John Leeds

This is the John Leeds introduction section

John Leeds

This is John's contents section. 

Introduction

Obvious exocrine pancreatic disease often presents late in its course but there is evidence that it may present earlier with more subtle symptoms.REFS Some recent studies have tried to identify patients presenting earlier and have used other markers such as faecal elastase-1 or serum protein markers.REFS Many of these studies are retrospective and have not had a robust assessment of known risk factors including alcohol, smoking status and presence of diabetes.REFS The most recent studies have also not performed multivariate analysis to identify those risk factors which are independently associated with exocrine pancreatic disease. Imaging of the pancreas was not performed in all patients to assess for structural abnormalities and response to treatment has been open labelled and not robustly carried out.REFS Early identification of exocrine pancreatic disease offers the opportunity to potentially alter the course of the disease by influencing modifiable risk factors such as smoking and alcohol. The latest assessments would suggest that around 13% of patients referred to secondary care gastroenterology services have a low faecal elastase suggestive of exocrine pancreatic insufficiency (EPI). Many of these patients had normal cross sectional imaging. Similarly, many of these studies mix together patients with EPI and chronic pancreatitis (CP). Whilst both commonly go together, there are a number of other causes of EPI not due to CP and this requires clarification. There is yet to be a study looking at patients referred to gastroenterology clinics which prospectively assesses all of these features and is able to robustly identify those features which independently associate with EPI and/or CP. Furthermore, the dose range of treatment in such studies has been wide (30,000 -240,000 units of lipase per day) and not consistently managed or monitored. Imaging of the pancreas in such studies has also been suboptimal. 

 

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