How to Cite
Abstract views: 0 PDF Downloads: 0
Abstract
In accordance with the United European Gastroenterology concept for the development of high-quality clinical guidelines, the European multidisciplinary guideline on the diagnosis and treatment of pancreatic exocrine insufficiency (PEI) (2024) has been developed. This guideline validates an approach to defining chronic pancreatitis not only in terms of inflammation and the decline in the gland’s exocrine function but also from the perspective of nutrient digestion.
Experts emphasize the definition of PEI as a reduction in pancreatic exocrine function to a level that prevents normal nutrient digestion. The authors highlight a crucial clinical distinction: reduced pancreatic secretion should not be considered synonymous with PEI, as threshold values for PEI can be influenced by factors characteristic of other conditions and diseases. In many cases, reduced secretion may remain sufficient for normal digestion or may even be reversible. In such instances, the condition can be defined as pancreatic exocrine dysfunction.
The authors review the causative factors of decreased pancreatic exocrine function and several pathogenetic aspects. It is underscored that the European guideline views PEI as a maldigestion syndrome rather than an isolated organ defect. Furthermore, experts believe that PEI should be regarded not only as enzyme secretion deficiency but also as a failure of pancreatic digestion, including malnutrition. PEI can lead to malabsorption symptoms and nutrient deficiencies, which negatively impact the quality of life and increase morbidity and mortality.
To clarify the role of pancreatic exocrine function in pancreatic and intestinal digestion, the authors present the interrelated physiological and pathophysiological mechanisms of these processes. Significant attention is paid to the causes and mechanisms of digestive disorders resulting from PEI.
The study highlights that experts in the European guideline (2024) acknowledge the possibility of diagnosing PEI based on a comprehensive assessment of symptoms, nutritional status, and secretion studies (e. g., fecal elastase-1). The authors discuss the expert group’s recommendations for a structured assessment, including clinical symptoms, nutritional status, and biochemical parameters (in accordance with the recommended parameters for long-term follow-up of patients with PEI and chronic pancreatitis, as per the guidelines of the UK, European Society for Clinical Nutrition and Metabolism, DGVS, and United European Gastroenterology). Experts maintain that pancreatic enzyme replacement therapy, combined with dietary advice and support, remains the cornerstone of management for this condition.
References
2. Гонцарюк Д. О. Особливості харчування при зовнішньосекреторній недостатності підшлункової залози та метаболічному синдромі. Вісник клубу панкреатологів. 2023; 3: 31–6. https://doi.org/10.33149/vkp.2023.03.02.
3. Губергріц М. М. Актуальні питання функціональної діагностики панкреатичної залози. Вісник клубу панкреатологів. 2023; 4(61): 60–6.
4. Губергріц Н. Б., Бєляєва Н. В., Можина Т. Л. та ін. Первинна та вторинна зовнішньосекреторна недостатність підшлункової залози. Вісник клубу панкреатологів. 2022; 4(57): 46–54.
5. Губергріц Н. Б., Можина Т. Л., Бєляєва Н. В. Кишкова мікробіота та захворювання підшлункової залози: мікробіом-асоційований підхід у лікуванні хронічного панкреатиту. Вісник клубу панкреатологів. 2023; 3(60): 17–30.
6. Коротько Г. Ф. Постпрандиальная секреция поджелудочной железы. Краснодар: ЭДВи; 2017. 115 с.
7. Христич Т. М., Телекі Я. М., Гонцарюк Д. О. та ін. Хронічний панкреатит: клінічно-патогенетичні особливості розвитку поєднання деяких захворювань та методи медикаментозної корекції (друге видання, перероблене та доповнене). Чернівці; 2022. 584 с.
8. Христич Т. М., Гонцарюк Д. О. Хронічний панкреатит: значення зовнішньосекреторної недостатності підшлункової залози, мальдигестії й мальабсорбції у перебігу захворювання. Здоров’я України. Гастроентерологія. Гепатологія. Колопроктологія. 2024; 3(73): 1–4.
9. Патратій М. В., Гонцарюк Д. О. Функціональні гастроінтестинальні розлади: роль замісної ферментної терапії. Вісник клубу панкреатологів. 2025; 2(67): 8–15. https://doi.org/10.33149/vkp.2025.02.03.
10. Al-Najjar Y., Clark A. L. Predicting outcome in patients with left ventricular systolic chronic heart failure using a nutritional risk index. Am J Cardiol. 2012; 109(9): 1315–20.
11. Arvanitakis M., Ockenga J., Bezmarevic M. et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2020; 39(3): 612–31.
12. Beyer G., Hoffmeister A., Michl P. et al. S3-Leitlinie Pankreatitis — Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) — September 2021 — AWMF Registernummer 021-003. Zeitschrift für Gastroenterologie. 2022; 60(3): 419–521.
13. Bjorkhaug S. T., Skar V., Medhus A. W. et al. Chronic alcohol overconsumption may alter gut microbial metabolism: a retrospective study of 719 (13)C-D-xylose breath test results. Microb Ecol Health Dis. 2017; 28(1): 1301725.
