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Update on the diagnosis and treatment of pancreatic exocrine insufficiency

Exocrine pancreatic insufficiency (EPI) characterized by a deficiency of exocrine pancreatic enzymes, resulting in an inability to properly digest food or poor digestion. Clinical manifestations of EPI are often nonspecific and can lead to lack of timely recognition and diagnosis. The etiology of this deficiency includes both pancreatic and non-pancreatic causes.

The condition is associated with significant morbidity and reduced quality of life, even in milder forms. Challenges in managing this condition include the nonspecific presentation of mild-to-moderate EPI and the lack of an accurate and convenient diagnostic test.

Inadequate digestion and fat malabsorption occur when intraduodenal lipase levels fall below 5– 10% of normal production. Early pancreatic disease, evident steatorrhea does not occur until approximately 90% of gland function has been lost.

EPI manifestations are steatorrhea, malnutrition, deficiency of fat-soluble vitamins (A, E K, D) and trace elements, abdominal discomfort, bloating, weight loss and metabolic bone disease.

Symptoms are non-specific and are shared with other common gastrointestinal conditions. Many diagnostic tests are available to diagnose and have been classified as direct and indirect measures of exocrine pancreatic function. The gold standard has been 72-hour fecal fat test. The key of treatment is correctly use of PERT, stop smoking and alcohol consumption, consultation with a dietitian and a follow-up to ensure optimal treatment effect. A set of actions for normalize digestion, alleviate PEI symptoms and prevent malnutrition-related morbidity and mortality.

This review will summarize current concepts, diagnosis methods and treatment approaches using pancreatic enzymes for EPI.


Vivian Florio Martini

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