Breath Test-Based Assessment of SIBO in Chronic Pancreatitis and Partial Pancreatectomy

Inclusion Criteria: * Age ≥ 18 years * Ability and willingness to participate in the study and to comply with study procedures * Diagnosis of chronic pancreatitis with pancreatic exocrine insufficiency (defined as fecal elastase \< 200 µg/g of stool) * Ongoing pancreatic enzyme replacement therapy (PERT) with persistent gastrointestinal symptoms (including abdominal pain, dyspepsia, bloating, excessive flatulence, diarrhea, or steatorrhea) or unintentional weight loss ≥ 10% within the previous 6 months despite adequate PERT dosing (≥ 40,000 IU per main meal and half dose for snacks) * Patients with ampullary or pancreatic tumors who underwent partial pancreatectomy and subsequently developed pancreatic exocrine insufficiency with persistent gastrointestinal symptoms * Indication to undergo glucose, lactulose, and mixed triglyceride breath tests as part of routine clinical practice * Signed written informed consent Exclusion Criteria: * Age \< 18 years or \> 75 years * Pancreatic adenocarcinoma or bile duct tumors under active or previous adjuvant therapy * Moderate to severe liver disease * Severe chronic kidney disease (eGFR \< 30 mL/min/1.73 m²) * History of major gastrointestinal surgery, including total pancreatectomy * Presence of other active organic gastrointestinal diseases * Diabetic gastroparesis * Known celiac disease * Obstructive jaundice * Liver cirrhosis Child-Pugh class C * Recent or ongoing infections * Severe chronic obstructive pulmonary disease (COPD) *…