Dominguez-Muñoz J Enrique
Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Curr Opin Gastroenterol. 2018 Sep;34(5):349-354. doi: 10.1097/MOG.0000000000000459.
Pancreatic exocrine insufficiency (PEI), defined as a secretion of pancreatic enzymes and bicarbonate insufficient to maintain a normal digestion, is a frequent but frequently underdiagnosed and undertreated condition. PEI may be secondary to different pancreatic diseases and extrapancreatic conditions. Recent data support the high clinical relevance of PEI and its treatment.
Together with symptoms of maldigestion, PEI is associated with nutritional deficiencies leading to osteoporosis, low-trauma fractures, sarcopenia and increased mortality. No single widely available test allows to diagnose PEI accurately. Diagnosis of PEI requires the evaluation of symptoms, nutritional markers and a noninvasive pancreatic function test in the appropriate clinical context. Pancreatic enzyme replacement therapy (PERT) improves digestion, symptoms, nutritional status and quality of life of patients with PEI. In addition, PERT is associated with a longer survival in patients with unresectable pancreatic cancer and after surgery for pancreatic cancer or chronic pancreatitis.
Awareness of PEI in different clinical conditions is required. Nutritional advice and appropriate PERT are mandatory to reduce the morbidity and mortality associated with PEI. Further studies on the clinical impact of PEI and its treatment are needed, especially in diseases other than chronic pancreatitis and cystic fibrosis.
胰腺外分泌功能不全（PEI）定义为胰腺酶和碳酸氢盐分泌不足，无法维持正常消化，是一种常见但常常诊断不足和治疗不足的病症。PEI可能继发于不同的胰腺疾病和胰腺外病症。近期数据支持PEI及其治疗具有高度临床相关性。
除消化不良症状外，PEI还与营养缺乏相关，可导致骨质疏松、低创伤性骨折、肌肉减少症和死亡率增加。目前尚无一种广泛可用的单一检测方法能准确诊断PEI。PEI的诊断需要在适当的临床背景下评估症状、营养指标和无创胰腺功能检测。胰酶替代疗法（PERT）可改善PEI患者的消化、症状、营养状况和生活质量。此外，PERT与不可切除胰腺癌患者以及胰腺癌或慢性胰腺炎手术后患者的生存期延长有关。
需要提高对不同临床情况下PEI的认识。营养咨询和适当的PERT对于降低与PEI相关的发病率和死亡率至关重要。需要进一步研究PEI及其治疗的临床影响，尤其是在慢性胰腺炎和囊性纤维化以外的疾病中。
