title: Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: a Dutch national survey.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, PO Box 2040, 3015 CE, Rotterdam, The Netherlands. e.sikkens@erasmusmc.nl
authors.forename: Edmée C M
authors.initials: EC
authors.lastname: Sikkens
authors.forename: Djuna L
authors.initials: DL
authors.lastname: Cahen
authors.forename: Casper
authors.initials: C
authors.lastname: van Eijck
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004041:Dietary Fats / Q000008:administration & dosage; D056947:Enzyme Replacement Therapy; D010188:Exocrine Pancreatic Insufficiency / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010179:Pancreas / Q000201:enzymology; D050500:Pancreatitis, Chronic / Q000150:complications*; D011446:Prospective Studies; D045602:Steatorrhea / Q000517:prevention & control
chemical_list: D004041:Dietary Fats