Hrvatske smjernice za liječenje egzokrine pankreasne insuficijencije

Professional paper - Professional paper

• Title (english): Croatian guidelines for the management of pancreatic exocrine insufficiency
• Author: Nadan Rustemović
• Author: Željko Krznarić
• Author: Darija Vranešić Bender
• Author: Rajko Ostojić
• Author: Silvija Čuković Čavka
• Author: Sandra Milić
• Author: Branimir Anić
• Author: Neven Ljubičić
• Author: Jasna Mesarić
• Author: Davor Štimac
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Pancreatic exocrine insufficiency is a major consequence of pancreatic diseases (e. g. chronic pancreatitis and cystic fibrosis), extrapancreatic diseases like celiac disease and Crohn's disease, and gastrointestinal and pancreatic surgical resections. Recognition of this entity is highly relevant to avoid malnutrition-related morbidity and mortality. The main clinical consequence of PEI is fat maldigestion and malabsorption, resulting in steatorrhoea. Pancreatic exocrine function should be assessed by measuring levels of faecal elastase-1. Pancreatic enzyme replacement therapy is the mainstay of treatment for PEI. Administration of enzymes in form of enteric-coated minimicrospheres avoids acid-mediated lipase inactivation and ensures gastric emptying of enzymes in parallel with nutrients. In adults, the initial recommended dose of pancreatic enzymes is 25.000 units of lipase per meal, titrating up to a maximum of 80000 units of lipase per meal. Large meals require 25.000 - 80.000 units of lipase per meal while snacks require 10.000 - 40.000 units of lipase per meal. 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. Patients with PEI should be encouraged to consume small, frequent meals and to abstain from alcohol. Dietary fat restriction is not recommended for patients with PEI.

Abstract (croatian)

Egzokrina pankreasna insuficijencija posljedica je brojnih bolesti gušterače (poput kroničnog pankreatitisa ili
cistične fibroze) te ekstrapankreasnih bolesti poput celijakije i upalnih bolesti crijeva, ali nastaje i zbog promjena anatomskih
odnosa nakon resekcija pankreasa i kirurških zahvata na crijevima i želucu. Prepoznavanje i adekvatno liječenje
ovoga poremećaja bitno utječe na smanjenje najčešćih simptoma, poboljšanje nutritivnog statusa i posljedično smanjenje
morbiditeta i mortaliteta. Osnovna klinička posljedica egzokrine pankreasne insuficijencije (EPI) jesu maldigestija i malapsorpcija,
u prvom redu masti i vitamina topljivih u mastima, što često rezultira steatorejom. Egzokrina funkcija gušterače
određuje se mjerenjem razina fekalne elastaze 1. Nadomjesna terapija enzimima gušterače okosnica je terapije EPI. Primjena
enzima u obliku obloženih minimikrosfera omogućuje otpornost u kiselome mediju i osigurava prijelaz enzima iz želuca
istodobno s hranom. U odraslih osoba preporučena doza pankreasnih enzima ovisi o težini pankreatične insuficijencije
te o veličini obroka i udjelu masti, a kreće se od 25.000 do 80.000 Ph. Eur. j. lipaze po obroku. Uz glavne obroke preporučuje
se od 25.000 do 80.000 Ph. Eur. j., a uz međuobroke 10.000 do 40.000 Ph. Eur. j. lipaze. Nadomjesnu enzimsku terapiju
potrebno je uzimati uz obrok kako bi se osiguralo adekvatno miješanje enzima s himusom. U bolesnika koji ne reagiraju
adekvatno na terapiju mogu se primijeniti znatno više doze enzima, a pritom se preporučuje pokušaj terapije inhibitorima
protonske pumpe. Bolesnici s EPI trebaju konzumirati manje, ali češće obroke uz potpunu apstinenciju od unosa alkohola.
Ograničenje unosa masti ne preporučuje se.

• Keywords (english): Exocrine Pancreatic Insufficiency/diagnosis; Exocrine Pancreatic Insufficiency/etiology; Exocrine Pancreatic Insufficiency/therapy; Humans
• Language: croatian
• Publication type: Professional paper - Professional paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Liječnički vjesnik
• Numbering: vol. 134, no. 5-6, pp. 141-147
• p-ISSN: 0024-3477
• URN:NBN: urn:nbn:hr:105:165960
• Publication: 2012-05
• Document URL: http://lijecnicki-vjesnik.hlz.hr/lijecnicki-vjesnik/hrvatske-smjernice-za-lijecenje-egzokrine-pankreasne-insuficijencije/
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-27 19:41:12