{
  "abstract": "Introduction Pancreatic exocrine insufficiency (PEI) is common in pancreatic cancer; UK consensus guidance recommends empirical pancreatic enzyme replacement therapy (PERT) as improved survival has been demonstrated. In contrast, PEI prevalence across other pancreatic disease subtypes is heterogeneous, and empirical PERT risks overtreatment. We evaluated PEI prevalence across pancreatic disease subtypes using faecal elastase-1 (FE-1) testing in a dual-centre cohort to help guide PERT initiation.Methods A retrospective service evaluation was performed across two UK centres, including patients with known pancreatic disease who underwent faecal elastase-1 (FE-1) testing between 2018–2023 at one centre and 2022–2024 at the other. PEI was defined as FE-1 <200 µg/g (severe <100 µg/g). Associations were assessed using chi-squared or Fisher’s exact tests.Results A total of 236 patients with pancreatic disease underwent FE-1 testing. Median age 65 (IQR 54-76); 53.8% female. Low FE-1 (<200 µg/g) was identified in 83/236 (35.2%), including 60/236 (25.4%) with FE-1 <100 µg/g, and was more common in males (46.8% vs 25.2%; OR 2.61, p=0.001). Increasing age was inversely associated with low FE-1 (OR 0.77 per decade; p=0.005) within this pancreatic disease cohort.Pancreatic phenotypes included pancreatic atrophy (77/236), previous acute pancreatitis (AP; 76/236), chronic pancreatitis (CP; 67/236), cystic lesions/IPMN (21/236), ductal abnormalities (11/236), prior pancreatic surgery (7/236), pancreatic cancer (4/236), and autoimmune (AI) pancreatitis (3/236).Within this cohort, weight loss (OR 1.88; p=0.025) and steatorrhoea (OR 5.88; p=0.03) were associated with low FE-1; other GI symptoms were not.PEI prevalence varied by pancreatic phenotype and was highest in progressive or tissue-ablative disease: 1) Prior pancreatic surgery: 6/7 (85.7%) had FE-1 <200 µg/g, 5/7 (71.4%) had FE-1 <100 µg/g, 2) Pancreatic cancer: 3/4 (75.0%) had FE-1 <200 µg/g, all 3 with FE-1 <100 µg/g, 3) AI pancreatitis: 2/3 (66.7%) had a low FE-1, both were <100 µg/g, 4) Ductal abnormalities: 6/11 (54.5%) had FE-1 <200 µg/g, 4/11 (36.4%) had FE-1 <100 µg/g 5) CP: 32/67 (47.8%) had FE-1 <200 µg/g, 26/67 (38.8%) had FE-1 <100 µg/g.In contrast, conditions reflecting prior injury or radiological change had lower PEI prevalence: 1) Previous AP: 24/76 (31.6%) had FE-1 <200 µg/g, 21/76 (27.6%) had FE-1 <100 µg/g, 2) Pancreatic atrophy: 24/77 (31.2%) had FE-1 <200 µg/g, 10/77 (13.0%) had FE-1 <100 µg/g, 3) Cystic lesions/IPMN: 6/21 (28.6%) had FE-1 <200 µg/g, 5/21 (23.8%) had FE-1 <100 µg/g .Conclusion PEI prevalence varies substantially by pancreatic phenotype, being highest in patients with prior pancreatic surgery and pancreatic cancer. Outside these conditions, our findings support targeted FE-1 testing to guide PERT rather than blanket empirical treatment.",
  "authors": [
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Connor Cotton"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Chesterfield Royal Hospital, Chesterfield, United Kingdom"
      ],
      "name": "Peter Evans"
    },
    {
      "affiliations": [
        "Department of Translational Medicine, University of Ferrara, Ferrara, Italy"
      ],
      "name": "Francesca Manza"
    },
    {
      "affiliations": [
        "Department of Molecular Medicine, University of Pavia, Pavia, Italy"
      ],
      "name": "Pashmi Liyanage"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Chesterfield Royal Hospital, Chesterfield, United Kingdom"
      ],
      "name": "Anju Gurung"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Aishwarya Devanand"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Suneil Raju"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom",
        "Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom"
      ],
      "name": "Andrew Hopper"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom",
        "Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom"
      ],
      "name": "David Sanders"
    }
  ],
  "title": "P159 Does pancreatic disease phenotype predict exocrine insufficiency? A dual-centre prevalence study",
  "uid": "7f3331d6-dbb4-5bc8-8214-7745ff9efa96"
}