From the Department of Surgery, Amsterdam UMC, Academic Medical Center Amsterdam.
Departments of Surgery.
Pancreas. 2020 Feb;49(2):242-248. doi: 10.1097/MPA.0000000000001473.
Pancreatic exocrine insufficiency (PEI) is a common complication of chronic pancreatitis. However, little is known about the natural course of PEI and the effect of pancreatic enzyme replacement therapy on symptoms. The aim of this study was to evaluate the natural course and treatment of PEI in a nationwide cohort of patients with chronic pancreatitis.
Patients with chronic pancreatitis were selected from the multicenter Dutch Chronic Pancreatitis Registry. Patients were classified in 3 groups: definite PEI, potential PEI, and no PEI. Definite PEI and no PEI were compared regarding the course of disease, symptoms, treatment, and quality of life.
Nine hundred eighty-seven patients were included from 29 centers, of which 304 patients (31%) had definite PEI; 451 (46%), potentially PEI; and 232 (24%), no PEI. Patients with definite PEI had significantly more malabsorption symptoms, a lower body mass index, and aberrant defecation. Lowered quality of life was not independently associated with PEI. Of the PEI patients using pancreatic enzyme replacement therapy, 47% still reported steatorrhea.
Pancreatic exocrine insufficiency is associated with malabsorption symptoms and a lower body mass index. Some form of pancreatic enzyme replacement therapy is reasonably effective in alleviating malabsorption symptoms, but improvement of treatment is needed.
胰腺外分泌功能不全（PEI）是慢性胰腺炎的常见并发症。然而，对于 PEI 的自然病程以及胰腺酶替代治疗对症状的影响知之甚少。本研究旨在评估慢性胰腺炎患者的全国性队列中 PEI 的自然病程和治疗情况。
从多中心荷兰慢性胰腺炎登记处中选择慢性胰腺炎患者。患者被分为 3 组：明确的 PEI、潜在的 PEI 和没有 PEI。比较明确的 PEI 和没有 PEI 两组患者的疾病过程、症状、治疗和生活质量。
从 29 个中心纳入了 987 名患者，其中 304 名（31%）患者患有明确的 PEI；451 名（46%）患者患有潜在的 PEI；232 名（24%）患者没有 PEI。患有明确 PEI 的患者有更多的吸收不良症状、较低的体重指数和异常的排便情况。生活质量下降与 PEI 无独立相关性。使用胰腺酶替代治疗的 PEI 患者中，47%仍有脂肪泻。
胰腺外分泌功能不全与吸收不良症状和较低的体重指数有关。某种形式的胰腺酶替代治疗对缓解吸收不良症状是合理有效的，但需要改进治疗方法。
