title: [Croatian guidelines for the management of pancreatic exocrine insufficiency].
abstract: Pancreatic exocrine insufficiency is a major consequence of pancreatic diseases (e. g. chronic pancreatitis and cystic fibrosis), extrapancreatic diseases like celiac disease and Crohn's disease, and gastrointestinal and pancreatic surgical resections. Recognition of this entity is highly relevant to avoid malnutrition-related morbidity and mortality. The main clinical consequence of PEI is fat maldigestion and malabsorption, resulting in steatorrhoea. Pancreatic exocrine function should be assessed by measuring levels of faecal elastase-1. Pancreatic enzyme replacement therapy is the mainstay of treatment for PEI. Administration of enzymes in form of enteric-coated minimicrospheres avoids acid-mediated lipase inactivation and ensures gastric emptying of enzymes in parallel with nutrients. In adults, the initial recommended dose of pancreatic enzymes is 25.000 units of lipase per meal, titrating up to a maximum of 80000 units of lipase per meal. Large meals require 25.000 - 80.000 units of lipase per meal while snacks require 10.000 - 40.000 units of lipase per meal. Oral pancreatic enzymes should be taken with meals to ensure adequate mixing with the chyme. Adjunct therapy with acid-suppressing agents may be useful in patients who continue to experience symptoms of PEI despite high-dose enzyme therapy. Patients with PEI should be encouraged to consume small, frequent meals and to abstain from alcohol. Dietary fat restriction is not recommended for patients with PEI.
authors.affiliation: Hrvatsko gastroenterolosko drustvo.
authors.forename: Nadan
authors.initials: N
authors.lastname: Rustemović
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Krznarić
authors.forename: Darija Vranesić
authors.initials: DV
authors.lastname: Bender
authors.forename: Rajko
authors.initials: R
authors.lastname: Ostojić
authors.forename: Silvija Cuković
authors.initials: SC
authors.lastname: Cavka
authors.forename: Sandra
authors.initials: S
authors.lastname: Milić
authors.forename: Branimir
authors.initials: B
authors.lastname: Anić
authors.forename: Neven
authors.initials: N
authors.lastname: Ljubicić
authors.forename: Jasna
authors.initials: J
authors.lastname: Mesarić
authors.forename: Davor
authors.initials: D
authors.lastname: Stimac
mesh_terms: D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans