Chronic pancreatitis (CP) is an inflammatory disease of the pancreas evolving in progressive fibrotic disruption of the gland with exocrine and endocrine pancreatic insufficiency. Although imaging features of CP are well known, their correlation with exocrine pancreatic function tests are not obvious, particularly in the early stage of the disease. There are many clinical classification of CP, all suggested for better distinguish and manage different forms based on etiological and clinical factors, and severity of the disease. Recently, a new classification of CP has been suggested: the M-ANNHEIM multiple risk factor classification that includes etiology, stage classification and degree of clinical severity. However, more accurate determination of clinical severity of CP requires a correct determination of exocrine function of the pancreas and fecal fat excretion. Recently, Kamath et al. (2017) demonstrated that the evaluation of exocrine pancreatic function by acid steatocrit and fecal elastase-1 (EF-1) was helpful, but EF-1 was able to detect exocrine pancreatic insufficiency in more patients, upgrading some patients in higher stage of disease according to M-ANNHEIM classification. So, EF-1 is a more accurate test to determine exocrine pancreatic insufficiency and to stage chronic pancreatitis in the M-ANNHEIM classification. On the contrary, EF-1 determination shows low sensitivity in detecting exocrine pancreatic insufficiency in early stage of the disease.
2. Diagnosis of exocrine pancreatic insufficiency in chronic pancreatitis: 13C-Mixed Triglyceride Breath Test versus Fecal Elastase / V. Gonzalez-Sanchez, R. Amrani, V. Gonzalez [et al.] // Pancreatology. – 2017. – Vol. 17. – P. 580–585.
3. Efficacy and safety of Creon 24,000 in subjects with exocrine pancreatic insufficiency due to cystic fibrosis / B. C. Trapnell, K. Maguiness, G. R. Graff [et al.] // J. Cyst. Fibros. – 2009. – Vol. 8. – P. 370–377.
4. Efficacy of a pancreatic enzyme formulation in the treatment of steatorrhea in patients with chronic pancreatitis / C. Pasquali, P. Fogar, C. Sperti [et al.] // Curr. Ther. Res. – 1996. – Vol. 57. – P. 358–365.
5. Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas / Pezzilli R, Andriulli A, Bassi C [et al.] ; Exocrine Pancreatic Insufficiency collaborative (EPIc) Group // World J. Gastroenterol. – 2013. – Vol. 19. – P. 7930–7946.
6. Hart P. A. Diagnosis of exocrine pancreatic insufficiency / P. A. Hart, D. L. Conwell // Curr. Treat. Options Gastroenterol. – 2015. – Vol. 13. – P. 347–353.
7. Lankisch P. G. Function tests in the diagnosis of chronic pancreatitis. Critical evaluation / P. G. Lankisch // Int. J. Pancreatol. – 1993. – Vol. 14. – P. 9–20.
8. Monocyte chemoattractant protein-1, transforming growth factor-beta1, nerve growth factor, resistin and hyaluronic acid as serum markers: comparison between recurrent acute and chronic pancreatitis / M. G. Kamath, C. G. Pai, A. Kamath, A. Kurien // Hepatobiliary Pancreat. Dis. Int. – 2016. – Vol. 15. – P. 209–215.
9. Novel blood-based microRNA biomarker panel for early diagnosis of chronic pancreatitis / L. Xin, J. Gao, D. Wang [et al.] // Sci. Rep. – 2017. – Vol. 7. – P. 40019.
10. Physiological evaluation of the severity of pancreatic exocrine dysfunction during endoscopy / S. J. O’Keefe, S. Stevens, R. Lee [et al.] // Pancreas. – 2007. – Vol. 35. – P. 30–36.
11. Ramakrishna B. S. The steatocrit as a measure of fecal fat excretion: uses and pitfalls / B. S. Ramakrishna // Indian J. Gastroenterol. – 2009. – Vol. 28. – P. 195–197.
12. Randomised clinical trial : a 1-week, double-blind, placebocontrolled study of pancreatin 25 000 Ph. Eur. minimicrospheres (Creon 25000 MMS) for pancreatic exocrine insufficiency after pancreatic surgery, with a 1-year open-label extension / C. M. Seiler, J. Izbicki, L. Varga-Szabo [et al.] // Aliment. Pharmacol. Ther. – 2013. – Vol. 37. – P. 691–702.
13. Schneider A. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease / A. Schneider, J. M. Lohr, M. V. Singer // J. Gastroenterol. – 2007. – Vol. 42. – P. 101–119.
14. Secretin-stimulated MRI characterization of pancreatic morphology and function in patients with chronic pancreatitis / A. Madzak, S. S. Olesen, I. S. Haldorsen [et al.] // Pancreatology. – 2017. – Vol. 17. – P. 228–236.
15. Survival rates and cause of death in 174 patients with chronic pancreatitis / S. Pedrazzoli, C. Pasquali, S. Guzzinati [et al.] // J. Gastrointest. Surg. – 2008. – Vol. 12. – P. 1930–1937.
16. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU) / J. M. Lohr, E. Dominguez-Munoz, J. Rosendahl ; HaPanEU/UEG Working Group // United European Gastroenterol. J. – 2017. Vol. 5. – P. 153–199.