Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.6927
Peer-review started: July 27, 2017
First decision: August 30, 2017
Revised: September 7, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: October 14, 2017
Processing time: 81 Days and 15.2 Hours
Chronic pancreatitis (CP) is an inflammatory disease of the pancreas evolving in progressive fibrotic disruption of the gland with exocrine and endocrine pancreatic insufficiency. Although imaging features of CP are well known, their correlation with exocrine pancreatic function tests are not obvious, particularly in the early stage of the disease. There are many clinical classification of CP, all suggested for better distinguish and manage different forms based on etiological and clinical factors, and severity of the disease. Recently, a new classification of CP has been suggested: the M-ANNHEIM multiple risk factor classification that includes etiology, stage classification and degree of clinical severity. However, more accurate determination of clinical severity of CP requires a correct determination of exocrine function of the pancreas and fecal fat excretion. Recently, Kamath et al demonstrated that the evaluation of exocrine pancreatic function by acid steatocrit and fecal elastase-1 (EF-1) was helpful, but EF-1 was able to detect exocrine pancreatic insufficiency in more patients, upgrading some patients in higher stage of disease according to M-ANNHEIM classification. So, EF-1 is a more accurate test to determine exocrine pancreatic insufficiency and to stage chronic pancreatitis in the M-ANNHEIM classification. On the contrary, EF-1 determination shows low sensitivity in detecting exocrine pancreatic insufficiency in early stage of the disease.
Core tip: Classification of chronic pancreatitis is useful for planning adequate diagnosis and management of the disease, particularly in the early detection and prevention of related-complications. Recognition of pancreatic exocrine insufficiency is useful for graduating severity of chronic pancreatitis in modern classification systems, and fecal elastase determination appears the better method in term of simplicity and sensitivity to stage exocrine function of the pancreas. However, sensitivity of elastase-1 is low in early stage of chronic pancreatitis, and new diagnostic tools or combination of different procedures are needed to better stage pancreatic function.