Abstract
Exocrine pancreatic insufficiency (EPI) is defined as the maldigestion of foods due to inadequate pancreatic secretion, which can be caused by alterations in its stimulation, production, transport, or interaction with nutrients at duodenal level. The most frequent causes are chronic pancreatitis in adults and cystic fibrosis in children. The prevalence of EPI is high, varying according to its etiology, but it is considered to be underdiagnosed and undertreated. Its importance lies in the quality of life impairment that results from the malabsorption and malnutrition and in the increased morbidity and mortality, being associated with osteoporosis and cardiovascular events. The diagnosis is based on a set of symptoms, indicators of malnutrition, and an indirect non-invasive test in at-risk patients. The treatment of choice combines non-restrictive dietary measures with pancreatic enzyme replacement therapy to correct the associated symptoms and improve the nutritional status of patients. Non-responders require the adjustment of pancreatic enzyme therapy, the association of proton pump inhibitors, and/or the evaluation of alternative diagnoses such as bacterial overgrowth. This review offers an in-depth overview of EPI in order to support the proper management of this entity based on updated and integrated knowledge of its etiopathogenesis, prevalence, diagnosis, and treatment.
Highlights
Exocrine pancreatic insufficiency (EPI) is defined in the most recent reviews as the inability of the pancreas to secrete enzymes and bicarbonate for action on the intestinal lumen to accomplish the normal digestion of food [1,2,3,4,5,6,7,8]
EPI can result from the treatment of neuroendocrine tumors with somatostatin analogs, given that somatostatin is a physiological pancreatic secretion inhibitor [3,9]
Pancreatic juice synthesis: Damage to the pancreatic parenchyma reduces the production and secretion of pancreatic enzymes by acinar cells and of bicarbonate by pancreatic ducts. This functional loss can be caused by various diseases, including chronic pancreatitis, cystic fibrosis, Medicina 2020, 56, 523; doi:10.3390/medicina56100523
Summary
Exocrine pancreatic insufficiency (EPI) is defined in the most recent reviews as the inability of the pancreas to secrete enzymes and bicarbonate for action on the intestinal lumen to accomplish the normal digestion of food [1,2,3,4,5,6,7,8]. Pancreatic juice transport: Obstruction of the passage of pancreatic juice through the pancreatic duct prevents its arrival into the intestinal lumen to carry out its digestive activity This problem can be caused by disorders such as cystic fibrosis, with the production of a thicker secretion, or by various types of pancreatic tumor. Other etiologies include acute pancreatitis [12,13], pancreatic tumors [14], diabetes mellitus [15,16], celiac disease, inflammatory bowel disease [17,18], gastrointestinal and pancreatic surgery [19,20,21], HIV and genetic and congenital factors Some of these causes have are less frequent, and there is even debate around their true role in the etiology of EPI.
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