de Rijk Florence E M, van Veldhuisen Charlotte L, Besselink Marc G, van Hooft Jeanin E, van Santvoort Hjalmar C, van Geenen Erwin J M, Hegyi Peter, Löhr J-Matthias, Dominguez-Munoz Juan E, de Jonge Pieter Jan F, Bruno Marco J, Verdonk Robert C
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands.
Pancreatology. 2022 May;22(4):457-465. doi: 10.1016/j.pan.2022.03.013. Epub 2022 Mar 16.
Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists regarding the management of exocrine pancreatic insufficiency.
An online survey and case vignette study was sent to experts in chronic pancreatitis and members of various pancreatic associations: EPC, E-AHPBA and DPSG. Experts were selected based on publication record from the past 5 years.
Overall, 252 pancreatologists participated of whom 44% had ≥ 15 years of experience and 35% treated ≥ 50 patients with chronic pancreatitis per year. Screening for exocrine pancreatic insufficiency as part of the diagnostic work-up for chronic pancreatitis is performed by 69% and repeated annually by 21%. About 74% considers nutritional assessment to be part of the standard work-up. Patients are most frequently screened for deficiencies of calcium (47%), iron (42%), vitamin D (61%) and albumin (59%). In case of clinically steatorrhea, 71% prescribes enzyme supplementation. Of all pancreatologists, 40% refers more than half of their patients to a dietician. Despite existing guidelines, 97% supports the need for more specific and tailored instructions regarding the management of exocrine pancreatic insufficiency.
This survey identified a lack of consensus and substantial practice variation among international pancreatologists regarding guidelines pertaining the management of exocrine pancreatic insufficiency. These results highlight the need for further adaptation of these guidelines according to current expert opinion and the level of available scientific evidence.
尽管有循证指南，但慢性胰腺炎患者的外分泌性胰腺功能不全常常诊断不足且治疗不充分。因此，本研究旨在深入了解国际胰腺病学家对外分泌性胰腺功能不全管理的当前观点和临床决策。
向慢性胰腺炎专家以及各胰腺协会（欧洲胰腺俱乐部、欧洲胰腺病协会和德国胰腺学会）成员发送了一项在线调查和病例 vignette 研究。专家根据过去 5 年的发表记录进行选择。
总体而言，252 名胰腺病学家参与了调查，其中 44% 有≥15 年经验，35% 每年治疗≥50 例慢性胰腺炎患者。69% 的人在慢性胰腺炎诊断检查中进行外分泌性胰腺功能不全筛查，21% 的人每年重复进行。约 74% 的人认为营养评估是标准检查的一部分。患者最常接受钙（47%）、铁（42%）、维生素 D（61%）和白蛋白（59%）缺乏的筛查。出现临床脂肪泻时，71% 的人会开酶补充剂。在所有胰腺病学家中，40% 的人将超过一半的患者转诊给营养师。尽管有现有指南，但 97% 的人支持需要针对外分泌性胰腺功能不全管理提供更具体和量身定制的指导。
这项调查发现，国际胰腺病学家在关于外分泌性胰腺功能不全管理的指南方面缺乏共识且实践差异很大。这些结果凸显了根据当前专家意见和现有科学证据水平进一步调整这些指南的必要性。
