Practice Guideline
doi: 10.1016/j.pan.2025.02.015.
Epub 2025 Feb 28.
Recommendations from the European guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency
Collaborators,
Affiliations
Collaborators
-
European PEI Multidisciplinary Group:
Hana Algül 5 , Livia Archibugi 6 , Marianna Arvanitakis 7 , Sorin Barbu 8 , Georg Beyer 9 , Mihailo Bezmarevic 10 , Frank Bodewes 11 , Marja A Boermeester 12 , Stefanos Bonovas 13 , Dmitry Bordin 14 , Marco Bruno 15 , Djuna Cahen 15 , Gabriele Capurso 16 , Güralp Ceyhan 17 , Laszlo Czako 18 , Ferdinando D'Amico 16 , Enrique De Madaria 19 , Julian De Martino 20 , Pierre H Deprez 21 , Christos Dervenis 22 , Petr Dité 23 , Asbjørn Drewes 24 , Sinead N Duggan 25 , Deniz Duman 26 , Trond Engjom 27 , Nils Ewald 28 , Ovidiu Fabian 8 , Pierluigi Fracasso 29 , Helmut Friess 30 , Jens Brøndum Frøkjær 31 , Luca Frulloni 32 , Sebastien Gaujoux 20 , Cristian Gheorghe 33 , Sophie Gohy 34 , Natalya Gubergrits 35 , Philip Hardt 36 , Truls Hauge 37 , Peter Hegyi 38 , Andrew Hopper 39 , Pali Hungin 40 , Julio Iglesias-Garcia 41 , Jutta Keller 42 , Mariia Kiriukova 43 , Jörg Kleeff 44 , Alexander Kleger 45 , Andrea Laghi 46 , José Larino-Noia 47 , Johanna Laukkarinen 48 , John Leeds 49 , Björn Lindkvist 50 , Etna Masip 51 , Giovanni Marchegiani 52 , Amir Mari 53 , Emma Martinez-Moneo 54 , Julia Mayerle 9 , Anders Molven 55 , Johann Ockenga 56 , Alexey Okhlobystin 57 , Salvatore Paiella 58 , Nikola Panic 59 , Andrea Parniczky 60 , Lukas Perkhofer 61 , Raffaele Pezzilli 62 , Mary Phillips 63 , Daniele Piovani 13 , Goran Poropat 64 , Jelena Rakic Matic 65 , Vinciane Rebours 66 , Keith Roberts 67 , Stuart Robinson 68 , Jonas Rosendahl 69 , Roberto Salvia 58 , Vasile Sandru 70 , Alain Sauvanet 71 , Isabelle Scheers 72 , Alexander Schneider 72 , Oleg Shvets 73 , Serena Stigliano 74 , Davor Stimac 75 , Oliver Strobel 76 , Andrea Szentesi 77 , Hester Timmerhuis 78 , Mihaela Udrescu 79 , Szilard Vancsa 80 , Vicki Veness 63 , Michael Wilschanski 81 , Heiko Witt 82
Affiliations
- 1 Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden. Electronic address: miroslav.vujasinovic@regionstockholm.se.
- 2 Department of Gastroenterology, University Hospital Puerta de Hierro, Madrid, Spain.
- 3 Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
- 4 Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institute and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
- 5 Comprehensive Cancer Center Munich TUM, Institute for Tumor Metabolism, Technical University of Munich, Munich, Germany.
- 6 Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
- 7 Service de Gastroenterologie, d'Hepato-Pancreatologie et d'Oncologie digestive, Hopital Erasme, HUB, Bruxelles, Belgium.
- 8 4th Surgery Department, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.
- 9 Department of Medicine II, Ludwig Maximilian University Hospital, Munich, Germany.
- 10 Department of Hepatobiliary and Pancreatic Surgery, Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia.
- 11 Division of Pediatric Gastroenterology/Hepatology, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- 12 Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology, & Metabolism, Amsterdam, the Netherlands.
- 13 Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- 14 Department of Upper Gastrointestinal, Pancreatic, and Biliary Diseases, A.S. Loginov Moscow Clinical Research Center, Moscow, Russia; Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia.
