J Gastrointestin Liver Dis, September 2016 Vol. 25 No 3: 303-309 1) Academic Department of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Shefeld, Shefeld, S10 2RX, UK 2) Department of Gastroenterology, Royal Hallamshire Hospital, Shefeld S10 2JF, UK 3) James Cook University Hospital, Middlesbrough, TS4 3BW, UK 4) Johns Hopkins Aramco Hospital, Dhahran 34465, Saudi Arabia Address for correspondence: Dr Jennifer A. Campbell, Clinical Fellow in Gastroenterology, Room P39, Dept of Gastroenterology, Royal Hallamshire Hospital, Glossop Road, Shefeld, S10 2JF, UK Jennifer.campbell@sth.nhs.uk Received: 18.05.2016 Accepted: 01.08.2016 Should we Investigate Gastroenterology Patients for Pancreatic Exocrine Insufciency? A Dual Centre UK Study Jennifer A. Campbell 1,2 , David S. Sanders 1,2 , Katherine A. Francis 2 , Matthew Kurien 1 , Sai Lee 3 , Hatim Taha 3 , Arvind Ramadas 3 , Diamond Joy 3,4 , Andrew D. Hopper 2 INTRODUCTION Post mortem studies suggest that chronic pancreatitis (CP) afects 6 to 12% of the general population [1-3]. There is, however, a mismatch between these reports and the incidence of clinically reported CP. Internationally the range is reported from 4.05-13.4/100,000 [4, 5]. It has been suggested that pancreatic exocrine insufficiency (PEI) may be an ORIGINAL PAPER ABSTRACT Background & Aims: Pancreatic exocrine insufciency may be under recognised in gastroenterological practice. We aimed to identify the prevalence of pancreatic insufciency in secondary care gastroenterology clinics and determine if co-morbidity or presenting symptoms could predict diagnosis. A secondary aim was to assess response to treatment. Methods: A dual centre retrospective analysis was conducted in secondary care gastroenterology clinics. Patients tested for pancreatic exocrine insufciency with faecal elastase-1 (FEL-1) between 2009 and 2013 were identifed in two centres. Demographics, indication and co-morbidities were recorded in addition to dose and response to pancreatic enzyme replacement therapy. Binary logistic regression was used to assess if symptoms or co-morbidities could predict pancreatic insufciency. Results: 1821 patients were tested, 13.1% had low FEL-1 (<200µg/g). Tis prevalence was sub-analysed with 5.4% having FEL-1 100-200µg/g (mild insufciency) and 7.6% having faecal elastase readings <100µg/g. Low FEL-1 was most signifcantly associated with weight loss or steatorrhoea. Co-morbidity analysis showed that low levels were signifcantly associated with excess alcohol intake, diabetes mellitus or human immunodefciency virus; 80.0% treated with enzyme supplements reported symptomatic beneft with no diference in response between high and low dose supplementation (p=0.761). Conclusion: Targeting the use of FEL-1 in individuals with specifc symptoms and associated conditions can lead to improved recognition of pancreatic exocrine insufciency in a signifcant proportion of secondary care patients. Intervening with lifestyle advice such as smoking cessation and minimising alcohol intake could improve outcomes. In addition, up to 80% of patients with low faecal elastase respond to supplementation. Key words: faecal elastase – pancreas – diarrhoea – pancreatic insufciency. Abbreviations: CFA: coefficient of fat absorption; CP: chronic pancreatitis; ELISA: enzyme-linked immune-absorbent assay; PEI: pancreatic exocrine insufciency; FEL-1: faecal elastase-1; HIV: human immunodefciency virus; IBD: infammatory bowel disease; IBS: irritable bowel syndrome; PERT: pancreatic enzyme replacement therapy. Available from: http://www.jgld.ro/wp/archive/y2016/n3/a9 DOI: http://dx.doi.org/10.15403/jgld.2014.1121.253.uks early manifestation of CP [6]. Te prevalence of PEI has been reported between 11.5% and 21.7% in individuals without pre-existing gastrointestinal disease [7, 8]. Each year in the United Kingdom, around 11,000 new cases of PEI are diagnosed [9]. Current recommendations suggest screening for PEI in patients presenting with diarrhoea [10]. If faecal elastase-1 (FEL-1) is checked only when features of advanced malabsorption and pancreatic disease are present (e.g. steatorrhoea), cases of subclinical PEI and early CP could be missed. Missing the opportunity to intervene with pancreatic enzyme replacement therapy (PERT) may result in more complications of exocrine failure developing [11]. Tese complications include malabsorption of fat soluble vitamins, osteoporosis and carbohydrate and protein malabsorption [12].