Research Progress in the Diagnosis and Treatment Drugs of Pancreatic Exocrine Insufficiency
Objective To provide a reference for the diagnosis of pancreatic exocrine insufficiency(PEI)and pancreatic enzyme replacement therapy(PERT).Methods The PEI-related studies in the PubMed,CNKI and WanFang databases from January 2009 to June 2022 were searched to analyze the epidemiological characteristics,etiology,clinical characteristics,diagnosis of PEI,exocrine function evaluation methods,the treatment timing and medication selection of PERT.The approved pancreatic enzyme preparations,relevant ingredients and the attentions for their use were summarized.Results The secretion function of the pancreas was regulated by nerves and hormones.The mechanisms of PEI included loss of pancreatic parenchyma,inhibition or inactivation of pancreatic secretion function and imbalance of postoperative pancreatic secretion function.The common etiologies of PEI were chronic pancreatitis and pancreatic cancer in adults,and cystic fibrosis in children.The gold standard for PEI diagnosis was the 72-hour fecal fat test,but it had gradually been replaced by the fecal elastase-1(FE-1)test,and the pancreatic exocrine function was evaluated by multidisciplinary methods.PERT was the preferred option for PEI recommended by relevant diagnostic and treatment standards,which can significantly improve the survival rate and quality of life of patients.A total of 18 commonly-used pancreatic enzyme preparations were approved by the United States,China,the United Kingdom and the European Union,including eight in China(five domestic and three imported drugs),in which the intestinal coating preparations with stable release,high stability to acids and ability to be used at high doses were the preferred drugs.There were limited studies involving the interaction between pancreatic enzymes and other drugs,which should be given attention in clinical medication.Conclusion Developing more accurate diagnostic methods for PEI and more stable and long-acting pancreatic enzyme preparations is of great significance for the treatment of PEI.This study expands the knowledge of PEI,improves clinical diagnosis and treatment regimens,promotes the utilization of PERT drugs,which can provide a reference for individualized clinical medication.
国家科技期刊平台
NSTL
万方数据
