Austin Health, Melbourne, VIC
South Western Sydney Clinical School, Liverpool Hospital, UNSW, Sydney, NSW.
Med J Aust. 2017 Aug 21;207(4):161-165. doi: 10.5694/mja16.00851.
In 2015, the Australasian Pancreatic Club (APC) published the Australasian guidelines for the management of pancreatic exocrine insufficiency (http://pancreas.org.au/2016/01/pancreatic-exocrine-insufficiency-guidelines). Pancreatic exocrine insufficiency (PEI) occurs when normal digestion cannot be sustained due to insufficient pancreatic digestive enzyme activity. This may be related to a breakdown, at any point, in the pancreatic digestive chain: pancreatic stimulation; synthesis, release or transportation of pancreatic enzymes; or synchronisation of secretions to mix with ingested food. Main recommendations: The guidelines provide advice on diagnosis and management of PEI, noting the following: A high prevalence of PEI is seen in certain diseases and conditions, such as cystic fibrosis, acute and chronic pancreatitis, pancreatic cancer and pancreatic surgery. The main symptoms of PEI are steatorrhoea or diarrhoea, abdominal pain, bloating and weight loss. These symptoms are non-specific and often go undetected and untreated. PEI diagnosis is predominantly based on clinical findings and the presence of underlying disease. The likelihood of PEI in suspected patients has been categorised into three groups: definite, possible and unlikely. If left untreated, PEI may lead to complications related to fat malabsorption and malnutrition, and have an impact on quality of life. Pancreatic enzyme replacement therapy (PERT) remains the mainstay of PEI treatment with the recommended adult initial enzyme dose being 25 000-40 000 units of lipase per meal, titrating up to a maximum of 75 000-80 000 units of lipase per meal. Adjunct acid-suppressing therapy may be useful when patients still experience symptoms of PEI on high dose PERT. Nutritional management by an experienced dietitian is essential. Changes in management as a result of these guidelines: These are the first guidelines to classify PEI as being definite, possible or unlikely, and provide a diagnostic algorithm to facilitate the early diagnosis of PEI and appropriate use of PERT.
2015 年，澳大拉西亚胰腺俱乐部（APC）发布了《澳大拉西亚胰腺外分泌不足管理指南》（http://pancreas.org.au/2016/01/pancreatic-exocrine-insufficiency-guidelines）。当正常消化因胰腺消化酶活性不足而无法维持时，就会发生胰腺外分泌不足（PEI）。这可能与胰腺消化链中的任何一点发生故障有关：胰腺刺激；胰腺酶的合成、释放或运输；或分泌物与摄入食物的混合同步。主要建议：该指南就 PEI 的诊断和管理提供了建议，指出以下内容：某些疾病和病症（如囊性纤维化、急性和慢性胰腺炎、胰腺癌和胰腺手术）中，PEI 的发病率较高。PEI 的主要症状是脂肪泻或腹泻、腹痛、腹胀和体重减轻。这些症状不具特异性，往往未被发现和治疗。PEI 的诊断主要基于临床发现和基础疾病的存在。疑似患者发生 PEI 的可能性分为三类：明确、可能和不太可能。如果不进行治疗，PEI 可能导致与脂肪吸收不良和营养不良相关的并发症，并对生活质量产生影响。胰腺酶替代疗法（PERT）仍然是 PEI 治疗的主要方法，建议成人初始酶剂量为每餐 25000-40000 单位脂肪酶，最大剂量可滴定至每餐 75000-80000 单位脂肪酶。当患者在高剂量 PERT 治疗时仍有 PEI 症状时，辅助酸抑制治疗可能有用。经验丰富的营养师进行营养管理至关重要。这些指南导致的管理变化：这些是首次将 PEI 分类为明确、可能或不太可能的指南，并提供了一个诊断算法，以促进 PEI 的早期诊断和 PERT 的合理使用。
