Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist. These include pancreatic tumors, pancreatic resection procedures, and cystic fibrosis. Other diseases and conditions, such as diabetes mellitus, celiac disease, inflammatory bowel disease, and advanced patient age, have also been shown to be associated with EPI, but the exact etiology of EPI has not been clearly elucidated in these cases. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Pancreatic enzyme replacement therapy (PERT) is indicated for the conditions described above presenting with clinically clear steatorrhea, weight loss, or symptoms related to maldigestion and malabsorption. This review summarizes the current literature concerning those etiologies of EPI less common than chronic pancreatitis, the pathophysiology of the mechanisms of EPI associated with each diagnosis, and treatment recommendations.

• Keywords
• celiac disease, cystic fibrosis, diabetes, exocrine pancreatic insufficiency, inflammatory bowel disease, microbiome, pancreatic cancer, pancreatic enzyme replacement therapy, pancreatic resection, surgery,
• Publication type
• Journal Article MeSH
• Review MeSH

Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic mesenteric ischaemia remains an underappreciated and undertreated disease entity. Probable explanations are the lack of knowledge and awareness among physicians and the lack of a gold standard diagnostic test. The underappreciation of this disease results in diagnostic delays, underdiagnosis and undertreating of patients with chronic mesenteric ischaemia, potentially resulting in fatal acute mesenteric ischaemia. This guideline provides a comprehensive overview and repository of the current evidence and multidisciplinary expert agreement on pertinent issues regarding diagnosis and treatment, and provides guidance in the multidisciplinary field of chronic mesenteric ischaemia.

• Keywords
• Median arcuate ligament syndrome, atherosclerosis, coeliac artery release, mesenteric arteries, mesenteric artery stenting,
• MeSH
• Mesenteric Arteries diagnostic imaging   MeSH
• Chronic Disease epidemiology   therapy   MeSH
• Computed Tomography Angiography MeSH
• Gastroenterology methods   standards   MeSH
• Risk Assessment methods   MeSH
• Contrast Media administration & dosage   MeSH
• Magnetic Resonance Angiography methods   MeSH
• Evidence-Based Medicine methods   standards   MeSH
• Mesenteric Ischemia diagnosis   epidemiology   therapy   MeSH
• Interdisciplinary Communication MeSH
• Radiology methods   standards   MeSH
• Societies, Medical standards   MeSH
• Severity of Illness Index MeSH
• Patient Care Team standards   MeSH
• Treatment Outcome MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Practice Guideline MeSH
• Geographicals
• Europe MeSH
• Names of Substances
• Contrast Media MeSH