The majority of patients with chronic pancreatitis will eventually develop pancreatic exocrine insufficiency depending on the etiology of the disease. Half of the patients with chronic alcoholic pancreatitis will suffer from pancreatic exocrine insufficiency after 12 years from the onset of the disease.1 Apart from abdominal cramps and the typical characteristics of fatty stools associated learn more with steatorrhea (loose, greasy, foul-smelling voluminous stools that are difficult to flush), which are not always evident because patients tend to limit fat ingestion, the main clinical manifestation of pancreatic exocrine insufficiency is

malnutrition. In fact, maldigestion is the main cause of weight loss in patients with pancreatic exocrine insufficiency. These patients present with low circulating levels of micronutrients,

fat soluble vitamins and lipoproteins, which have been related to a high morbidity and mortality secondary to an increased risk of malnutrition-related complications and cardiovascular events.2 In fact, chronic pancreatitis is associated with a 4- to 5-fold increased risk of death compared to the general population matched by age and gender.3,4 Functional evaluation of the exocrine pancreas may be important to support the diagnosis of chronic pancreatitis in cases of inconclusive morphological findings on imaging methods. However, the most relevant role of the functional evaluation of the pancreas is the detection of primary

or secondary pancreatic insufficiency in patients with known pancreatic disease CB-839 cost find more or after gastrointestinal surgery, to aid in the indication of enzyme substitution therapy and to monitor the efficacy of this therapy. Quantification of the coefficient of fat absorption (CFA) after fecal fat determination by the classical Van de Kamer test is the gold standard for the diagnosis of fat maldigestion. Despite that, this test has several important disadvantages limiting its clinical applicability. Patients must keep on a standard diet containing around 100 g of fat daily for 5 consecutive days and collect the whole amount of feces produced over the last 3 days. This is not easy to comply for many patients. A three-day collection is needed to allow a sufficiently long period to reduce errors and variability. Not only patient compliance is a limitation for the fecal fat quantification but mainly difficulty in handling of stool samples in the lab. Stool samples collected over 3 days must be first homogenized and then processed according to a manual method that renders this test unpleasant and cumbersome. A methodology based on near infrared reflectance analysis (NIRA) has greatly simplified the quantification of fat in stool and thus helps enable the wide application of this test in clinical routine.5 Nevertheless, difficulties associated with patient compliance remain to be addressed.