From the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY.
Pancreas. 2022 Jan 1;51(1):25-27. doi: 10.1097/MPA.0000000000001967.
Chronic pancreatitis (CP) is a common cause of exocrine pancreatic insufficiency (EPI). Regular monitoring and treatment are recommended to decrease morbidity. This study evaluates whether provider type impacts EPI monitoring and management in CP.
Fecal elastase 1 (FE-1) testing and pancreatic enzyme replacement therapy (PERT) utilization were retrospectively compared between primary care providers (PCPs), gastroenterologists and pancreas specialists using pairwise comparisons. Multivariate analysis was conducted to study the association between adequate PERT and age, sex, race, insurance status, provider type, and etiology.
Among 256 patients, FE-1 was measured in 115 (44.9%) and of 143 (55.9%) patients who received PERT, 100 (69.9%) received adequate dosage. Fecal elastase 1 testing was performed in 7/57 (12.3%) by PCP, 11/38 (28.9%) by gastroenterologists, and 97/161 (60.2%) by pancreas specialists (P < 0.0001). Adequate PERT was prescribed in 7/24 (29.2%) patients by PCPs, 11/20 (55.0%) by gastroenterologists, and 82/99 (82.8%) by pancreas specialists (P < 0.0001). On multivariate analysis, pancreas specialists were significantly more likely to prescribe adequate PERT compared with PCP (odds ratio, 11.3; 95% confidence interval, 3.3-38.2; P < 0.001).
Many patients with CP receive inadequate surveillance and EPI treatment. Pancreas specialists are more likely to surveil and treat EPI adequately.
慢性胰腺炎（CP）是外分泌胰腺功能不全（EPI）的常见原因。建议定期监测和治疗，以降低发病率。本研究评估提供者类型是否会影响 CP 中 EPI 的监测和管理。
使用配对比较法，回顾性比较初级保健提供者（PCP）、胃肠病学家和胰腺专家之间的粪便弹性蛋白酶 1（FE-1）检测和胰酶替代疗法（PERT）的使用情况。进行多变量分析，以研究充分的 PERT 与年龄、性别、种族、保险状况、提供者类型和病因之间的关联。
在 256 名患者中，有 115 名（44.9%）进行了 FE-1 检测，在 143 名（55.9%）接受 PERT 的患者中，有 100 名（69.9%）接受了足够剂量的 PERT。PCP 进行了 7/57（12.3%）的粪便弹性蛋白酶 1 检测，胃肠病学家进行了 11/38（28.9%）的检测，胰腺专家进行了 97/161（60.2%）的检测（P<0.0001）。PCP 开具了 7/24（29.2%）患者的充分 PERT，胃肠病学家开具了 11/20（55.0%）患者的 PERT，胰腺专家开具了 82/99（82.8%）患者的 PERT（P<0.0001）。多变量分析显示，与 PCP 相比，胰腺专家开具充分 PERT 的可能性显著更高（比值比，11.3；95%置信区间，3.3-38.2；P<0.001）。
许多 CP 患者接受的监测和 EPI 治疗不足。胰腺专家更有可能充分监测和治疗 EPI。
