Chronic pancreatitis and pancreatic cancer; the clinical aspects and treatment of pancreatic exocrine insufficiency

textabstractIn exocrine pancreatic insufficiency, the pancreas is unable to deliver a sufficient quantity of pancreatic enzymes to the small intestine to digest food. It may occur in several life threatening diseases, including chronic pancreatitis and pancreatic cancer. Due to this lack or absence of pancreatic enzymes, malabsorption of fat develops, which causes steatorrhea-related symptoms, weight loss, and malnutrition. To reduce morbidity and even mortality, patients should be treated with a sufficient amount of oral pancreatic enzymes. In clinical practice, enzyme supplementation therapy seems to be a challenge, because the optimal enzyme dose is highly variable, depending on the remaining pancreatic function, the postsurgical anatomy, and dietary fat content. Unfortunately, this seems to be an underexposed topic (as the literature overview in chapter 2 shows), and physicians are often not well informed about the need to supplement exocrine insufficiency in a patient-tailored manner. In addition, exocrine insufficiency is frequently overlooked, because the primary attention is directed towards treatment of the underlying disease. Despite the seriousness of this condition, so far, both research and guidelines have given very little attention to the importance of diagnosing and optimizing treatment efficacy of exocrine pancreatic insufficiency. The general aim of this thesis was to explore various clinical aspects of exocrine pancreatic insufficiency in chronic pancreatitis and pancreatic cancer. First, an attempt was made to gain insight in the current practice of enzyme supplementation, in particular the prevalence of under-treatment and its consequences. Furthermore, possible strategies to improve treatment outcome were researched