Exocrine Pancreatic Insufficiency

Exocrine pancreatic insuffiency is loss of ability to properly digest food due to inadequate pancreatic enzyme activity. The etiology of exocrine pancreatic insuffiency, in humans, is mostly chronic pancreatitis or diseases affecting pancreas such as cytsic fibrosis, Shwachman-Diamond syndrome. It may also occur as a complication of gastric or pancreatic surgical procedures due to decrease of exocrine enzyme producing cell reserve. Symptoms related with exocrine pancreatic insuffiency are associated with maldigestion including steatorhea, diarrhea, and abdominal pain and weight loss. Diagnosis can be made on clinical observation that is supported with direct and indirect tests for exocrine pancreatic insuffiency. So called, 13C labeled mixed triglyceride breath test offer promising results. Supplemental pancreatic-enzyme replacement therapy is widely accepted method of choice or treatment of exocrine pancreatic insuffiency. Main goal of pancreatic-enzyme replacement therapy is to minimize malabsorption and associated malnutrition especially of lipids and lipid soluble vitamins. There are various preparations of pancreatic enzyme formulas according to ingredients and physical properties such as Kreon (Abbott, IL,USA), Zenpep (Eurand, Milan, Italy) and Pancreaze (Johnson & Johnson, NJ, USA). Exocrine pancreatic insufficiency is not an infrequent clinical entity and replacement therapy can be initiated for proven cases or empirically for patients with mild symptoms. Enteric-coated preparations should be given with recommended dosage.