Is pancreatic exocrine insufficiency an under-recognised diagnosis?

The prevalence of pancreatic exocrine insufficiency (PEI) has been estimated at 11.5% of population in adults aged 50-75 years old. Advanced disease can present with weight loss and malnutrition but early features may be subtle, for example diarrhoea, abdominal discomfort or bloating. These symptoms may not trigger screening for pancreatic dysfunction in routine clinical practice. The implications of a missed diagnosis of PEI include osteoporosis, malnutrition, chronic pain and increased morbidity. In some cases, patients may present with exocrine insufficiency due to underlying malignancy which requires identification and treatment.

PEI is easily screened for using faecal elastase-1 (FEL-1) in stool samples. Current recommendations from the British Society of Gastroenterology advocate checking pancreatic function in patients presenting with diarrhoea and other abdominal symptoms. FEL-1 is the most widely available test of pancreatic function and broadly speaking is acceptable to patients.

Data from post mortem studies assessing the prevalence of chronic pancreatitis (CP) in the general population estimate between 6 and 12% of individuals may be affected. CP is significantly associated with development of PEI. The risk of developing PEI increases with duration of disease.

The null hypothesis set out is: PEI is adequately recognised. This body of work aims to quantify the prevalence of chronic pancreatitis with a novel method- post mortem computed tomography. I will then examine the prevalence of PEI in secondary care and primary care. Finally, I will assess whether elastography can be employed to test for CP and predict PEI.