14. Capurso G., Archibugi L., Pasquali P. et al. Prevalence of chronic pancreatitis: Results of a primary care physician-based population study. Dig Liver Dis. 2017; 49(5): 535–9.
15. Chaudhary A., Domínguez-Muñoz J. E., Layer P., Lerch M. M. Pancreatic exocrine insufficiency as a complication of gastrointestinal surgery and the impact of pancreatic enzyme replacement therapy. Dig Dis. 2020; 38(1): 53–68.
16. de la Iglesia-Garcia D., Vallejo-Senra N., Iglesias-Garcia J. et al. Increased risk of mortality associated with pancreatic exocrine insufficiency in patients with chronic pancreatitis. J Clin Gastroenterol. 2018; 52(8): e63–e72.
17. Del Rosario M. A., Fitzgerald J. F., Gupta S. K., Croffie J. M. Direct measurement of pancreatic enzymes after stimulation with secretin versus secretin plus cholecystokinin. J Pediatr Gastroenterol Nutr. 2000; 31(1): 28–32.
18. Dumonceau J. M., Delhaye M., Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline — updated August 2018. Endoscopy. 2019; 51: 179–93.
19. El Kurdi B., Babar S., El Iskandarani M. et al. Factors that affect prevalence of small intestinal bacterial overgrowth in chronic pancreatitis: A systematic review, meta-analysis, and meta-regression. Clin Transl Gastroenterol. 2019; 10(9): e00072.
20. Frost F., Kacprowski T., Ruhlemann M. et al. Long-term instability of the intestinal microbiome is associated with metabolic liver disease, low microbiota diversity, diabetes mellitus and impaired exocrine pancreatic function. Gut. 2021; 70(3): 522–30.
21. Frulloni L., Falconi M., Gabbrielli A. et al. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis. 2010; 42(6): S381–S406.
22. Gopi S., Qamar S., Singh N. et al. Malnutrition by GLIM criteria in chronic pancreatitis: Prevalence, predictors, and its impact on quality of life. Pancreatology. 2022; 22(3): 367–73.
23. Jalal M., Campbell J. A., Tesfaye S. et al. Yield of testing for micronutrient deficiencies associated with pancreatic exocrine insufficiency in a clinical setting: An observational study. World J Clin Cases. 2021; 9(36): 11320–9.
24. Khan M., Rutkowski W., Vujasinovic M., Löhr J. M. Adherence to European guidelines for treatment and management of pancreatic exocrine insufficiency in chronic pancreatitis patients. J Clin Med. 2021; 10: 2737.
25. Kucheryavyi Y. A., Andreev D. N. Nutritional status in patients with chronic pancreatitis. J Nutr Ther. 2014; 3: 122–32.
26. Kuan L. L., Dennison A. R., Garcea G. Prevalence and impact of sarcopenia in chronic pancreatitis: A review of the literature. World J Surg. 2021; 45(2): 590–7.
27. Leeds J. S., Hopper A. D., Sidhu R. et al. Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency. Clin Gastroenterol Hepatol. 2010; 8(5): 433–8.
28. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013; 19(42): 7258–66.
29. Löhr J. M., Dominguez-Munoz E., Rosendahl J. et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). UEG J. 2017; 5(2): 153–99.
30. Makar M., Vodusek Z., Xia W. et al. Rising prevalence of anxiety and depression in chronic pancreatitis: a nationwide analysis. Pancreas. 2022; 51(4): 325–9.
31. Martínezmoneo E., Stigliano S., Hedström A. et al. Rising prevalence of anxiety and depression in chronic pancreatitis: a nationwide analysis. Pancreas. 2022; 51(4): 325–9.
32. Mascarenhas M. R., Mondick J., Barrett J. S. et al. Malabsorption blood test: Assessing fat absorption in patients with cystic fibrosis and pancreatic insufficiency. J Clin Pharmacol. 2015; 55(8): 854–65.
33. Phillips M. E., Hopper A. D., Leeds J. S. et al. Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines. BMJ Open Gastroenterology. 2021; 8(1).
34. Rasmussen H. H., Irtun O., Olesen S. S. et al. Nutrition in chronic pancreatitis. World J Gastroenterol. 2013; 19(42): 7267–75.
35. Scholten L., Stoop T. F., Del Chiaro M. et al. Systematic review of functional outcome and quality of life after total pancreatectomy. Br J Surg. 2019; 106(13): 1735–46.
36. Straatman J., Wiegel J., van der Wielen N. et al. Systematic review of exocrine pancreatic insufficiency after gastrectomy for cancer. Dig Surg. 2017; 34(5): 364–70.
37. Vujasinovic M., Hedström A., Maisonneuve P. et al. Zinc deficiency in patients with chronic pancreatitis. World J Gastroenterol. 2019; 25(5): 600–7.
38. Vujasinovic M., Nezirevic Dobrijevic L., Asplund E. et al. Low bone mineral density and risk for osteoporotic fractures in patients with chronic pancreatitis. Nutrients. 2021; 13(7): 2386.
39. Werner J., Dumonceau J. M., Fockens P. et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). UEG J. 2017; 5(2): 153–99.