<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

Abstract

Exocrine pancreatic insufficiency (EPI) is a condition caused by reduced or inappropriate secretion or activity of pancreatic juice and its digestive enzymes, pancreatic lipase in particular. EPI can result in clinical manifestation and biochemical alterations causing reduced quality of life and life-threating complications. EPI is common in pancreatic disorders, where it should be suspected and actively investigated, and in many extrapancreatic conditions. There are various tests available to diagnose EPI, with indirect, noninvasive ones, such as concentration of fecal elastase being more commonly employed. Administration of pancreatic enzymes replacement therapy remains the mainstay of EPI treatment. The present review article will discuss current evidence regarding the prevalence of EPI, the available tests to diagnose it and its treatment.

State of the Art in Exocrine Pancreatic Insufficiency

“…Exocrine pancreatic insufficiency (EPI) is defined in the most recent reviews as the inability of the pancreas to secrete enzymes and bicarbonate for action on the intestinal lumen to accomplish the normal digestion of food [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. EPI can be caused by an alteration at any point in the digestive chain in which the exocrine pancreas is involved [ 1 , 4 , 6 , 7 ].…”

“…Alterations have been described in the following processes: Pancreatic stimulation: Insufficient activation of pancreatic secretion can be caused by diseases (e.g., celiac disease) that reduce the release of cholecystokinin (CCK) from the duodenal mucosa or by pancreatic/gastrointestinal surgery. EPI can also result from the treatment of neuroendocrine tumors with somatostatin analogs, given that somatostatin is a physiological pancreatic secretion inhibitor [ 3 , 9 ]. Pancreatic juice synthesis: Damage to the pancreatic parenchyma reduces the production and secretion of pancreatic enzymes by acinar cells and of bicarbonate by pancreatic ducts.…”

“…Pancreatic stimulation: Insufficient activation of pancreatic secretion can be caused by diseases (e.g., celiac disease) that reduce the release of cholecystokinin (CCK) from the duodenal mucosa or by pancreatic/gastrointestinal surgery. EPI can also result from the treatment of neuroendocrine tumors with somatostatin analogs, given that somatostatin is a physiological pancreatic secretion inhibitor [ 3 , 9 ].…”

Using Global Criteria to Detect Malnutrition: Application in Disease States

“…Pancreatic exocrine insufficiency related to pancreatic cancer, pancreatic resection, or asynchrony as a result of gastrointestinal tract resections (including gastrectomy and esophagectomy) contribute to malabsorption in patients with cancer . Additionally, malabsorption may occur because of short‐bowel syndrome as a result of tumor debulking or tumor bypass surgeries, gastrointestinal decompression in the setting of bowel obstruction, and past medical histories significant for gastric bypass surgery and pancreatitis . Radiation and chemotherapy can impact absorption and present as both an acute and latent side effect of treatment .…”

Ekzokrin Pankreas Yetmezliği: Diyabetin Göz Ardı Edilen Bir Komplikasyonu mudur?

“…Besides the nonspecific symptoms such as abdominal pain, flatulence, weight loss, and steatorrhea, more specific symptoms and findings may reveal albumin malabsorption and lack of fat-soluble (A, D, E, K) vitamins. EPI can be seen in many local or systemic diseases and conditions which affect either structure or function of the pancreas but is most commonly found in chronic pancreatitis (1). Today, the general diagnosis is based on the determination of fecal elastase-1 (FE-1) levels.…”