Applicability of a checklist for the diagnosis and treatment of severe exocrine pancreatic insufficiency: a survey on the management of pancreatic maldigestion in Italy.
BACKGROUND
Exocrine pancreatic insufficiency coverage (EPIc) is an educational project for gastroenterologists, which is supported by the Italian Association for the Study of the Pancreas to disseminate knowledge regarding severe exocrine pancreatic insufficiency (EPI). The aim of this study was to produce a rapid checklist capable of identifying EPI in outpatients and evaluating whether the educational project is able to modify the clinical practice of participant gastroenterologists.


METHODS
Seven pancreatologists and two gastroenterologists produced a checklist to be applied in clinical practice. The checklist is divided into three parts as follows: 1) patient complaints; 2) physical examination; 3) tubeless tests. The checklist underwent an objective evaluation using the AGREE II 23-item instrument. In addition, a questionnaire was administered to the gastroenterologists, which contained specific questions regarding the utility of the project.


RESULTS
Forty of the 49 (81.6%) gastroenterologists completed the AGREE II questionnaire and all six domains were high. More than 90% of the participants answered that the knowledge which had emerged from the meetings had had an impact on their daily practice in the diagnostic as well as in the therapeutic and follow-up phases. The mean units of the pancreatic extracts administered to the patients with steatorrhea were significantly increased before and after the meetings. The results of the fecal examination, an increased number of bowel movements and the presence of postprandial bowel movements were significantly associated with steatorrhea. Metabolic parameters had a poor diagnostic accuracy in the diagnosis of EPI.


CONCLUSIONS
The EPIc project is a good methodology for changing the behavior of gastroenterologists regarding the correct approach to EPI.
Pancreas Unit, Department of Digestive System, Sant'Orsola-Malpighi Hospital, Bologna, Italy, for Exocrine Pancreatic Insufficiency Coverage (EPIc) Network - raffaele.pezzilli@aosp.bo.it.
Raffaele
R
Pezzilli
D000328:Adult; D000368:Aged; D057189:Checklist; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D000072102:Gastroenterologists; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000628:therapy*; D011795:Surveys and Questionnaires