Abstract：
There is cumulative evidence that pancreatic exocrine insufficiency (PEI) is under-recognised and can occur in patients with \'at-risk\' conditions. Thus, we aimed to assess the current practice and yield of requesting faecal elastase (FEL-1), an indicator of PEI, in patients with \'at-risk\' conditions. We prospectively recruited patients attending secondary care clinics with diabetes mellitus (DM), people living with HIV (PLHIV) and inpatients admitted to hospital with high alcohol intake (HAI). All patients underwent testing with FEL-1. Those patients with PEI (FEL-1 <200 μg/g) were contacted and offered a follow-up review in gastroenterology clinic. In total, 188 patients were recruited (HAI, n=78; DM, n=64; and PLHIV, n=46). Previous FEL-1 testing had not been performed in any of the patients. The return rate of samples was 67.9% for patients with HAI, 76.6% for those with DM and 56.5% for those with PLHIV. The presence of PEI was shown in 20.4% of patients with DM, 15.4% of patients with PLHIV and 22.6% in those with HAI. Diarrhoea and bloating were the most reported symptoms in followed-up patients with low FEL-1 (31.8% and 22.7% of patients, respectively). Follow-up computed tomography (CT) scans in those patients with PEI identified chronic pancreatitis changes in 13.6% and pancreatic atrophy in 31.8% of patients. These results suggest that there is a lack of testing for PEI in \'at-risk\' groups. Our findings also suggest that using FEL-1 to test for PEI in patients with DM, PLHIV and HAI has a significant impact, although further studies are required to validate these findings.
摘要：
有累积证据表明，胰腺外分泌功能不全（PEI）未被认识到，并且可能发生在有“高危”疾病的患者中。因此，我们旨在评估要求粪便弹性蛋白酶（FEL-1）的当前实践和产量，PEI的指标，在“有风险”的患者中。我们前瞻性招募了在二级护理诊所就诊的糖尿病（DM）患者，艾滋病毒感染者（PLHIV）和住院患者因酒精摄入量高（HAI）而入院。所有患者均接受FEL-1测试。接触PEI患者（FEL-1<200μg/g），并在胃肠病诊所进行随访。总的来说,招募了188名患者(HAI，n=78；DM，n=64；PLHIV，n=46）。先前未在任何患者中进行FEL-1测试。HAI患者的样本回报率为67.9%，DM患者为76.6%，PLHIV患者为56.5%。20.4%的DM患者出现PEI，15.4%的PLHIV患者和22.6%的HAI患者。腹泻和腹胀是低FEL-1随访患者中报告最多的症状（31.8％和22.7％的患者，分别)。PEI患者的后续计算机断层扫描（CT）扫描发现13.6％的慢性胰腺炎变化和31.8％的患者的胰腺萎缩。这些结果表明，在“高危人群”中缺乏对PEI的测试。我们的发现还表明，使用FEL-1测试DM患者的PEI，PLHIV和HAI具有重大影响，尽管需要进一步的研究来验证这些发现。
