Conflicts of interest Dr Dominguez-Muñoz is a consultant and speaker for Abbott Pharmaceuticals and Axcan Pharma Inc.
Pancreatic exocrine insufficiency: Diagnosis and treatment
Article first published online: 16 FEB 2011
© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Special Issue: Challenges of Pancreatitis in Asia Pacific Region
Volume 26, Issue Supplement s2, pages 12–16, March 2011
How to Cite
Domínguez-Muñoz, J. E. (2011), Pancreatic exocrine insufficiency: Diagnosis and treatment. Journal of Gastroenterology and Hepatology, 26: 12–16. doi: 10.1111/j.1440-1746.2010.06600.x
- Issue published online: 16 FEB 2011
- Article first published online: 16 FEB 2011
- pancreatic exocrine insufficiency;
Pancreatic insufficiency is a major consequence of pancreatic diseases leading to a loss of pancreatic parenchyma, obstruction of the main pancreatic duct, decreased pancreatic stimulation, or acid-mediated inactivation of pancreatic enzymes. In addition, gastrointestinal and pancreatic surgical resections are frequent causes. Clinical manifestations include abdominal cramps, steatorrhea and malnutrition. Malnutrition, the main contributing factor of weight loss, has been related to a high morbidity and mortality secondary to an increased risk of malnutrition-related complications and cardiovascular events.
Assessments of exocrine pancreatic function, such as fecal fat quantification and 13C-triglyceride breath test, are the method of choice for diagnosis. In clinical practice, high-risk patient populations include those with severe necrotizing pancreatitis, gastrointestinal and pancreatic surgery, cancer of pancreas head, and those with pancreatic calcifications.
Apart from relief of maldigestion-related symptoms, the main goal of pancreatic enzyme substitution therapy is to ensure a normal nutritional status. Therapy of pancreatic insufficiency is based on the oral administration of exogenous pancreatic enzymes. Restriction of fat intake, though traditionally important in conventional treatment, should be reconsidered.
Enzyme substitution therapy should ideally mimic the physiological pattern of pancreatic exocrine secretion, and pancreatic enzymes in the form of enteric-coated minimicrospheres are considered as the most elaborated commercially available enzyme preparations. In general, pancreatic exocrine insufficiency in patients after surgery may be managed similarly to patients with chronic pancreatitis. This review focuses on current perspectives in diagnosis and treatment of pancreatic exocrine insufficiency and practical suggestions on its clinical management.