Exocrine Pancreatic Insufficiency

EPI causes malabsorption of fats and fat-soluble vitamins (A, D, E, K, and B12) when more than 90% of the pancreatic enzyme function is lost. Patients are at significant risk for malnutrition. ETIOLOGIES

• Pancreatitis, often due to excess alcohol consumption.

• Cystic fibrosis, which is the most common cause in children.

• Tumors that obstruct pancreatic enzyme transport to the small intestine.

The pancreas secretes amylase, protease, and lipase. Pancreatic insufficiency causes fat malabsorption but doesn't usually affect carbohydrate or protein absorption, because carbohydrate and protein digestion and absorption are typically maintained by amylase and protease secreted by other organs (salivary glands, stomach, small intestine). SIGNS AND SYMPTOMS Steatorrhea: the feces of patients with EPI are loose, bulky, oily, and pale – the stool often floats because of the oil content. Pain that starts in the left epigastric area and radiates to the back, bloating, abdominal discomfort. Malnutrition and weight loss. DIAGNOSIS Reduced duodenal pH and fecal elastase-1 (FE-1), which is an enzyme marker of pancreatic secretion. The gold-standard test is the 72-hour fecal fat quantification, but it's use is limited by the need for repeated stool sampling. TREATMENT Lifestyle modifications (alcohol cessation), vitamin supplements, and exogenous pancreatic enzyme administration.