Background & Aims
Pancreatic exocrine insufficiency may be under recognised in gastroenterological practice. We aimed to identify the prevalence of pancreatic insufficiency in secondary care gastroenterology clinics and determine if co-morbidity or presenting symptoms could predict diagnosis. A secondary aim was to assess response to treatment.
Methods
A dual centre retrospective analysis was conducted in secondary care gastroenterology clinics. Patients tested for pancreatic exocrine insufficiency with faecal elastase-1 (FEL-1) between 2009 and 2013 were identified in two centres. Demographics, indication and co-morbidities were recorded in addition to dose and response to pancreatic enzyme replacement therapy. Binary logistic regression was used to assess if symptoms or co-morbidities could predict pancreatic insufficiency.
Results
1821 patients were tested, 13.1% had low FEL-1 (<200μg/g). This prevalence was sub-analysed with 5.4% having FEL-1 100-200μg/g (mild insufficiency) and 7.6% having faecal elastase readings <100μg/g. Low FEL-1 was most significantly associated with weight loss or steatorrhoea. Co-morbidity analysis showed that low levels were significantly associated with excess alcohol intake, diabetes mellitus or human immunodeficiency virus; 80.0% treated with enzyme supplements reported symptomatic benefit with no difference in response between high and low dose supplementation (p=0.761).
Conclusion
Targeting the use of FEL-1 in individuals with specific symptoms and associated conditions canlead to improved recognition of pancreatic exocrine insufficiency in a significant proportion of secondary carepatients. Intervening with lifestyle advice such as smoking cessation and minimising alcohol intake couldimprove outcomes. In addition, up to 80% of patients with low faecal elastase respond to supplementation.
Key words
faecal elastase – pancreas – diarrhoea – pancreatic insufficiency.
Abbreviations
CFA: coefficient of fat absorption
CP: chronic pancreatitis
ELISA: enzyme-linked immune-absorbent assay
PEI: pancreatic exocrine insufficiency
FEL-1: faecal elastase-1
HIV: human immunodeficiency virus
IBD: inflammatory bowel disease
IBS: irritable bowel syndrome
PERT: pancreatic enzyme replacement therapy