- 15 Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
- 16 Department of Gastroenterology, San Raffaele University Hospital, Milan, Italy.
- 17 Department of General Surgery, HBP-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Istanbul, Turkey.
- 18 Center for Gastroenterology, University of Szeged, Szeged, Hungary.
- 19 Department of Gastroenterology, Dr. Balmis General University Hospital-ISABIAL, Alicante, Spain.
- 20 Department of Hepato-Biliary, Pancreatic Surgery and Liver Transplantation, Hôpital la PitiéSalpêtrière, AP-HP, Paris, France; Sorbonne Université, Paris, France.
- 21 Department of Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
- 22 Department of Surgery, AGIA OLGA Hospital, Athens, Greece.
- 23 Internal Gastroenterology Clinic, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
- 24 Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
- 25 Center for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Northern Ireland, UK.
- 26 Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.
- 27 Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway.
- 28 Institute for Endocrinology, Diabetology and Metabolism, Johannes Wesling University Hospital Minden, Minden, Germany; Justus-Liebig University Giessen, Giessen, Germany.
- 29 Department of Gastroenterology and Digestive Endoscopy, Ospedale Sandro Pertini, Local Health Agency Roma 2, Rome, Italy.
- 30 Department of Surgery, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
- 31 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark and Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
- 32 Department of Medicine, Pancreas Unit, University of Verona, Verona, Italy.
- 33 Center of Gastroenterology & Hepatology, Fundeni Clinical Institute, "Carol Davila" University of Medicine, Bucharest, Romania.
- 34 Department of Pneumology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Cystic Fibrosis Reference Center, Cliniques Universitaires Saint-Luc, Université Catholique de Louvai, Brussels, Belgium.
- 35 Into-Sana Multi-Field Clinic, Odesa, Ukraine.
- 36 Institute for Endocrinology, Diabetology, and Metabolism, Johannes Wesling University Hospital Minden, Minden, Germany; Institute for Endocrinology, Diabetology and Metabolism, Johannes Wesling University Hospital Minden, Minden, Germany.
- 37 Department of Gastroenterology, Oslo University Hospital, Ullevål, Norway; University of Oslo, Clinical Medicine, Oslo, Norway.
- 38 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research and Development and Innovation, University of Szeged, Szeged, Hungary.
- 39 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
- 40 Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK.
- 41 Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain.
- 42 Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany.
- 43 Pancreatic, Biliary, and Upper GI Diseases Department, Moscow Clinical Scientific Center, Moscow, Russia.
- 44 Department of Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
- 45 Institute of Molecular Oncology and Stem Cell Biology (IMOS), Ulm University Hospital, Ulm, Germany; Division of Interdisciplinary Pancreatology, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany.
- 46 Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Sant'Andrea University Hospital, Rome, Italy.
- 47 Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
- 48 Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
- 49 HPB Unit and Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK; Population Health Sciences Institute, Newcastle University, UK.
- 50 Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
- 51 Hospital Universitari i Politecnic La Fe, Valencia, Spain.
- 52 Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy.
- 53 Gastroenterology Institute and Neurogastroenterology Unit, Nazareth Hospital, Nazareth, Israel; Bar Ilan Faculty of Medicine, Nazareth, Israel.
- 54 Gastroenterology Department, University Hospital of Cruces, Bizkaia, Barakaldo, Spain.
- 55 Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Section for Cancer Genomics, Haukeland University Hospital, Bergen, Norway.
- 56 Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
- 57 Department of Internal Disease Propedeutics, Gastroenterology and Hepatology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
- 58 Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
- 59 Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Digestive Endoscopy Unit, University Clinic "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia.
- 60 Heim Pal National Pediatric Institute, Budapest, Hungary; Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research and Development and Innovation, University of Szeged, Szeged, Hungary.
- 61 Section of Interdisciplinary Pancreatology, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany.
- 62 Potenza Medical County Association, Potenza, Italy.
- 63 Department of Nutrition and Dietetics, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, UK.
- 64 Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka, Croatia; Department of Internal Medicine, Faculty of Medicine of the University of Rijeka, Rijeka, Croatia.
- 65 Health Center Zagreb West, Zagreb, Croatia.
