title: Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency.
abstract: OBJECTIVE
  Because of increasing awareness of variations in the use of pancreatic exocrine replacement therapy, the Australasian Pancreatic Club decided it was timely to re-review the literature and create new Australasian guidelines for the management of pancreatic exocrine insufficiency (PEI).
  
  
  METHODS
  A working party of expert clinicians was convened and initially determined that by dividing the types of presentation into three categories for the likelihood of PEI (definite, possible and unlikely) they were able to consider the difficulties of diagnosing PEI and relate these to the value of treatment for each diagnostic category.
  
  
  CONCLUSIONS
  Recent studies confirm that patients with chronic pancreatitis receive similar benefit from pancreatic exocrine replacement therapy (PERT) to that established in children with cystic fibrosis. Severe acute pancreatitis is frequently followed by PEI and PERT should be considered for these patients because of their nutritional requirements. Evidence is also becoming stronger for the benefits of PERT in patients with unresectable pancreatic cancer. However there is as yet no clear guide to help identify those patients in the 'unlikely' PEI group who would benefit from PERT. For example, patients with coeliac disease, diabetes mellitus, irritable bowel syndrome and weight loss in the elderly may occasionally be given a trial of PERT, but determining its effectiveness will be difficult. The starting dose of PERT should be from 25,000-40,000 IU lipase taken with food. This may need to be titrated up and there may be a need for proton pump inhibitors in some patients to improve efficacy.
authors.affiliation: Department of Surgery, University of Sydney, NSW, Australia; Australasian Pancreatic Club, Australia. Electronic address: Ross.smith@sydney.edu.au.
authors.forename: Ross C
authors.initials: RC
authors.lastname: Smith
authors.affiliation: Australasian Pancreatic Club, Australia.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Smith
authors.affiliation: Liverpool Hospital, University of NSW, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Institute for Immunology and Infectious Diseases, Murdoch University, WA, Australia; Fremantle Hospital, WA, Australia.
authors.forename: Callum
authors.initials: C
authors.lastname: Pearce
authors.affiliation: Nutrition & Dietetics, School of Health Sciences, Flinders University, Adelaide, SA, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Wray
authors.affiliation: Liverpool Hospital, University of NSW, Australia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Vo
authors.affiliation: South Australian Liver Transplant & HPB Unit, RAH & Flinders Medical Centre, SA, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chen
authors.affiliation: School of Women's and Children's Health, Dept. of Medicine, University of NSW, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia.
authors.forename: Chee Y
authors.initials: CY
authors.lastname: Ooi
authors.affiliation: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Oliver
authors.affiliation: Sydney Children's Hospital, Randwick, NSW, Australia.
authors.forename: Tamarah
authors.initials: T
authors.lastname: Katz
authors.affiliation: Hobart Clinical School and Dept. Surgery, University of Tasmania, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Turner
authors.affiliation: Dept. Surgery, University of Melbourne, VIC, Australia; Australasian Pancreatic Club, Australia.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Nikfarjam
authors.affiliation: School of Medicine, University of Adelaide, SA, Australia; Centre for Digestive Diseases, Royal Adelaide Hospital, SA, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rayner
authors.affiliation: Endocrine and Metabolic Unit, University of Adelaide and Royal Adelaide Hospital, SA, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia; Translational Research Institute, Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Qld, Australia.
authors.forename: Gerald
authors.initials: G
authors.lastname: Holtmann
authors.affiliation: Faculty of Health and Medicine, University of Newcastle, NSW, Australia; Royal Australasian College of Physicians, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Talley
authors.affiliation: Dept. of Surgery, University of Auckland, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Windsor
authors.affiliation: Faculty of Medicine, SW Sydney Clinical School, University of NSW, Australia.
authors.forename: Ron
authors.initials: R
authors.lastname: Pirola
authors.affiliation: Cancer Control Laboratory, Queensland Institute of Medical Research, Qld, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Neale
mesh_terms: D044362:Australasia; D006801:Humans; D010182:Pancreatic Diseases / Q000628:therapy*; D020799:Pancrelipase / Q000627:therapeutic use; D017410:Practice Guidelines as Topic
chemical_list: D020799:Pancrelipase
keywords: Exocrine pancreatic insufficiency; Pancreatic diseases; Pancreatic exocrine replacement therapy; Pancreatic function tests; Pancreatic neoplasms; Pancreatitis