Bashar Attar
Cook County Health and Hospitals System, USA
Title: Subclinical exocrine pancreatic insufficiency (EPI): A disease that merits treatment
Biography
Biography: Bashar Attar
Abstract
Introduction: Exocrine pancreatic insufficiency (EPI) is one of the long-term consequences of chronic pancreatitis (CP). Majority of patients with EPI are undiagnosed or undertreated.
Study Design: We prospectively evaluated 200 consecutive individuals seen in a pancreatic outpatient practice. These individuals were screened on 2 occasions to determine their baseline stool elastase excretion. The 200 individuals were segmented into 4 distinct groups: a)“Normals” (n=105) with stool elastase >500 ug/g stool, received no treatment; b) “Minimal EPI” (n=60) with stool elastase >200 to <500 ug/g stool, received 3000 IU of a standard pancreatic enzyme preparation (Creon) with their 2 ingested meals; c) “Moderate EPI” (n=23) with stool elastase >100 to 200 ug/g stool, received 12,000 IU of the same pancreatic enzyme preparation with each meal; d) “Severe/Overt EPI” (n=12) with stool elastase <100 ug /g stool, received 24,000 IU of the same pancreatic enzyme preparation with each meal and with a bedtime snack.
Results: These groups presented with abdominal pain, bloating, flatulence, diarrhea, large bulky stools, and greasy stools. Symptoms were graded (1-10) at entry and monthly for 3 months. Symptom scores decreased in all groups. The response to therapy was maximal in those with most severe disease identified by their greatest reduction in stool elastase at entry. Lesser responses were seen in the other groups and mired the severity of the disease at entry as defined by their stool elastase levels.
Conclusions: We conclude that 1) pancreatic elastase in stool enable the segmentation of individuals into distinct subgroups of EPI. 2) pancreatic elastase in stool enables identification of not only overt EPI but those with minimal and moderate EPI. 3) therapy with pancreatic enzyme preparations can be individualized based upon the concentration of pancreatic elastase in stools. 4) individuals with “subclinical” EPI with stool elastase level of 100-500 improve with treatment.