부산대학교 도서관

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in the pancreatic enzymes available in the small bowel for digestion to a level that results in malabsorption and maldigestion. PEI can lead to fat malabsorption, micronutrient deficiencies, weight loss and malnutrition-related complications such as osteoporosis and loss of skeletal muscle. Fat malabsorption in severe PEI can cause steatorrhoea but milder symptoms include diarrhoea, abdominal pain, and abdominal bloating termed 'maldigestion' are non-specific and may not trigger testing for PEI causing the diagnosis to be overlooked. Early detection and treatment of PEI can improve patient's symptoms, quality of life and reduce complications. The two major causes of PEI are chronic pancreatitis (CP) and pancreatic cancer, but other diseases have been reported to be associated with PEI termed 'at-risk' conditions and include diabetes mellitus, people living with human immunodeficiency virus, and patients admitted to hospital with high alcohol intake, however, there is a lack of guidance about testing for PEI in 'at-risk' conditions. Gold standard tests to directly measure exocrine secretion to diagnose PEI are invasive, and not widely available. A stool sample to test for faecal elastase-1 (FEL-1) is currently the most common test used in practice to diagnose PEI. FEL-1 is inexpensive, easy to handle by laboratory staff and widely available, however, it has been shown to lack sensitivity especially in mild PEI. The null hypothesis set out is: pancreatic exocrine insufficiency is adequately recognised in 'at-risk' groups and other methods to test for the consequences of PEI are unhelpful. This body of work aims to quantify the prevalence of PEI in at-risk group and identify positive and negative predictive parameters in order to aid diagnosis, investigation and treatment; this will be done by performing studies to answer the following four questions: Study 1: What is the current practice and yield of testing for pancreatic exocrine insufficiency in 'at-risk' patients? Study 2: Is there a role for micronutrient deficiencies in diagnosing pancreatic exocrine insufficiency? Study 3: Can a skeletal muscle index measurement be used as diagnostic tool for the detection of pancreatic exocrine insufficiency? Study 4: Can a skeletal muscle index measurement in patients with pancreatic cancer at high risk of pancreatic exocrine insufficiency predict prognosis and aid treatment plan?