- 66 Department of Pancreatology, Beaujon Hospital, DMU Digest, AP-HP, Clichy, France.
- 67 Department of HPB Surgery, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, UK.
- 68 Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.
- 69 Department of Internal Medicine I, Martin Luther University, Halle, Germany.
- 70 Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, Bucharest, Romania; Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania.
- 71 Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hopital Beaujon, AP-HP, Clichy, France & Université de Paris Cité, Paris, France.
- 72 Department of Gastroenterology and Hepatology, Medical Center Bad Hersfeld-Rotenburg, Bad Hersfeld, Germany.
- 73 Department of Health and Nutrition, National University of Life and Environmental Sciences of Ukraine, Ukraine.
- 74 Therapeutic Digestive Endoscopy Unit, Fondazione Policlinico Universitartio Campus BioMedico, Rome, Italy.
- 75 Specialty Hospital Medico, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
- 76 Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria.
- 77 Institute for Translational Medicine, Medical School, University of Pécs, Hungary.
- 78 Department of Surgery, St. Antonius Hospital Location Nieuwegein, the Netherlands.
- 79 CMI Dr. Udrescu Mihaela, Bucharest, Romania.
- 80 Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.
- 81 Pediatric Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- 82 Pediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany.
- PMID: 40097316
- DOI: 10.1016/j.pan.2025.02.015
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Practice Guideline
Recommendations from the European guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency
Miroslav Vujasinovic et al.
Pancreatology.
2025 May.
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doi: 10.1016/j.pan.2025.02.015.
Epub 2025 Feb 28.
Authors
Collaborators
-
European PEI Multidisciplinary Group:
Hana Algül 5 , Livia Archibugi 6 , Marianna Arvanitakis 7 , Sorin Barbu 8 , Georg Beyer 9 , Mihailo Bezmarevic 10 , Frank Bodewes 11 , Marja A Boermeester 12 , Stefanos Bonovas 13 , Dmitry Bordin 14 , Marco Bruno 15 , Djuna Cahen 15 , Gabriele Capurso 16 , Güralp Ceyhan 17 , Laszlo Czako 18 , Ferdinando D'Amico 16 , Enrique De Madaria 19 , Julian De Martino 20 , Pierre H Deprez 21 , Christos Dervenis 22 , Petr Dité 23 , Asbjørn Drewes 24 , Sinead N Duggan 25 , Deniz Duman 26 , Trond Engjom 27 , Nils Ewald 28 , Ovidiu Fabian 8 , Pierluigi Fracasso 29 , Helmut Friess 30 , Jens Brøndum Frøkjær 31 , Luca Frulloni 32 , Sebastien Gaujoux 20 , Cristian Gheorghe 33 , Sophie Gohy 34 , Natalya Gubergrits 35 , Philip Hardt 36 , Truls Hauge 37 , Peter Hegyi 38 , Andrew Hopper 39 , Pali Hungin 40 , Julio Iglesias-Garcia 41 , Jutta Keller 42 , Mariia Kiriukova 43 , Jörg Kleeff 44 , Alexander Kleger 45 , Andrea Laghi 46 , José Larino-Noia 47 , Johanna Laukkarinen 48 , John Leeds 49 , Björn Lindkvist 50 , Etna Masip 51 , Giovanni Marchegiani 52 , Amir Mari 53 , Emma Martinez-Moneo 54 , Julia Mayerle 9 , Anders Molven 55 , Johann Ockenga 56 , Alexey Okhlobystin 57 , Salvatore Paiella 58 , Nikola Panic 59 , Andrea Parniczky 60 , Lukas Perkhofer 61 , Raffaele Pezzilli 62 , Mary Phillips 63 , Daniele Piovani 13 , Goran Poropat 64 , Jelena Rakic Matic 65 , Vinciane Rebours 66 , Keith Roberts 67 , Stuart Robinson 68 , Jonas Rosendahl 69 , Roberto Salvia 58 , Vasile Sandru 70 , Alain Sauvanet 71 , Isabelle Scheers 72 , Alexander Schneider 72 , Oleg Shvets 73 , Serena Stigliano 74 , Davor Stimac 75 , Oliver Strobel 76 , Andrea Szentesi 77 , Hester Timmerhuis 78 , Mihaela Udrescu 79 , Szilard Vancsa 80 , Vicki Veness 63 , Michael Wilschanski 81 , Heiko Witt 82
Affiliations
- 1 Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden. Electronic address: miroslav.vujasinovic@regionstockholm.se.
