Shandro Benjamin Myles, Nagarajah Rani, Poullis Andrew
Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, Tooting, London SW17 0QT, United Kingdom.
World J Gastrointest Pharmacol Ther. 2018 Oct 25;9(5):39-46. doi: 10.4292/wjgpt.v9.i5.39.
Pancreatic exocrine insufficiency (PEI) occurs when the insufficient secretion or function of pancreatic enzymes leads to maldigestion, most commonly as a result of chronic pancreatitis and pancreatic cancer. The condition is associated with significant morbidity and reductions in quality of life, even in milder forms. The challenges in approaching this condition include the non-specific presentation of mild to moderate PEI, and the lack of a convenient, accurate diagnostic test in this cohort. Classical symptoms appear late in the disease, and the diagnosis should be considered before steatorrhoea develops. Direct pancreatic function tests are the reference standard for diagnosis, but are invasive and not widely available. The faecal elastase-1 (FE-1) stool test is widely available and has been shown to be as effective as the C-mixed triglyceride breath test in more advanced disease. We recommend a pragmatic diagnostic approach that combines clinical history, assessment of nutritional status and measurement of FE-1. The critical first step is to consider the diagnosis. Once the diagnosis is confirmed, pancreatic enzyme replacement therapy should be initiated. The variety of enzyme preparations and recommended dosing regimens can present a challenge when selecting an adequate initial dose. Non-response should be actively sought and addressed in a systematic manner. This article discusses these challenges, and presents a practical approach to the diagnosis and management of PEI.
胰腺外分泌功能不全（PEI）是指胰腺酶分泌不足或功能异常导致消化功能不良，最常见的病因是慢性胰腺炎和胰腺癌。即使是轻度的PEI，也会导致明显的发病率增加和生活质量下降。诊断该疾病面临的挑战包括轻度至中度PEI的非特异性表现，以及该人群缺乏便捷、准确的诊断测试。典型症状在疾病后期才出现，应在脂肪泻出现之前考虑诊断。直接胰腺功能测试是诊断的参考标准，但具有侵入性且应用并不广泛。粪便弹性蛋白酶-1（FE-1）粪便检测易于开展，且在病情较严重时已被证明与C-混合甘油三酯呼气试验同样有效。我们建议采用一种务实的诊断方法，将临床病史、营养状况评估和FE-1检测相结合。关键的第一步是考虑诊断。一旦确诊，应开始胰腺酶替代治疗。在选择合适的初始剂量时，酶制剂的种类繁多和推荐的给药方案可能会带来挑战。应积极寻找无反应情况并进行系统处理。本文讨论了这些挑战，并提出了一种诊断和管理PEI的实用方法。
