Response to Talukdar et al

摘要

We read with interest the letter by Talukdar and Reddy on the rational use of pancreatic enzymes in patients with chronic pancreatitis (CP) [1]. Accepting the fact that CP is a complex disease, with different etiologies, pathogenic mechanisms and natural history, pancreatic exocrine insufficiency (PEI) is consistently a common event in the advanced phase of the disease. Diagnosis of PEI in clinical practice is a challenge since pancreatic function tests (mainly coefficient of fat absorption and ~(13)C-mixed triglyceride -MTG- breath test) are not available in most centers worldwide [2]. Because of that, diagnosis of PEI is usually based on symptoms. Contrarily to what is said by Talukdar and Reddy, this runs the risk of undertreating these patients. Actually, asymptomatic PEI is frequent in CP and these patients consistently have nutritional deficiencies [3].