- 2 Department of Gastroenterology, University Hospital Puerta de Hierro, Madrid, Spain.
- 3 Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
- 4 Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institute and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
- 5 Comprehensive Cancer Center Munich TUM, Institute for Tumor Metabolism, Technical University of Munich, Munich, Germany.
- 6 Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
- 7 Service de Gastroenterologie, d'Hepato-Pancreatologie et d'Oncologie digestive, Hopital Erasme, HUB, Bruxelles, Belgium.
- 8 4th Surgery Department, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.
- 9 Department of Medicine II, Ludwig Maximilian University Hospital, Munich, Germany.
- 10 Department of Hepatobiliary and Pancreatic Surgery, Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia.
- 11 Division of Pediatric Gastroenterology/Hepatology, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- 12 Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology, & Metabolism, Amsterdam, the Netherlands.
- 13 Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- 14 Department of Upper Gastrointestinal, Pancreatic, and Biliary Diseases, A.S. Loginov Moscow Clinical Research Center, Moscow, Russia; Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia.
- 15 Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
- 16 Department of Gastroenterology, San Raffaele University Hospital, Milan, Italy.
- 17 Department of General Surgery, HBP-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Istanbul, Turkey.
- 18 Center for Gastroenterology, University of Szeged, Szeged, Hungary.
- 19 Department of Gastroenterology, Dr. Balmis General University Hospital-ISABIAL, Alicante, Spain.
- 20 Department of Hepato-Biliary, Pancreatic Surgery and Liver Transplantation, Hôpital la PitiéSalpêtrière, AP-HP, Paris, France; Sorbonne Université, Paris, France.
- 21 Department of Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
- 22 Department of Surgery, AGIA OLGA Hospital, Athens, Greece.
- 23 Internal Gastroenterology Clinic, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
- 24 Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
- 25 Center for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Northern Ireland, UK.
- 26 Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.
- 27 Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway.
- 28 Institute for Endocrinology, Diabetology and Metabolism, Johannes Wesling University Hospital Minden, Minden, Germany; Justus-Liebig University Giessen, Giessen, Germany.
- 29 Department of Gastroenterology and Digestive Endoscopy, Ospedale Sandro Pertini, Local Health Agency Roma 2, Rome, Italy.
- 30 Department of Surgery, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
- 31 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark and Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
- 32 Department of Medicine, Pancreas Unit, University of Verona, Verona, Italy.
- 33 Center of Gastroenterology & Hepatology, Fundeni Clinical Institute, "Carol Davila" University of Medicine, Bucharest, Romania.
- 34 Department of Pneumology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Cystic Fibrosis Reference Center, Cliniques Universitaires Saint-Luc, Université Catholique de Louvai, Brussels, Belgium.
- 35 Into-Sana Multi-Field Clinic, Odesa, Ukraine.
- 36 Institute for Endocrinology, Diabetology, and Metabolism, Johannes Wesling University Hospital Minden, Minden, Germany; Institute for Endocrinology, Diabetology and Metabolism, Johannes Wesling University Hospital Minden, Minden, Germany.
- 37 Department of Gastroenterology, Oslo University Hospital, Ullevål, Norway; University of Oslo, Clinical Medicine, Oslo, Norway.
- 38 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research and Development and Innovation, University of Szeged, Szeged, Hungary.
- 39 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
- 40 Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK.
- 41 Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain.
- 42 Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany.
- 43 Pancreatic, Biliary, and Upper GI Diseases Department, Moscow Clinical Scientific Center, Moscow, Russia.
- 44 Department of Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
- 45 Institute of Molecular Oncology and Stem Cell Biology (IMOS), Ulm University Hospital, Ulm, Germany; Division of Interdisciplinary Pancreatology, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany.
- 46 Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Sant'Andrea University Hospital, Rome, Italy.
- 47 Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
- 48 Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
- 49 HPB Unit and Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK; Population Health Sciences Institute, Newcastle University, UK.
