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dc.contributor.authorSupot Pongprasobchaien_US
dc.contributor.otherMahidol Universityen_US
dc.date.accessioned2018-10-19T05:36:22Z-
dc.date.available2018-10-19T05:36:22Z-
dc.date.issued2013-01-01en_US
dc.identifier.citationJournal of Gastroenterology and Hepatology (Australia). Vol.28, No.S4 (2013), 99-102en_US
dc.identifier.issn14401746en_US
dc.identifier.issn08159319en_US
dc.identifier.other2-s2.0-84897661750en_US
dc.identifier.urihttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84897661750&origin=inwarden_US
dc.identifier.urihttp://repository.li.mahidol.ac.th/dspace/handle/123456789/32620-
dc.description.abstractPancreatic exocrine insufficiency (PEI) is one of the long-term consequences of chronic pancreatitis (CP). Majority of patients with PEI were undiagnosed or undertreated. Inadequately treated or subclinical severe PEI causes malnutrition and may pose the patients at risk of premature atherosclerosis and cardiovascular events. Indication of pancreatic enzyme replacement therapy (PERT) is patients with severe PEI, as indicated by the presence of steatorrhea, diarrhea, weight loss, fecal fat >7g/day, 13C-mixed triglyceride breath test <29%, fecal elastase <100ug/g stool, imaging or endoscopic findings of pancreatic ductal dilatation or calculi, and eight endosonographic criteria of CP. The mainstay treatment of PEI is PERT. Dietary fat restriction is unnecessary. PERT with lipase >40000U per meal is recommended. Enteric-coating may be preferred to conventional enzymes because of the availability of high-dose preparations and no need of acid suppression co-therapy. Administration of enzymes with meals is proven to be the most effective regimen. Response to PERT should be measured by the improvement of patients' symptoms, nutritional status, and, in selected cases, by fecal fat or 13C-mixed triglyceride breath test. Patients unresponsive to PERT should be checked for compliance, increase the dose of lipase to 90000 units/meal or co-therapy with proton pump inhibitor. In patient with previous gastrointestinal surgery that may interfere enzyme-food mixing, opening the capsules and administering the enzyme granules with meals. Finally, search for small intestinal bacterial overgrowth syndrome and other causes of small bowel malabsorption. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.en_US
dc.rightsMahidol Universityen_US
dc.source.urihttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84897661750&origin=inwarden_US
dc.subjectMedicineen_US
dc.titleMaldigestion from pancreatic exocrine insufficiencyen_US
dc.typeArticleen_US
dc.rights.holderSCOPUSen_US
dc.identifier.doi10.1111/jgh.12406en_US
Appears in Collections:Scopus 2011-2015

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