UPDATED APPROACH TO EXOCRINE PANCREATIC INSUFFICIENCY: 2023 GUIDELINES

• DOI: https://doi.org/10.22533/at.ed.1594592426067

• Palavras-chave: Exocrine Pancreatic Insufficiency; Treatment; Diagnosis; Clinical manifestations.

• Keywords: Exocrine Pancreatic Insufficiency; Treatment; Diagnosis; Clinical manifestations.

• Abstract:

  Objective: To analyze the signs, diagnoses and treatments for Exocrine Pancreatic Insufficiency (EPI), according to 2023 updates, aiming to improve identification and management. Methodology: Bibliographic review structured by the PVO strategy, through the PubMed – MEDLINE database, through the search strategy: (Exocrine Pancreatic Insufficiency) AND (Management) AND ((2023) OR (Updates) OR (Guidelines), with results of 121 articles, from 2023 and 2024, and, after applying the inclusion and exclusion criteria, 16 articles remained. Review: It is noted that the symptoms of EPI are steatorrhoea/diarrhea, abdominal pain, bloating, weight loss, hypovitaminosis and, in children, developmental delay. The diagnosis is made in clinical evaluation, essential to avoid underdiagnosis, and after complementary exams: fecal elastase test, respiratory tests and pancreatic enzymes in the blood, endoscopic test, secretin-stimulated test, computed tomography, magnetic resonance imaging, endoscopic ultrasonography and Endoscopic retrograde cholangiopancreatography. Less commonly used tests are fecal fat collection and disaccharidase tests, in addition to genetic tests. Treatment must be early and consists of nutritional assessment and development of a therapeutic plan, with pancreatic enzyme replacement therapy (PERT) and lifestyle changes. PERT must be taken throughout the meal for better absorption. A new product for EPI is Encala (Envara Health), which does not depend on enzymes and offers good results. Restricted fat diets are a concern for compromising the absorption of vitamins and reducing the effectiveness of PERT. Final considerations: Exocrine pancreatic insufficiency (EPI) is characterized by poor digestion and absorption of nutrients, with symptoms such as steatorrhea and abdominal pain. Early diagnosis is crucial, especially in patients at high risk due to conditions such as chronic pancreatitis. Diagnostic methods include laboratory and imaging tests, and treatment focuses on enzyme replacement and lifestyle adjustments. There is a continued need for research to optimize the diagnosis and treatment of EPI.