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Pancreatic disease
Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines
  1. Mary E Phillips1,
  2. Andrew D Hopper2,
  3. John S Leeds3,
  4. Keith J Roberts4,
  5. Laura McGeeney5,
  6. Sinead N Duggan6,
  7. Rajesh Kumar7
  1. 1Nutrition and Dietetics, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
  2. 2Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  3. 3HPB Unit, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
  4. 4HPB Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  5. 5Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  6. 6Department of Surgery, Trinity College Dublin, Dublin, Ireland
  7. 7HPB Surgery, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
  1. Correspondence to Mary E Phillips; mary.phillips1{at}nhs.net

Abstract

Introduction Pancreatic exocrine insufficiency is a finding in many conditions, predominantly affecting those with chronic pancreatitis, pancreatic cancer and acute necrotising pancreatitis. Patients with pancreatic exocrine insufficiency can experience gastrointestinal symptoms, maldigestion, malnutrition and adverse effects on quality of life and even survival.

There is a need for readily accessible, pragmatic advice for healthcare professionals on the management of pancreatic exocrine insufficiency.

Methods and analysis A review of the literature was conducted by a multidisciplinary panel of experts in pancreatology, and recommendations for clinical practice were produced and the strength of the evidence graded. Consensus voting by 48 pancreatic specialists from across the UK took place at the 2019 Annual Meeting of the Pancreatic Society of Great Britain and Ireland annual scientific meeting.

Results Recommendations for clinical practice in the diagnosis, initial management, patient education and long term follow up were developed. All recommendations achieved over 85% consensus and are included within these comprehensive guidelines.

  • pancreas
  • pancreatic disorders
  • pancreatic enzymes
  • exocrine pancreatic function

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgast-2021-000643

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.

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    Footnotes

    • Contributors All authors were involved in the design, writing and reviewing of this document. All authors contributed to the design, analysis and interpretation of data. All authors drafted sections of the paper and critically appraised the entire paper prior to submission.

    • Funding Editorial assistance was provided by Alpharmaxim Healthcare Communications which was funded by Mylan Products Limited. The guideline content is independent of and not influenced by Mylan. Publication fees were met from an academic research account affiliated with Sheffield Teaching Hospitals.

    • Competing interests MEP has received honoraria for teaching and resource development from Mylan, Nutricia, and Sanofi. AH has received honoraria for teaching and resource development from Mylan. JSL has received honoraria for teaching and consulting from Mylan. KJR has received honoraria for teaching from Mylan and Abbott. LM has received honoraria for teaching and conference attendance from Mylan. SND has received honoraria for teaching, consulting and conference attendance from Mylan and Abbott. RK has received honoraria for teaching from Mylan.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.