European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence‐based recommendations

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreaticexocrine secretion below the level that allows the normal digestion of nutrients.Pancreatic disease and surgery are the main causes of PEI. However, other con-ditions and upper gastrointestinal surgery can also affect the digestive function ofthe pancreas. PEI can cause symptoms of nutritional malabsorptionand deficiencies, which affect the quality of life and increase morbidity and mor-tality. These guidelines were developed following the United European Gastro-enterology framework for the development of high‐quality clinical guidelines. Aftera systematic literature review, the evidence was evaluated according to the OxfordCenter for Evidence‐Based Medicine and the Grading of RecommendationsAssessment, Development, and Evaluation methodology, as appropriate. State-ments and comments were developed by the working groups and voted on usingthe Delphi method. The diagnosis of PEI should be based on a global assessment ofsymptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzymereplacement therapy (PERT), together with dietary advice and support, are thecornerstones of PEI therapy. PERT is indicated in patients with PEI that is sec-ondary to pancreatic disease, pancreatic surgery, or other metabolic or gastro-enterological conditions. Specific recommendations concerning the management ofPEI under various clinical conditions are provided based on evidence and expertopinions. This evidence‐based guideline summarizes the prevalence, clinical impact,and general diagnostic and therapeutic approaches for PEI, as well as the specificsof PEI in different clinical conditions. Finally, the unmet needs for future researchare discussed.