[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-508683-105":59,"doc-detail-508683-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","pancreatic-exocrine-insufficiency-guidelines-more-questions-than-answers","Pancreatic exocrine insufficiency guidelines: more questions than answers!","","Editorial commentary analyzing pancreatic exocrine insufficiency (PEI) management guidelines and diagnostic challenges. It highlights that PEI is a maldigestion–malabsorption disorder caused by reduced pancreatic digestive enzyme activity, yet key issues remain: no standardized definition, reliance on limited diagnostic signals, and weak guideline recommendations supported by low- to moderate-quality evidence. The discussion addresses fecal elastase-1 testing constraints, clinical contextualization, and the risks of over- or prolonged pancreatic enzyme replacement therapy after acute necrotizing pancreatitis.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pancreatic-exocrine-insufficiency-guidelines-more-questions-than-answers/508683/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pancreatic-exocrine-insufficiency-guidelines-more-questions-than-answers/508683.png","ImageObject",300,407,{"name":92,"@type":93},"adawds","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-09","2026-10-05",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why do the UK practical guidelines for PEI still leave “more questions than answers”?","Question",{"text":112,"@type":113},"The commentary notes that although most guideline statements reached high panel agreement, the strength of recommendations was weak and evidence quality was low to moderate due to limited high-quality studies.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What is the main problem with current PEI diagnosis in clinical practice?",{"text":117,"@type":113},"There is no standardized definition for PEI, and clinicians often rely mainly on decreased pancreatic enzyme output and FE-1, while other important PEI domains may be overlooked in decision-making.",{"name":119,"@type":110,"acceptedAnswer":120},"What are key cautions when interpreting fecal elastase-1 (FE-1) results?",{"text":121,"@type":113},"The article emphasizes that FE-1 interpretation must be clinically contextualized, and that stool water content can affect results (liquid stool may cause false positives), so clinicians should consider specimen consistency and patient context.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},508683,1791513192,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},3985747872983,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Editorial Commentary  \nPancreatic exocrine insufficiency guidelines: more questions than answers!  \nNikhil Bush, Vikesh K. Singh  \nDivision of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Correspondence to: Vikesh K. Singh, MD, MSc. Division of Gastroenterology, Johns Hopkins Medical Institutions, 1830 E. Monument Street, Room  \n428, Baltimore, MD 21287, [USA. Email: vsingh1@jhmi.edu](USA. Email: vsingh1@jhmi.edu).  \nComment on: Phillips ME, Hopper AD, Leeds JS, et al. Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines. BMJ Open Gastroenterol 2021;8:e000643 .  \nKeywords: Pancreatic exocrine insufficiency (EPI); pancreatic enzyme replacement therapy (PERT); fecal elastase-1 (FE-1); chronic pancreatitis  \nSubmitted Apr 24, 2023. Accepted for publication May 10, 2023. Published online May 22, 2023.  \ndoi: 10.21037/hbsn-23-214  \nView this article at: [https://dx.doi.org/10.21037/hbsn-23-214](https://dx.doi.org/10.21037/hbsn-23-214)  \nPancreatic exocrine insufficiency (PEI) has classically been described as a maldigestive disorder resulting from decreased secretion or altered function of pancreatic digestive enzymes (1) . As a result of this maldigestion and ensuing malabsorption, patients can experience symptoms such as steatorrhea and weight loss as well as complications related to the loss of fat-soluble vitamins and micronutrients. PEI has been most extensively studied in cystic fibrosis, but other causes include acute and chronic pancreatitis (CP), pancreatic adenocarcinoma (PDAC), and rarely, congenital syndromes such as Shwachman-Diamond and Johnson-Blizzard (2) .  \nThe recent United Kingdom (UK) practical guidelines for the management of PEI by Phillips et al. (3) represent oneof the very few guidelines utilizing GRADE methodology to develop management recommendations for clinicians caring for patients with PEI. While most statements in the guideline achieved >90% agreement among a panel of 48 pancreatic specialists, the strength of the recommendations was weak, and the quality of evidence was low to moderate. This is due to the fact that there are a paucity of high quality studies in PEI and the few trials conducted to date have been primarily to evaluate different pancreatic enzyme replacement therapy (PERT) formulations for regulatory approval. As a result, PEI is one of those conditions where more is known about the treatment than the condition itself.  \nThere continues to be no standardized definition for PEI. The UK guidelines define PEI as the loss of functioning pancreatic parenchyma and/or reduced secretion of  \npancreatic digestive enzymes that overemphasizes the role of pancreatic enzyme production and secretion. The recent American College of Gastroenterology guidelines on CP describes PEI as a syndrome consisting of 4 domains including nutritional need, nutritional intake, decreased pancreatic digestive enzyme output, and intestinal adaptation (3) . However, decreased pancreatic enzyme output is typically the only factor that clinicians rely on to diagnose PEI and administer PERT. The incorporation of the other PEI domains into clinical decision making are just as important. For instance, a clinician may decide not to start anasymptomatic obese patient with a low FE-1 but normal fatsoluble vitamin and micronutrient levels on PERT.  \nFE-1 is the most frequently used laboratory test to diagnose PEI owing to its low cost, convenience, and wide availability. The coefficient of fat absorption (CFA), determined through a 72-h fecal fat collection, is the criterion standard for diagnosing steatorrhea and not PEI despite often being considered as such by clinicians (4) . The UK guidelines highlight the importance of adjusting for the water content in a stool specimen when testing for FE-1, as liquid stool can be associated with false positive results. However, not all laboratories adjust the water content","cbCaijvXmRG3fkgx","https://ap.wps.com/l/cbCaijvXmRG3fkgx","pdf",148829,"English","# Editorial Commentary\n## Challenges in definition and diagnosis of PEI\n## Laboratory testing: fecal elastase-1 (FE-1) and interpretation\n## When to use PERT, especially after acute necrotizing pancreatitis","[{\"question\":\"Why do the UK practical guidelines for PEI still leave “more questions than answers”?\",\"answer\":\"The commentary notes that although most guideline statements reached high panel agreement, the strength of recommendations was weak and evidence quality was low to moderate due to limited high-quality studies.\"},{\"question\":\"What is the main problem with current PEI diagnosis in clinical practice?\",\"answer\":\"There is no standardized definition for PEI, and clinicians often rely mainly on decreased pancreatic enzyme output and FE-1, while other important PEI domains may be overlooked in decision-making.\"},{\"question\":\"What are key cautions when interpreting fecal elastase-1 (FE-1) results?\",\"answer\":\"The article emphasizes that FE-1 interpretation must be clinically contextualized, and that stool water content can affect results (liquid stool may cause false positives), so clinicians should consider specimen consistency and patient context.\"}]","Pancreatic exocrine insufficiency guidelines: more questions than answers! | PDF",1791231929]