title: Romanian guidelines on the diagnosis and treatment of exocrine pancreatic insufficiency.
abstract: In assessing exocrine pancreatic insufficiency (EPI), its diverse etiologies and the heterogeneous population affected should be considered. Diagnosing this condition remains a challenge in clinical practice especially for mild-to-moderate EPI, with the support of the time-consuming breath test or the coefficient of fat absorption. The fecal elastase-1 test, less precise for the diagnosis, cannot be useful for assessing treatment efficacy. Pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment, whereby enteric-coated mini-microspheres are taken with every meal, in progressive doses based on an individual's weight and clinical symptoms. The main indication for PERT is chronic pancreatitis, in patients who have clinically relevant steatorrhea, abnormal pancreatic function test or abnormal function tests associated with symptoms of malabsorption such as weight loss or meteorism. While enzyme replacement therapy is not recommended in the initial stages of acute pancreatitis, pancreatic exocrine function should be monitored for at least 6-18 months. In the case of unresectable pancreatic cancer, replacement enzyme therapy helps to maintain weight and improve overall quality of life. It is also indicated in patients with celiac disease, who have chronic diarrhea (in spite of gluten-free diet), and in patients with cystic fibrosis with proven EPI.
authors.affiliation: Carol Davila University of Medicine and Pharmacy;Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Gheorghe
authors.affiliation: Iuliu Hatieganu University of Medicine and Pharmacy;Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. andradaseicean@gmail.com.
authors.forename: Andrada
authors.initials: A
authors.lastname: Seicean
authors.affiliation: Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark; University of Medicine; Research Center of Gastroenterology and Hepatology, Craiova, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Saftoiu
authors.affiliation: Iuliu Hatieganu University of Medicine and Pharmacy;Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
authors.forename: Marcel
authors.initials: M
authors.lastname: Tantau
authors.affiliation: Faculty of Medicine, Ovidius University, Constanta, Romania.
authors.forename: Eugen
authors.initials: E
authors.lastname: Dumitru
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Medicine and Gastroenterology Clinic, Carol Davila Central University Emergency Military Hospital, Bucharest, Romania.
authors.forename: Mariana
authors.initials: M
authors.lastname: Jinga
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Emergency University Hospital, Bucharest, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Negreanu
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Mateescu
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Liana
authors.initials: L
authors.lastname: Gheorghe
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Ciocirlan
authors.affiliation: Grigore T. Popa University of Medicine and Pharmacy; Institute of Gastroenterology and Hepatology, Iasi, Romania.
authors.forename: Cristina
authors.initials: C
authors.lastname: Cijevschi
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Gastroenterology Department, Floreasca Hospital, Bucharest, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Constantinescu
authors.affiliation: Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Dima
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Mircea
authors.initials: M
authors.lastname: Diculescu
mesh_terms: D056947:Enzyme Replacement Therapy / Q000009:adverse effects / Q000592:standards*; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000201:enzymology / Q000628:therapy*; D006801:Humans; D010186:Pancreatic Function Tests / Q000592:standards*; D011237:Predictive Value of Tests; D012383:Romania; D013997:Time Factors; D016896:Treatment Outcome