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Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: A Dutch national survey.
MedLine Citation:
PMID:  22487479     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Treating exocrine pancreatic insufficiency with pancreatic enzymes is challenging because there is no fixed dose regimen. The required dose varies per patient, depending on the residual pancreatic function, the gut lumen physiology, and the fat content of each meal. Using a sufficient dose of enzymes is crucial to prevent weight loss, nutritional deficiencies, and to ameliorate steatorrhea-related symptoms. Data regarding the practise of enzyme replacement therapy are lacking. Therefore, we evaluated if patients with exocrine insufficiency caused by chronic pancreatitis receive proper treatment in the Netherlands.
METHODS: An anonymous survey was distributed to the members of the Dutch Association of Patients with Pancreatic Disorders. The survey focused on enzyme use, steatorrhea-related symptoms, dietary consultation, and food restrictions. Responding patients were included if they had chronic pancreatitis and were treated for exocrine insufficiency with pancreatic enzymes.
RESULTS: The survey was returned by 178 members who suffered from chronic pancreatitis, 161 of whom (90%) met the inclusion criteria. The mean age was 56 years and 53% were male. The median enzyme intake was 6 capsules per day and 25% of patients took 3 or less capsules. Remarkably, 70% of patients still reported steatorrhea-related symptoms, despite treatment. Only 25% of cases were referred to a dietician and 58% kept a restriction of fat (either instructed by a dietician or self-imposed).
CONCLUSION: Many patients with exocrine insufficiency caused by chronic pancreatitis are under-treated in the Netherlands, a country with a well-organized healthcare system. To improve treatment efficacy, patients should be educated in adjusting the enzyme dosage according to steatorrhea-related symptoms and dietary fat intake. Moreover, patients should be referred to a well-trained, specialized dietician.
Edmée C M Sikkens; Djuna L Cahen; Casper van Eijck; Ernst J Kuipers; Marco J Bruno
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Publication Detail:
Type:  Journal Article     Date:  2011-12-31
Journal Detail:
Title:  Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]     Volume:  12     ISSN:  1424-3911     ISO Abbreviation:  Pancreatology     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-04-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100966936     Medline TA:  Pancreatology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  71-3     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Ltd. All rights reserved.
Department of Gastroenterology and Hepatology, Erasmus Medical Center, PO Box 2040, 3015 CE, Rotterdam, The Netherlands.
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