Date: {{$ActivityAssignDate}}

Dear Dr. {{$doctorName}},

Subject: Understanding Usage of pancreatic enzyme replacement therapy (PERT) in patients of pancreatic exocrine insufficiency (PEI)

The pancreas is a major organ that regulates food digestion and absorption in harmonization with other organs. Pancreatic diseases are associated with deterioration of the pancreatic parenchyma and of the dual physiological functions of pancreas (ie, its exocrine and endocrine functions). This deterioration occurs over several years to decades, and involves atrophic/fibrotic changes that ultimately result in pancreatic exocrine insufficiency (PEI) and pancreatic endocrine insufficiency (eg, pancreatic diabetes).

PEI is often observed in individuals with chronic pancreatitis, cystic fibrosis, and pancreatic tumors, or after surgical resection of the pancreas (Figure 1).1–4 During progression of pancreatic disease, PEI is associated with malnutrition, including low levels of micronutrients and fat-soluble vitamins, particularly vitamin D, and essential fatty acids, coupled with gradual weight loss and steatorrhea as a result of maldigestion. Pancreatic enzyme replacement therapy (PERT) not only improves the clinical symptoms and malnutrition caused by PEI, but can also allow the patient to discontinue a low-fat diet.

There is limited data available on physician’s current practice for the diagnosis and management of pancreatic exocrine insufficiency due to various pancreatic disorders. Therefore, this cross-sectional study is designed to understand the diagnosis and management of PEI due to pancreatic disorders from consultant physicians in India.

If you agree to participate, you will be required to respond to questions of the enclosed questionnaire. We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this study. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.