Management of pancreatic exocrine insufficiency: Australasian Pancreatic Club recommendations.

• Pancreatic exocrine insufficiency (PEI) occurs when the amounts of enzymes secreted into the duodenum in response to a meal are insufficient to maintain normal digestive processes. • The main clinical consequence of PEI is fat maldigestion and malabsorption, resulting in steatorrhoea. • Pancreatic exocrine function is commonly assessed by conducting a 3-day faecal fat test and by measuring levels of faecal elastase-1 and serum trypsinogen. • Pancreatic enzyme replacement therapy is the mainstay of treatment for PEI. • In adults, the initial recommended dose of pancreatic enzymes is 25000 units of lipase per meal, titrating up to a maximum of 80000 units of lipase per meal. • In infants and children, the initial recommended dose of pancreatic enzymes is 500 units of lipase per gram of dietary fat; the maximum daily dose should not exceed 10000 units of lipase per kilogram of bodyweight. • Oral pancreatic enzymes should be taken with meals to ensure adequate mixing with the chyme. • Adjunct therapy with acid-suppressing agents may be useful in patients who continue to experience symptoms of PEI despite high-dose enzyme therapy. • A dietitian experienced in treating PEI should be involved in patient management. • Dietary fat restriction is not recommended for patients with PEI. • Patients with PEI should be encouraged to consume small, frequent meals and to abstain from alcohol. • Medium-chain triglycerides do not provide any clear nutritional advantage over long-chain triglycerides, but can be trialled in patients who fail to gain or to maintain adequate bodyweight in order to increase energy intake.