Pancreatic Insufficiency

What is Pancreatic Insufficiency?

Pancreatic Insufficiency is a medical condition, in which the pancreas is unable to function properly and produce the required quantity of digestive enzymes.

This deficiency of pancreatic enzymes can lead to maldigestion and malabsorption of important nutrients. The condition is also called Exocrine Pancreatic Insufficiency (EPI).

Who does Pancreatic Insufficiency Affect?

Pancreatic insufficiency can affect both children and adults.

In children, it is more often caused as part of an inherited disorder
In adults, it is more often caused as part of pancreatic damage.

People with diabetes, pancreatic cancer, Crohn’s disease, coeliac disease and auto-immune pancreatitis are more likely to develop pancreatic insufficiency.

How does Pancreatic Insufficiency Occur?

Pancreatic Insufficiency occurs when the pancreatic exocrine tissue is damaged due to an ongoing disease or genetic disorder. As a result, enzymes which are required to digest fats and other substances in the small intestine are not produced.

The absorption of fatty substances and fat-soluble vitamins is affected, and malabsorption occurs.

Causes of Pancreatic Insufficiency

Pancreatic insufficiency can be caused by a number of conditions and disorders which include:

Acute or chronic pancreatitis,
Auto-immune pancreatitis,
Cystic Fibrosis,
Schwachman-Diamond Syndrome,
Pancreatic Cancer,
Diabetes,
Crohn's Disease,
Coeliac Disease,
Pancreatic cancer, and
Zollinger-Ellison Syndrome

Symptoms of Pancreatic Insufficiency

The symptoms for pancreatic insufficiency do not appear until later in the disease when fat is no longer being digested due to lack of enzymes.

The most common symptoms include:

Abdominal pain and tenderness,
Foul-smelling stool/bowel movements of the greasy texture,
Chronic diarrhea,
Bloating and gas,
A sensation of feeling full all the time,
Lethargy and tiredness, and
Weight loss might also occur, with additional vitamin deficiency.

Stages of Pancreatic Insufficiency

The Pancreatic insufficiency severity is directly proportional to the extent of the pancreatic tissue damage and the symptoms become more prominent as the condition progresses.

How is Pancreatic Insufficiency Diagnosed?

The diagnosis for Pancreatic insufficiency is initially made by:

Taking a complete medical history, and
Performing a complete physical examination.

The doctor will also order the following lab tests that aid in determining a diagnosis of pancreatic insufficiency. The tests include:

Stool elastase test
Chymotrypsin test
Fecal fat test
Immunoreactive trypsinogen (IRT) test

Additional tests and procedures to help diagnose pancreatic insufficiency include:

Abdominal CT Scan
Endoscopic retrograde cholangiopancreatography (ERCP)
Magnetic resonance cholangiopancreatography (MRCP)
Ultrasound

How is Pancreatic Insufficiency Treated?

Pancreatic Insufficiency is very manageable if diagnosed early.

The treatment can involve a multi-faceted approach that may require a change in diet and medication. Treatment options include:

Eating a high-calorie diet with reduced fatty substances
Limiting alcohol consumption
Taking vitamins and supplements
Pancreatic enzyme replacement therapies (PERT) to help improve the absorption of fats from foods, ease symptoms like stomach upset or oily stools,
Removal of the affected tissue or blockage by surgery
Removal of the pancreas and give you an Autologous Islet Cell Transplant. These are cells from your own body that make insulin
Radiation therapy
Chemotherapy, and
Hormone therapy.

What if Pancreatic Insufficiency is Untreated?

If left untreated or improperly managed, Pancreatic insufficiency can result in reduced quality of life, poor digestive health, malabsorption, unexplained weight loss and malnutrition.