithm for monitoring and treating exocrine pancreatic insufficiency. Algorithm for monitoring and treating exocrine pancreatic insufficiency summarized from Italian[9], German[47] and Spanish[31] guidelines, and a synopsis of the guidelines[51]. CFA: Coefficient of fat absorption; FE1: Fecal elastase-1; PERT: Pancreatic enzymes replacement therapy; PPI: Proton pump inhibitor.
Figure 3
Figure 3
Algorithm for monitoring and treating exocrine pancreatic insufficiency and malnutrition in unresectable pancreatic ductal adenocarcinoma patients. EPI: Exocrine pancreatic insufficiency; PERT: Pancreatic enzymes replacement therapy.
Figure 4
Figure 4
Algorithm for monitoring and treating exocrine pancreatic insufficiency in patients with diabetes mellitus. PERT: Pancreatic enzymes replacement therapy.
Figure 5
Figure 5
Algorithm for monitoring and treating exocrine pancreatic insufficiency in patients with celiac disease. PERT: Pancreatic enzymes replacement therapy.
Figure 6
Figure 6
Algorithm for treating exocrine pancreatic insufficiency in patients who undergo gastric resection. PERT: Pancreatic enzymes replacement therapy.
Figure 7
Figure 7
Algorithm for monitoring and treating exocrine pancreatic insufficiency in patients who receive pancreaticoduodenectomy. EPI: Exocrine pancreatic insufficiency; PERT: Pancreatic enzyme replacement therapy.
Figure 8
Figure 8
Algorithm for monitoring and treating exocrine pancreatic insufficiency in patients who undergo distal pancreatectomy. EPI: Exocrine pancreatic insufficiency; PERT: Pancreatic enzymes replacement therapy.
Figure 9
Figure 9
Algorithm for monitoring and treating exocrine pancreatic insufficiency in patients who undergo atypical resection of the pancreas. EPI: Exocrine pancreatic insufficiency; PERT: Pancreatic enzymes replacement therapy.
See this image and copyright information in PMC

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