Exocrine Pancreatic Insufficiency: A Comprehensive Guide to Diagnosis and Treatment

The pancreas releases enzymes into the small intestine that help break down food so the body can access the nutrients within. People with exocrine pancreatic insufficiency do not produce or release enough of these enzymes and so cannot absorb fat and certain vitamins and minerals properly from their food. This can lead to malnutrition and weight loss.

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Damage to the pancreas is the primary cause of exocrine pancreatic insufficiency. A condition called chronic pancreatitis can cause inflammation of the organ because it causes the enzymes to begin working early before they have left the pancreas. Alternatively, surgery of the digestive system may lead to exocrine pancreatic insufficiency. Certain inherited disorders can also cause the condition.

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People who drink alcohol heavily are at a higher risk of developing exocrine pancreatic insufficiency because heavy drinking can lead to pancreatic inflammation. People with immune system disorders are also at higher risk. Cystic fibrosis raises a person's chance of getting the condition because the body makes very thick mucus that can create blockages in the pancreas. Crohn's disease, celiac disease, and Schwachman-Diamond syndrome also make developing exocrine pancreatic insufficiency more likely.

In mild cases, people with exocrine pancreatic insufficiency may have no symptoms. However, as the condition progresses, symptoms develop such as abdominal discomfort or pain and a feeling of excessive fullness. The individual may also feel bloated and gassy, and pass unpleasant-smelling stools. People with exocrine pancreatic insufficiency often lose weight because the body cannot adequately absorb fats and other nutrients.

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The doctor will gather medical history and a description of symptoms. If symptoms are consistent with the suspected condition, the doctor will order further tests such as those that look for nutrient deficiencies and conditions associated with exocrine pancreatic insufficiency, such as Crohn's. The doctor may also request stool samples, which a lab will analyze for digestive enzyme content to help the doctor determine if the pancreas is working properly.

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The doctor may also order imaging tests that allow them to take a detailed look at the pancreas and assess whether it has become inflamed. CT and MRI scans take intricate images of the organ, or the doctor may perform an endoscopy. This procedure involves feeding a small camera through the digestive system using a catheter.

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The most common treatment for exocrine pancreatic insufficiency is pancreatic enzyme replacement therapy (PERT). Prescription medications replace the enzymes the pancreas is not producing. These need to be taken during meals to ensure the enzymes work at the right time. Some people require additional medicines to reduce acid in the stomach, an excess of which may destroy the enzymes from PERT before they can work. Painkillers can alleviate physical discomfort.

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A healthy and balanced diet can help to manage exocrine pancreatic insufficiency. Splitting food consumption into several smaller meals throughout the day can ease digestive problems. Some doctors recommend supplementary vitamins to prevent deficiencies. People with exocrine pancreatic disorder should avoid drinking alcohol, as consumption can make the pancreas more inflamed and worsen the condition. It can also make it harder for the body to absorb fat, which can make weight loss more severe.

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Often, exocrine pancreatic insufficiency cannot be avoided because it has resulted from a factor outside the person's control, such as a pre-existing health condition. However, certain steps can help prevent chronic pancreatitis, which is a leading cause of exocrine pancreatic insufficiency. Limiting or even eliminating alcohol makes developing pancreatitis far less likely. Quitting smoking, maintaining a healthy diet that's low in fat, and regular exercise can also prevent pancreas inflammation and pancreatitis.

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As long as a doctor promptly diagnoses and treats the condition, the outlook for people with exocrine pancreatic insufficiency is good. Although the condition is unlikely to resolve, PERP and diet can maintain good health. The biggest challenge for people living with exocrine pancreatic insufficiency long-term is maintaining a healthy body weight. It can be helpful to seek advice from a nutritionist to avoid unwanted weight loss.

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