- 50 Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
- 51 Hospital Universitari i Politecnic La Fe, Valencia, Spain.
- 52 Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy.
- 53 Gastroenterology Institute and Neurogastroenterology Unit, Nazareth Hospital, Nazareth, Israel; Bar Ilan Faculty of Medicine, Nazareth, Israel.
- 54 Gastroenterology Department, University Hospital of Cruces, Bizkaia, Barakaldo, Spain.
- 55 Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Section for Cancer Genomics, Haukeland University Hospital, Bergen, Norway.
- 56 Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
- 57 Department of Internal Disease Propedeutics, Gastroenterology and Hepatology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
- 58 Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
- 59 Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Digestive Endoscopy Unit, University Clinic "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia.
- 60 Heim Pal National Pediatric Institute, Budapest, Hungary; Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research and Development and Innovation, University of Szeged, Szeged, Hungary.
- 61 Section of Interdisciplinary Pancreatology, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany.
- 62 Potenza Medical County Association, Potenza, Italy.
- 63 Department of Nutrition and Dietetics, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, UK.
- 64 Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka, Croatia; Department of Internal Medicine, Faculty of Medicine of the University of Rijeka, Rijeka, Croatia.
- 65 Health Center Zagreb West, Zagreb, Croatia.
- 66 Department of Pancreatology, Beaujon Hospital, DMU Digest, AP-HP, Clichy, France.
- 67 Department of HPB Surgery, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, UK.
- 68 Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.
- 69 Department of Internal Medicine I, Martin Luther University, Halle, Germany.
- 70 Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, Bucharest, Romania; Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania.
- 71 Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hopital Beaujon, AP-HP, Clichy, France & Université de Paris Cité, Paris, France.
- 72 Department of Gastroenterology and Hepatology, Medical Center Bad Hersfeld-Rotenburg, Bad Hersfeld, Germany.
- 73 Department of Health and Nutrition, National University of Life and Environmental Sciences of Ukraine, Ukraine.
- 74 Therapeutic Digestive Endoscopy Unit, Fondazione Policlinico Universitartio Campus BioMedico, Rome, Italy.
- 75 Specialty Hospital Medico, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
- 76 Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria.
- 77 Institute for Translational Medicine, Medical School, University of Pécs, Hungary.
- 78 Department of Surgery, St. Antonius Hospital Location Nieuwegein, the Netherlands.
- 79 CMI Dr. Udrescu Mihaela, Bucharest, Romania.
- 80 Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.
- 81 Pediatric Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- 82 Pediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany.
- PMID: 40097316
- DOI: 10.1016/j.pan.2025.02.015
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Abstract
Background: Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below a level that allows normal digestion of nutrients. Pancreatic disease and pancreatic surgery are the main causes of PEI, but other conditions can affect the digestive function of the pancreas.
Methods: In collaboration with European Digestive Surgery (EDS), European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), European Society for Clinical Nutrition and Metabolism (ESPEN), European Society of Digestive Oncology (ESDO), and European Society of Primary Care Gastroenterology (ESPCG) the working group developed European guidelines for the diagnosis and therapy of PEI. United European Gastroenterology (UEG) provided both endorsement and financial support for the development of the guidelines.
Results: Recommendations covered topics related to the clinical management of PEI: concept, pathogenesis, clinical relevance, general diagnostic approach, general therapeutic approach, PEI secondary to chronic pancreatitis, PEI after acute pancreatitis, PEI associated with pancreatic cancer, PEI secondary to cystic fibrosis, PEI after pancreatic surgery, PEI after esophageal, gastric, and bariatric surgery, PEI in patients with type 1 and type 2 diabetes, and PEI in other conditions.
Conclusions: The European guidelines for the diagnosis and therapy of PEI provide evidence-based recommendations concerning key aspects of the etiology, diagnosis, therapy, and follow-up, based on current available evidence. These recommendations should serve as a reference standard for existing management of PEI and as a guide for future clinical research. This article summarizes the recommendations and statements.
Keywords: Exocrine; Guideline; Insufficiency; PERT; Pancreatic.
Copyright © 2025 IAP and EPC. Published by Elsevier B.V. All rights reserved.
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