Abstract
European evidence-based guidelines for the treatment and management of chronic pancreatitis (CP) have been made available following the harmonizing diagnosis and treatment of CP across Europe (HaPanEU) initiative by the United European Gastroenterology (UEG). The aim of this study was to evaluate adherence to the guideline recommendations in the management of patients with pancreatic exocrine insufficiency (PEI) at Karolinska University Hospital in Stockholm. UEG guideline recommendations were evaluated and categorized into 55 different quality indicators (QIs). Data from a retrospective cohort of CP patients being treated at Karolinska University Hospital were evaluated with regard to overall adherence as well as adherence to specific QIs. A total number of 118 patients out of 956 patients diagnosed with CP were eligible for inclusion with mean overall adherence of 61.9% to the defined QIs. A significant difference in mean overall adherence was shown between patients diagnosed with CP prior to 1 January 2016 and following 1 January 2016 (59.3% and 67.7% respectively, p = 0.004), with linear regression analysis also demonstrating improvement correlating to date of diagnosis (p = 0.002). In conclusion, diagnosis and treatment of PEI improved after the HaPanEU guidelines became available and is continuously improving; however, there is room for further improvement.
Highlights
Chronic Pancreatitis (CP) is an irreversible, progressive and chronic inflammatory disease-causing life-altering disorders and disabilities in a significant proportion of affected individuals [1,2]
In addition to reduced mean life expectancy with a median survival of 15–20 years following diagnosis [3], many chronic pancreatitis (CP) patients suffer significantly reduced quality of life owing to the development of debilitating complications and sequalae, such as chronic pain, diabetes mellitus (DM), pancreatic cancer and pancreatic exocrine insufficiency (PEI), the latter being indicative of an advanced disease stage affecting more than 90% of the pancreatic gland [2,4]
In order to address this multifaceted spectrum of disease presentation, progression, and complications, treatment of CP requires a multidisciplinary approach with the involvement of pharmacologic treatment, lifestyle modifications including dietary counseling for nutritional rehabilitation and possible surgical or endoscopic interventions [8,9]
Summary
Chronic Pancreatitis (CP) is an irreversible, progressive and chronic inflammatory disease-causing life-altering disorders and disabilities in a significant proportion of affected individuals [1,2]. While epidemiologic data on CP patients are unreliable due to high variability in clinical presentation and difficulties in following long-term progression, salient studies have estimated an annual incidence of up to 13/100,000 people and a prevalence of 41/100,000 people [2,3]. In addition to reduced mean life expectancy with a median survival of 15–20 years following diagnosis [3], many CP patients suffer significantly reduced quality of life owing to the development of debilitating complications and sequalae, such as chronic pain, diabetes mellitus (DM), pancreatic cancer and pancreatic exocrine insufficiency (PEI), the latter being indicative of an advanced disease stage affecting more than 90% of the pancreatic gland [2,4].
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