Incidence and severity of nutritional deficiency states in chronic exocrine pancreatic insufficency: comparison with nontropical sprue.

LTHOUCH chronic exocrine pancreatic insufficiency with marked steatorrhea and azotorrhea is not uncommon, tittle has been writ ten about any associated nutr i t ional deficiency states. Our review of the l i terature reveals no series of cases studied from this point of view, but it is our clinical impression, supported by the published opinions of others, 1-3 that such nutr i t ional deficiencies, except for those due to caloric deficits (weight loss), are mild and infrequent compared with those encountered among patients having nontropicat sprue with similar degrees of steatorrhea. Normal digestion and absorption of fat and nitrogen are dependent on the availability of an adequate amount of exocrine pancreatic secretions. Exclusion of pancreatic juice from the intestine of dogs results in reduced assimilation of fat and nitrogen. -~ In one study ~ complete obstruction of pancreatic ducts in man resulted in the toss of 66~o of ingested fat in the stool. Lesser degrees of steatorrhea and azotorrhea are often found among patients with destruction of pancreatic tissue due to chronic relapsing pancreatitis 6 and to other diseases that interfere with exocrine pancreatic functionT, ~ In contrast to the impaired assimilation of fat and nitrogen, exocrine pancreatic insufficiency apparently produces little if any defect in the absorption of monosaccharide carbohydrates2-~0 The polysaccharide starch, on the other hand, is not normally assimilated, as demonstrated by the fact that a starch tolerance test has been employed to detect the presence of exocrine pancreatic insufficiency. 11 Since exocrine pancreatic insufficiency is known to cause malabsorption of fat, protein, and starch, it seems reasonable to suppose that other dietary constituents such as vitamins and minerals might not be normally absorbed either. T h e present study was initiated to obtain more specific evidence reregarding the incidence and severity of nutri t ional deficiency states associated with untreated or inadequately treated chronic exocrine pancreatic insufficiency. T h e findings were compared with those obtained from a group of